前列腺癌根治术后远期膀胱过度活动症的危险因素

doi:10.19723/j.issn.1671-167X.2024.04.007

摘要/Abstract

摘要：

目的: 分析前列腺癌根治术后膀胱过度活动症(overactive bladder, OAB)的发生及转归情况，并探讨其相关危险因素。方法: 选择北京大学第三医院2013年1月至2017年5月住院接受根治性前列腺切除术的263例患者进行回顾性研究，分析并收集患者临床基线信息、计算影像特征、围术期参数、术前患者尿控情况、病理学诊断与术后1年内OAB发生情况的相关性。在影像特征中，定义膀胱壁厚度(bladder wall thickness, BWT)和膀胱黏膜光滑程度(bladder mucosal smoothness, BMS)两个参数，用于预测OAB的发生情况。结果: 263例前列腺癌根治术后患者中，术后1年存在OAB状态者共52例，占所有患者的19.8%。术前既往存在OAB症状者40例，术后缓解者17例(42.5%)，症状持续者23例(57.5 %)；术后新发OAB者29例，占术后所有OAB患者的55.77%。单因素分析显示膀胱壁厚度、膀胱黏膜光滑程度、膀胱过度活动症状评分和国际前列腺症状评分均与术后OAB的发生相关。进一步多因素分析发现，BMS是远期OAB的独立危险因素(P < 0.001)。结论: 根治性前列腺切除术后远期膀胱过度活动症是临床常见的并发症，通过术前磁共振成像测量充盈状态下膀胱壁厚度或膀胱黏膜光滑程度，可以预测根治术后OAB的发生风险。

关键词: 前列腺癌, 前列腺切除手术, 膀胱过度活动症, 危险因素, 预测

Abstract:

Objective: To analyze the incidence and progression of overactive bladder (OAB) symptoms following radical prostatectomy for prostate cancer patients and to identify related risk factors. Methods: A retrospective study was conducted on 263 local stage prostate cancer patients who underwent radical prostatectomy at Peking University Third Hospital from January 2013 to May 2017. Clinical baseline information, comprehensive imaging features, perioperative parameters, preoperative urinary control status, pathological diagnosis, and the incidence of OAB within one year postoperatively were collected and analyzed. In the imaging features, two parameters were defined: Bladder wall thickness (BWT) and bladder mucosal smoothness (BMS), which were used to predict the occurrence of OAB. Patients were evaluated based on their clinical baseline characteristics, including age, body mass index (BMI), comorbidities, and prostate-specific antigen (PSA) levels. The imaging characteristics were assessed using preoperative MRI, focusing on BWT and BMS. Perioperative parameters included operative time, blood loss, and length of hospital stay. The OAB symptoms were assessed using the overactive bladder symptom score (OABSS) and the international prostate symptom score (IPSS). These scores were correlated with the postoperative incidence of OAB. Results: Among the 263 patients who underwent radical prostatectomy, 52 (19.8%) exhibited OAB within one year postoperatively. Of the 40 patients with preoperative OAB symptoms, 17 (42.5%) showed remission postoperatively, while 23 (57.5%) had persistent symptoms. Additionally, 29 patients developed new-onset OAB, accounting for 55.77% of all postoperative OAB cases. Univariate analysis indicated that BWT, BMS, OABSS, and IPSS score were all associated with the occurrence of postoperative OAB. Further multivariate analysis identified BMS as an independent risk factor for long-term OAB (P < 0.001). Conclusion: Long-term postoperative overactive bladder is a common complication following radical prostatectomy. The findings suggest that preoperative MRI measurements of bladder wall thickness and bladder mucosal smoothness during bladder filling phase can predict the risk of OAB occurrence postoperatively. Identifying these risk factors preoperatively can help in counseling patients about potential complications and in developing strategies to mitigate the risk of developing OAB after surgery. Early detection and management of these parameters might improve the quality of life for patients undergoing radical prostatectomy.

