根治性前列腺切除术后早期尿控恢复的相关术前因素分析

Preoperative factors related to early urinary continence recovery after radical prostatectomy

目的探讨术前相关因素对根治性前列腺切除患者术后早期尿控恢复的影响。方法行根治性前列腺切除术的前列腺癌患者446例,分别在患者拔除导尿管后及术后1、2、3、6个月评估尿控恢复情况。根据患者拔除导尿管后和术后3个月两个时间点的尿控恢复情况,分成尿控组和尿失禁组,比较两组患者年龄、吸烟、BMI、高血压、糖尿病、术前前列腺特异性抗原水平、Gleasorl评分、是否术前盆底肌训练等术前因素的差异。结果患者拔除导尿管后以及术后1、2、3、6个月的尿控率分别为1.3%、2.5%、20.0%、53.4%、92.2%。多因素分析显示,是否术前盆底肌训练与患者拔除导尿管后尿控恢复有关;患者年龄、BMI、是否术前盆底肌训练与患者术后3个月尿控恢复有关。结论患者年龄、BMI及是否术前盆底肌训练是RP术后早期尿控恢复的相关因素,这有助于临床医师术前与患者的沟通及作出下一步临床决策。

Objective To identify the preoperative risk factors associated with urinary incontinence （UI） after radical prostatectomy （RP）. Methods A total of 446 patients treated with non-nerve-sparing RP were included in the study. UI was evaluated after catheter removal, and at 1, 2, 3 and 6 month after surgery. Univariate and multivariate logistic regression analyses were applied to examine the preoperative factors related to urinary continence, including age, body mass index （BMI）, co-morbidities, preoperative prostate-specific antigen （PSA） level, Gleason score, and preoperative pelvic floor muscle exercise （PFME） after catheter removal and at 3 months after surgery. Results The continence rate was 1.3%, 2.5%, 20.0%, 53.4%, 92.2% and 98.7% after catheter removal and at 1, 2, 3 and 6 months, respectively. Preoperative PFME was the only independent protective factor for immediate continence after catheter removal. Age was a risk factor for delayed continence at 3 month following surgery, while BMI and preoperative PFME were the protective factors for postoperative UI. Conclusion Our results support that age, BMI and preoperative PFME are predictive factors for early incontinence after radical prostatectomy.