术前盆底肌电生理参数对前列腺癌根治性切除术后早期尿失禁的预测价值

doi:10.19723/j.issn.1671-167X.2024.04.008

摘要/Abstract

摘要：

目的: 探索术前盆底肌电生理参数对前列腺癌术后尿失禁风险的预测价值。方法: 选择2020年1月至2022年10月在北京大学第一医院泌尿外科行根治性前列腺切除术患者的病例资料进行回顾性分析，记录患者的年龄、体重指数(body mass index, BMI)、国际前列腺症状评分(international prostate symptom score, IPSS)、前列腺特异性抗原(prostate-specific antigen, PSA)水平、Gleason评分、手术方式、是否尿道功能重建、是否淋巴结清扫、性神经是否保留、留置导尿时间、D’ Amico风险分级、美国麻醉医师协会(American Society of Anesthesiologists, ASA)评分、查尔森(Charlson)合并症指数、术后随访时间、前列腺体积，以及盆底肌电生理参数(前静息均值、快肌均值和慢肌均值)。通过多因素Logistic回归分析，筛选出影响术后早期尿失禁发生的独立危险因素，并通过计算受试者工作特征曲线(receiver operating characteristic, ROC)下面积，评估盆底肌电参数的预测效能，再利用约登指数(Youden index)并结合临床意义，共同确定术后早期尿失禁发生的最佳临界值。结果: 纳入患者271例，术后自主控尿率为81.9%。患者快肌评分为23.5(18.2, 31.6)分，慢肌评分为12.5(9.6, 17.3)分，179例(66.1%)患者未保留性神经，110例(40.6%)患者进行了尿道功能重建。高龄和盆底快肌评分低被确认为尿失禁发生的独立危险因素。≤60岁患者是≥70岁患者自主控尿率的5.482倍(95%CI: 1.532~19.617，P＜0.05)；患者的盆底快肌评分与尿失禁恢复的关系密切(OR=1.209，95%CI: 1.132~1.291, P＜0.05)。当术前盆底快肌评分的最佳临界值设定为18.5分时，ROC的敏感度和特异度分别为80.6%和61.2%。结论: 术前盆底肌电生理参数对于前列腺癌术后尿失禁风险表现出较好的预测准确性和临床应用性，能够用于前列腺癌术后尿失禁风险的早期识别，其中年龄和盆底快肌评分是重要的预测因子。

关键词: 盆底肌电生理参数, 前列腺癌根治性切除, 尿失禁

Abstract:

Objective: To explore the predictive value of preoperative pelvic floor electromyography (EMG) parameters for the risk of urinary incontinence after prostate cancer surgery. Methods: This study retrospectively analyzed the medical records of 271 patients who underwent radical prostatectomy in the urology department of Peking University First Hospital from January 2020 to October 2022. The data included patient age, body mass index (BMI), international prostate symptom score (IPSS), prostate-specific antigen (PSA) levels, Gleason score, type of surgery, urethral reconstruction, lymph node dissection, nerve preservation, catheterization duration, D ' Amico risk classification, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, postoperative duration, prostate volume, and pelvic floor EMG parameters (pre-resting mean, fast muscle mean, and slow muscle mean scores). Independent risk factors affecting early postoperative urinary incontinence were identified through multivariate Logistic regression analysis. The predictive efficacy of pelvic floor EMG results was evaluated by calculating the area under the receiver operating characteristic (ROC) curve, and the optimal threshold for early postoperative urinary incontinence was determined based on the Youden index and clinical significance. Results: The study included 271 prostate cancer patients, with an 81.9% rate of voluntary urinary control post-surgery. The median score for fast pelvic floor muscles was 23.5(18.2, 31.6), and for slow muscles, it was 12.5(9.6, 17.3). Among the patients, 179 (66.1%) did not preserve nerves, and 110 (40.6%) underwent urethral reconstruction. Advanced age and low fast muscle scores were identified as independent risk factors for urinary incontinence. Patients aged ≤60 had 5.482 times the voluntary urinary control rate compared with those aged ≥70 (95%CI: 1.532-19.617, P < 0.05). There was a significant correlation between fast muscle scores and urinary incontinence recovery (OR=1.209, 95%CI: 1.132-1.291, P < 0.05). When the optimal threshold for preoperative fast muscle score was set at 18.5, the ROC sensitivity and specificity were 80.6% and 61.2%, respectively. Conclusion: Preoperative pelvic floor EMG parameters show good predictive accuracy and clinical applicability for the risk of urinary incontinence after prostate cancer surgery. These parameters can be used for early identification of urinary incontinence risk, with age and fast muscle scores being important predictors.

