外科医生前列腺钬激光去核术(HoLEP)术后尿失禁的早期预测因素

IF 1.5 4区 医学 Q3 UROLOGY & NEPHROLOGY
Karen M. Doersch, Laena Hines, Timothy D. Campbell, Rajat K. Jain, Scott O. Quarrier
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引用次数: 0

摘要

目的 评估影响前列腺钬激光去核术(Holmium Laser Enucleation of the prostate,HoLEP)术后尿失禁恢复的因素。 方法 从前瞻性维护的数据库中评估预定义因素对 HoLEP 术后尿失禁恢复的影响。两位外科医生作为主治医师均实施了少于 150 例 HoLEP。纳入标准为至少有 6 个月尿失禁数据或有尿失禁恢复记录的受试者。每天使用一个或更少的尿垫被定义为尿失禁。统计分析使用 R 和 Prism 进行,包括斯皮尔曼相关性、线性建模和 Mantel-Cox 对数秩检验。 结果 从 2020 年 12 月到 2023 年 5 月,共有 152 名受试者符合纳入标准,中位年龄为 70 岁(范围:51-93 岁)。病例数中位数为 56 例(1-146 例)。在研究期间,144/152(94.7%)例患者在术后中位数 1.6 个月时恢复了大小便失禁。线性建模显示,年龄较小(p = 0.01)和剜除时间较短(p = 0.001)预示着恢复情况。根据 Mantel-Cox 检验(p = 0.0004),剜除时间少于 100 分钟预示着尿失禁恢复更早。 结论 在外科医生的 HoLEP 学习曲线中,年龄和去核时间可预测尿失禁的恢复情况。去核时间在 100 分钟以下,预示着尿失禁恢复的速度更快。去核时间与尿失禁恢复之间的关系可能是病例难度的体现,也可能是去核过程中尿道外括约肌受压的结果。这些发现进一步加深了我们对外科医生学习曲线早期 HoLEP 结果的理解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in Their Experience

Objectives

To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience.

Methods

Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel–Cox log-rank testing as appropriate.

Results

From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51–93). The median case number was 56 (1–146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel–Cox testing (p = 0.0004).

Conclusions

During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.

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来源期刊
LUTS: Lower Urinary Tract Symptoms
LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-
CiteScore
3.00
自引率
7.70%
发文量
52
审稿时长
>12 weeks
期刊介绍: LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.
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