经尿道钬激光前列腺剜除术后早期尿失禁与膜性尿道长度的相关性研究

Relationship between early urinary incontinence after holmium laser enucleation of the prostate and preoperativemembranous urethral length

目的探讨术前MRI测量的膜性尿道长度(MUL)与经尿道钬激光前列腺剜除术(HoLEP)后尿失禁的相关性。方法回顾性分析2019年1月至2021年4月北京大学第三医院收治的96例因良性前列腺增生(BPH)行HoLEP患者的临床资料。患者年龄(70.0±7.7)岁, 体质量指数(23.9±2.9)kg/m^(2)。术前PSA为0.39~28.30ng/ml, 中位值为3.79(2.48, 6.03) ng/ml;22例(22.9%)合并糖尿病, 17例(17.7%)既往发生过≥1次尿潴留。术前MRI测量前列腺体积(60.5±35.0)ml。MUL定义为冠状位前列腺尖部与尿道球部之间的距离;术前MRI测量MUL为7~20 mm, 中位值13(11, 17) mm。所有手术均为单一术者完成。HoLEP术后2周对患者控尿功能恢复情况进行随访。比较HoLEP术后2周正常控尿组(无需使用尿垫)和尿失禁组(需使用尿垫)患者年龄、体质量指数、术前PSA、有无糖尿病、有无尿潴留、前列腺体积和MUL的差异, 将P<0.1的变量纳入logistic多因素回归, 分析HoLEP术后发生尿失禁的独立危险因素。结果术后2周正常控尿组72例(75.0%), 尿失禁组24例(25.0%)。单因素分析结果显示, 正常控尿组与尿失禁组的年龄[≥70岁者:27例(37.5%)与16例(66.7%)]、前列腺体积[≥60ml者:21例(29.2%)与13例(54.2%)]和MUL[<13 mm者:30例(41.7%)与20例(83.3%)]差异均有统计学意义(P值分别为0.013、0.027、<0.001)。多因素logistic回归分析结果显示, 仅MUL<13 mm是HoLEP术后2周尿失禁的独立危险因素(P=0.003)。结论 BPH患者HoLEP术后2周发生尿失禁的比例较高, 术前MRI测量的MUL是预测HoLEP术后2周控尿功能恢复的独立危险因素。

Objective To assess whether urinary incontinence after holmium laser enucleation of the prostate(HoLEP)is associated with membranous urethral length(MUL)on preoperative magnetic resonance imaging.MethodsThe data of 96 patients who underwent HoLEP from January 2019 to April 2021 in Peking University Third Hospital were retrospectively analyzed.For all patients,the average age was(70.0±7.7)years old,the average body mass index was(23.9±2.9)kg/m^(2),median pre-biopsy PSA was 3.79(2.48,6.03)ng/ml,the average prostatic volume was(60.5±35.0)ml.22 patients(22.9%)suffered with diabetes mellitus,and 17 patients(17.7%)had at least one time urinary retention.MUL was measured on MRI as the vertical distance from prostatic apex to the entry of the urethra into the penile bulb.All patients"median MUL was 13(11,17)mm.The recovery of continence was followed up 2 weeks after HoLEP.The difference of age,body mass index,preoperative PSA,diabetes mellitus,urinary retention,prostate volume and MUL between urinary continence and incontinence group 2 weeks after HoLEP operation.The variables with P<O.1 were included in multivariable logistic regression to analyze the independent risk factors of urinary incontinence after HoLEP were compared.ResultsAll operations were successfully completed.The continence returned to normal in 72 cases(75.0%)and urinary incontinence existed in 24 cases(25.0%)in 2 weeks after surgery.There were 27 cases(37.5%)in continence group and 16 cases(66.7%)in incontinence group for those aged≥70 years.21 cases(29.2%)in continence group and 13 cases(54.2%)in incontinence group had prostate volume≥60 ml.There were 30 cases(41.7%)in continence group and 20 cases(83.3%)in incontinence group with MUL<13 mm.X^(2)test showed that age(P=0.013),prostate volume(P=0.027)and MUL(P<0.001)were related to the incontinence after surgery.The age,prostate volume and MUL were included in the multivariate logistic regression analysis.Multiple logistic regression showed that MUL<13 mm(P<0.001)was independent predictor for incontinence after HoLEP.ConclusionsThe incidence of urinary incontinence was high 2 weeks after HoLEP.Short MUL,which is less than 13 mm,is significantly associated with delayed recovery of urinary continenceafter HoLEP.