Key words: Pelvic floor electromyography parameters, Radical prostatectomy, Urinary incontinence

中图分类号:

R737.25

于书慧,韩佳凝,钟丽君,陈聪语,肖云翔,黄燕波,杨洋,车新艳. 术前盆底肌电生理参数对前列腺癌根治性切除术后早期尿失禁的预测价值[J]. 北京大学学报（医学版）, 2024, 56(4): 594-599.

Shuhui YU,Jianing HAN,Lijun ZHONG,Congyu CHEN,Yunxiang XIAO,Yanbo HUANG,Yang YANG,Xinyan CHE. Predictive value of preoperative pelvic floor electrophysiological parameters on early urinary incontinence following radical prostatectomy[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 594-599.

图/表 3

表1

前列腺癌术后早期发生尿失禁的单因素分析"

Items	Urinary incontinence (n=49)	Urinary continence (n=222)	F/χ²/Z	P
Age/years, n (%)			-3.668	0.000
≤60	4 (7.5)	49 (92.5)
60＜Age＜70	25 (15.7)	134 (84.3)
≥70	20 (33.9)	39 (66.1)
Pelvic floor muscle assessment
Resting assessment, n (%)			10.386	0.001
High muscle tension	4 (5.6)	68 (94.4)
Normal muscle tension	45 (22.6)	154 (77.4)
Fast muscle score, M(P₂₅, P₇₅)	16.6 (11.9, 22.3)	25.2 (19.9, 33.3)	-6.759	0.000
Slow muscle score, M(P₂₅, P₇₅)	8.1 (5.7, 11.5)	14.0 (10.5, 18.4)	-6.555	0.000
BMI/(kg/m²)，n (%)			-0.432	0.665
BMI＜18.5	1 (16.7)	5 (83.3)
18.5≤BMI＜24.0	17 (16.8)	84 (83.2)
BMI≥24.0	31 (18.9)	133 (81.1)
Surgical method, n (%)			0.072	0.788
LSRP	11 (19.3)	46 (80.7)
RARP	38 (17.8)	176 (82.2)
IPSS score, M(P₂₅, P₇₅)	8 (3.0, 13.0)	6 (3.0, 12.0)	-1.310	0.190
ASA, n (%)			5.244	0.022
Ⅰ or Ⅱ	33 (15.3)	182 (84.7)
Ⅲ	16 (28.6)	40 (71.4)
CCI, n (%)			0.036	0.850
< 4	45 (18.2)	202 (81.8)
≥4	4 (16.7)	20 (83.3)
D’Amico risk classification, n (%)			0.986	0.321
Low or medium risk	0 (0.0)	9 (100.0)
High risk	49 (18.7)	213 (81.3)
Preservation of nerves, n (%)			4.891	0.027
No	39 (21.8)	140 (78.2)
Fully or partially	10 (10.9)	82 (89.1)
Lymphatic drainage, n (%)			0.009	0.926
No	39 (18.0)	178 (82.0)
Yes	10 (18.5)	44 (81.5)
Urinary reconstruction, n (%)			6.796	0.009
No	21 (13.0)	140 (87.0)
Yes	28 (25.5)	82 (74.5)
Postoperative duration/months, ${\bar x}$±s	3.78±1.09	3.43±1.16	-1.892	0.060
Prostate volume/mL, ${\bar x}$±s	45.25±29.00	41.19±19.65	-1.190	0.235
Indwelling catheterization/d, n (%)			0.352	0.839
21	5 (22.7)	17 (77.3)
14	36 (17.7)	167 (82.3)
≤10	8 (17.4)	38 (82.6)

表1

表2

图1

参考文献 19

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Item	β	SE	Wald χ²	P	OR	95%CI
Age/years				0.020
≤60	1.701	0.651	6.841	0.009	5.482	1.532-19.617
60 < Age < 70	0.793	0.404	3.856	0.050	2.210	1.001-4.877
Fast muscle score	0.190	0.033	32.176	0.000	1.209	1.132-1.291