经尿道前列腺电切术后行机器人辅助前列腺根治术患者的尿控恢复评价及影响因素

Evaluation of urinary continence and analysis of predictors in patients undergoing robot-assisted radical prostatectomy after transurethral resection of the prostate

目的评估经尿道前列腺电切术(TURP)后行机器人辅助前列腺根治术(RARP)患者的尿控恢复率,并探讨术后尿控恢复的影响因素。方法回顾性分析2015年1月-2020年12月期间TURP术后确诊为前列腺癌并由单一术者行RARP的104例患者的临床资料,评估TURP术后RARP患者的尿控恢复率,并采用Cox比例风险回归模型分析TURP术后RARP患者尿控恢复的影响因素。结果该研究的中位随访时间为31个月[四分位差(IQR):20~49],合并TURP史行RARP术患者术后1、3、6、12个月和24个月的尿控率分别为13%(14/104)、33%(34/104)、50%(52/104)、63%(64/102)和71%(70/99),24个月后无新患者恢复尿控。统计分析表明糖尿病与尿控恢复显著相关(P=0.013),且Cox回归分析表明糖尿病(HR=0.38,95%CI:0.17~0.89)能够显著延迟RARP术后的尿控恢复;其他因素与TURP术后RARP患者的尿控恢复无显著相关。结论合并TURP史行RARP术患者的尿控恢复随时间逐渐提高,在术后24个月达到稳定状态;糖尿病是影响TURP术后RARP患者尿控恢复的独立危险因素。

Objective To evaluate the urinary continence and analyze the influencing factors in patients undergoing robot-assisted radical prostatectomy(RARP)after transurethral resection of the prostate(TURP).Methods Clinical data of 104 pa⁃tients who underwent RARP by a single surgeon after TURP during Jan.2015 and Dec.2020 were retrospectively analyzed.The urinary continence 1,3,6,12,24,36,48 and 64 months after surgery were evaluated,and the risk factors of urinary continence re⁃covery were identified with Cox regression analysis.Results The median duration of follow-up after RARP was 31 months(IQR:20-49).The urinary continence rate 1,3,6,12 and 24 months after surgery were 14/104(13%),34/104(33%),52/104(50%),64/102(63%)and 70/99(71%),respectively.No patients had urinary continence recovered after 24 months.Statistical analysis showed that diabetes mellitus was significantly associated with the recovery of urinary continence.Cox regression analy⁃sis showed diabetes mellitus significantly delayed the restoration of urinary continence(HR=0.38,95%CI:0.17-0.89).Other factors were not significantly related to the recovery of urinary continence.Conclusion The recovery of urinary continence in patients undergoing RARP after TURP improves gradually over time and reaches a stable state 24 months after surgery.Diabe⁃tes is an independent risk factor for urinary continence.