老年前列腺癌患者腹腔镜根治术后发生尿失禁的影响因素

Influencing factors of urinary incontinence after laparoscopic radical prostatectomy in elderly patients with prostate cancer

目的:分析老年前列腺癌患者腹腔镜根治术后发生尿失禁的影响因素。方法:回顾性分析2018年1月至2023年9月在该院行腹腔镜根治术治疗的108例老年前列腺癌患者的临床资料,根据患者术后1个月内是否发生尿失禁将其分为尿失禁组(n=35)和尿控组(n=73),分别采用单因素分析和Logistic回归分析患者腹腔镜前列腺癌根治术后发生尿失禁的影响因素。结果:108例前列腺癌患者术后发生尿失禁35例,发生率为32.41%。单因素分析结果显示,两组吸烟史、饮酒史、体质量指数(BMI)、术前前列腺体积、Gleason评分、国际前列腺症状(IPSS)评分、血清前列腺特异性抗原(PSA)水平、手术时间、术中出血量、手术入路、盆腔淋巴结清扫情况及术后病理分期比较,差异均无统计学意义(P>0.05);尿失禁组年龄≥70岁、术前有电切手术史、有尿路感染史、膀胱功能失代偿、术中切除膀胱颈患者占比均高于尿控组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,年龄≥70岁、术前电切手术史、术前膀胱功能失代偿、术前尿路感染史、术中切除膀胱颈均为老年前列腺癌患者腹腔镜根治术后发生尿失禁的独立危险因素(OR>1,P<0.05)。结论:老年前列腺癌患者腹腔镜根治术后尿失禁的发生率较高。年龄≥70岁、术前电切手术史、术前膀胱功能失代偿、术前尿路感染史、术中切除膀胱颈均为老年前列腺癌患者腹腔镜根治术后发生尿失禁的独立危险因素。

Objective:To analyze influencing factors of urinary incontinence after laparoscopic radical prostatectomy in elderly patients with prostate cancer.Methods:The clinical data of 108 elderly patients with prostate cancer who underwent laparoscopic radical prostatectomy in this hospital from January 2018 to September 2023 were retrospectively analyzed.According to whether urinary incontinence occurred within 1 month after the surgery,these patients were divided into urinary incontinence group(n=35) and urinary continence group(n=73).Univariate analysis and Logistic regression were used to analyze the influencing factors of urinary incontinence after laparoscopic radical prostatectomy.Results:35 cases of urinary incontinence occurred in the 108 patients with prostate cancer,the incidence rate was 32.41%.Univariate analysis showed that there were no significant differences in smoking history,drinking history,BMI,preoperative prostate volume,Gleason score,IPSS score,serum PSA level,operation time,intraoperative blood loss,surgical approach,pelvic lymph node dissection and postoperative pathological staging between the two groups(P>0.05).The proportions of the patients with age ≥ 70 years old,preoperative electrotomy history,urinary tract infection history,bladder function decompensation,and intraoperative resection of bladder neck in the urinary incontinence group was higher than that in the urinary continence group,and the difference was statistically significant(P<0.05).The logistic regression analysis showed that age ≥ 70 years old,preoperative electrotomy history,preoperative bladder dysfunction compensation,preoperative history of urinary tract infection,and intraoperative resection of bladder neck were all independent risk factors for urinary incontinence in the elderly prostate cancer patients after laparoscopic radical surgery(OR>1,P<0.05).Conclusions:The incidence of urinary incontinence after laparoscopic radical prostatectomy in the elderly patients with prostate cancer is higher.Age ≥ 70 years old,preoperative electrotomy history,preoperative bladder dysfunction,preoperative urinary tract infection history,and intraoperative resection of bladder neck are the independent risk factors for urinary incontinence after laparoscopic radical prostatectomy in the elderly patients with prostate cancer.