Key words: Prostate cancer, Radical prostatectomy, Overactive bladder, Risk factors, Prediction

中图分类号:

R737.25

颜野,李小龙,夏海缀,朱学华,张羽婷,张帆,刘可,刘承,马潞林. 前列腺癌根治术后远期膀胱过度活动症的危险因素[J]. 北京大学学报（医学版）, 2024, 56(4): 589-593.

Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU,Lulin MA. Analysis of risk factors for long-term overactive bladder after radical prostatectomy[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 589-593.

图/表 3

图1

表1

前列腺根治术后OAB组患者和非OAB组患者的基线情况对比"

Items	Non-OAB (n=211)	With OAB (n=52)	Overall (n=263)	P	Statistical value
Age/years, ${\bar x}$±s	69.8±7.17	70.8±6.66	70.0±7.07	0.375	-0.893
BMI/(kg/m²)，n(%)				0.858	0.766
18.5-24.9	121 (57.3)	28 (53.8)	149 (56.7)
≥25	90 (43.7)	24 (46.2)	114 (43.3)
Total PSA/(μg/L)，n(%)				0.279	3.845
0-	16 (7.6)	8 (15.4)	24 (9.1)
4-	86 (40.8)	19 (36.5)	105 (39.9)
10-	67 (31.8)	11 (21.2)	78 (29.7)
≥20	42 (19.9)	14 (26.9)	56 (21.3)
NCCN risk group, n(%)				0.134	7.042
Very low/ low	6 (2.8)	3 (5.8)	9 (3.4)
Intermediate	81 (38.4)	13 (25.0)	94 (35.7)
High	73 (34.6)	21 (40.4)	94 (35.7)
Very high	51 (24.2)	15 (28.8)	66 (25.1)
Prostate volume/mL, ${\bar x}$±s	46.6±21.3	48.8±25.5	47.0±22.2	0.575	-0.563
Bladder thickness/mm, ${\bar x}$±s	2.82±0.85	3.63±1.84	2.98±1.16	0.003	-3.088
Bladder smoothness, n(%)				< 0.001	42.900
0 smooth	60 (28.4)	7 (13.5)	67 (25.5)
1 intermediate	122 (57.8)	16 (30.8)	138 (52.5)
2/3 mild/severe trabecular	29 (13.7)	29 (55.8)	58 (22.1)
Margin, n(%)				0.109	2.574
Negative	145 (68.7)	29 (55.8)	174 (66.2)
Positive	66 (31.3)	23 (44.2)	89 (33.8)
Capsule invasion, n(%)				0.968	0.002
Non-invasion	132 (62.6)	33 (63.5)	165 (62.7)
Invasion	79 (37.4)	19 (36.5)	98 (37.3)
NVB preservation, n(%)				0.199	3.234
Preserved	189 (89.6)	43 (82.7)	232 (88.5)
None	22 (10.4)	9 (17.3)	31 (11.8)
Op_time/min, ${\bar x}$±s	233±78	229±58	233±74	0.658	0.444
eBloodloss/ mL, ${\bar x}$±s	158.36±169.96	125.40±112.87	152.67±160.74	0.208	1.266
Pre_IPSS, ${\bar x}$±s	18.9±7.6	18.3±4.3	18.8±7.1	0.458	0.745
Pre_OABSS, ${\bar x}$±s	7.75±3.57	8.63±2.74	7.92±3.44	< 0.001	-5.022
Post_IPSS, ${\bar x}$±s	10.8±5.5	15.0±3.8	11.6±5.5	< 0.001	-6.451
Post_OABSS, ${\bar x}$±s	4.27±2.22	9.58±3.29	5.32±3.25	< 0.001	-11.014
Incontinence, n(%)				< 0.001	21.605
Continent	186 (88.2)	31 (59.6)	217 (82.5)
Incontinent	25 (11.8)	21 (40.4)	46 (17.5)

表1

表2

参考文献 12

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Bladder mucosal smoothness (BMS)	OR (95%CI)	P
0	1.00
1	6.85 (2.90-16.39)	< 0.001
2/3	6.90 (3.24-14.71)	< 0.001