膀胱内前列腺突出程度对根治性前列腺切除术后尿控恢复的影响

Impact of the degrees of intravesical prostatic protrusion on the recovery of urinary continence after radical prostatectomy

目的:探讨膀胱内前列腺突出(IPP)程度对根治性前列腺切除术患者术后尿控功能恢复的影响。方法:回顾性分析2010年5月至2016年5月接受前列腺穿刺活检确诊为前列腺癌,并由同一名医师完成的腹腔镜根治性前列腺切除术212例患者的临床资料。根据患者前列腺MRI上测量的IPP值分为非显著IPP组(IPP≤10 mm,n=146)和显著性IPP组(IPP>10 mm,n=66),通过单因素和多因素Logistic回归探讨影响术后尿控恢复的因素。结果:212例患者术后1、3、6、12个月尿控率分别为32.5%、50.5%、82.1%和91%。单因素分析显示,IPP、体质量指数(BMI)、膀胱颈部保留(BNP)、保留神经血管束(NVB)以及临床T分期是术后3个月尿控恢复的影响因子(P<0.05、P<0.01),多因素Logistic回归分析显示,IPP>10 mm(P<0.01)、BMI≥25 kg/m^2(P=0.004)和BNP(P=0.032)是术后3个月尿控恢复的独立影响因子;单因素分析显示,年龄、IPP、BMI、BNP以及临床T分期是术后6个月尿控恢复的影响因子(P<0.05、P<0.01);Logistic多因素回归分析显示,IPP(P<0.01)和BMI(P<0.01)是术后6个月尿控恢复的独立影响因子;单因素分析显示,年龄、IPP、BMI、BNP、保留NVB以及临床T分期是术后12个月尿控恢复的影响因子(P<0.05);进一步行多因素Logistic回归分析显示,IPP(P<0.01)和BMI(P=0.033)是术后远期尿控恢复的独立影响因子。结论:IPP>10 mm和BMI≥25 kg/m^2不利于腹腔镜根治性前列腺切除术后长期尿控的恢复。

Objective: To investigate the influence of the degrees of intravesical prostatic protrusion(IPP) on the recovery of urinary continence after radical prostatectomy. Methods: We retrospectively analyzed the clinical data on 212 patients diagnosed with prostate cancer by biopsy and treated by laparoscopic radical prostatectomy by the same surgeon. Based on the degrees of IPP measured by MRI, we divided the patients into an IPP ≤ 10 mm group(n = 146) and an IPP > 10 mm group(n = 66) and determined the factors influencing the recovery of urinary continence by univariate and multivariate logistic regression analyses. Results: At 1, 3, 6 and 12 months after surgery, the urinary continence rates of the patients were 32.5%, 50.5%, 82.1% and 91%, respectively. Univariate analysis indicated that the factors influencing the recovery of urinary continence included IPP, body mass index(BMI), bladder neck preservation(BNP), neurovascular bundle preservation(NVBP) and clinical tumor(T) stage at 3 months(P < 0.05 or P < 0.01), age, IPP, BMI, BNP and clinical T stage at 6 months(P < 0.05 or P < 0.01), and age, IPP, BMI, BNP, NVBP and clinical T stage at 12 months(P < 0.05), while multivariate logistic regression analysis showed the independent influencing factors to be IPP > 10 mm(P < 0.001), BMI ≥ 25 kg/m^2(P = 0.004) and BNP(P = 0.032) at 3 months, and IPP and BMI at 6 months(both P < 0.01) and 12 months(P < 0.01 and P = 0.033). Conclusion: IPP > 10 mm and BMI ≥ 25 kg/m^2 are independent factors influencing the long-term recovery of urinary continence after radical prostatectomy.