医学
前列腺切除术
尿失禁
性功能
排尿
勃起功能障碍
前列腺癌
前瞻性队列研究
泌尿科
生活质量(医疗保健)
单中心
逻辑回归
围手术期
外科
泌尿系统
内科学
癌症
护理部
作者
Lorine Haeuser,Karl H. Tully,Alina Reicherz,Quoc‐Dien Trinh,Rudolf Moritz,Florian Roghmann,Joachim Noldus,Rein‐Jüri Palisaar
出处
期刊:The Prostate
[Wiley]
日期:2023-06-23
卷期号:83 (13): 1290-1297
被引量:4
摘要
Abstract Objectives To assess the impact of urinary continence and erectile function on the quality of life in men undergoing radical prostatectomy (RP) for prostate cancer (PC), we analyzed the preoperative and 1‐year postoperative outcomes of five functional domains and their influencing factors. Patients and Methods In this prospective study, all patients undergoing open or robot‐assisted RP between Febuary 2017 and March 2020 in a single academic center were included. Patient‐reported outcomes were assessed pre‐ and 12 months postoperatively using the Expanded Prostate Index Composite (EPIC‐26) survey, evaluating continence, irritative/obstructive micturition, gastrointestinal symptoms, sexuality, and overall vitality. We examined the impact of RP on sexual function and urinary continence using multivariable logistic regression models, accounting for patient and tumor characteristics. Results Overall, 1313 consecutive patients gave consent for study participation and completed both surveys. The median age was 66 years (IQR: 60−70). The majority of patients ( n = 601, 46%) had an intermediate risk PC. Robotic RP was performed in 71.6% and nerve‐sparing technique in 81% of the cases. The median pre‐ versus postoperative scores were the following: urinary continence 100 (IQR: 91.8−100) versus 85.5 (64.8−100), irritative micturition 87.5 (IQR: 75−100) versus 93.8 (IQR: 87.5−100), gastrointestinal symptoms the same with 100 (IQR: 95.8−100), vitality 95 (IQR: 80−100) versus 90 (IQR: 75−100), and erectile function 65.3 (IQR: 38.8−87.5) versus 22.2 (IQR: 12.5−48.7), respectively. Age ( p < 0.001), risk classification ( p = 0.002), and nerve‐sparing surgery ( p = 0.016) were associated with good sexual function (EPIC‐26 score ≥60), while only age ( p = 0.001) was statistically significantly associated with good urinary continence (EPIC‐26 score ≥80). Conclusion Non‐modifiable factors such as age and PC risk classification impact urinary continence and sexual function after RP. Nevertheless, urologic surgeons should further focus on improving nerve‐sparing techniques, the only modifiable variable, to reduce the surgery's negative impact on urinary continence and sexual function.
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