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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 594-599. doi: 10.19723/j.issn.1671-167X.2024.04.008

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Predictive value of preoperative pelvic floor electrophysiological parameters on early urinary incontinence following radical prostatectomy

Shuhui YU1,Jianing HAN1,2,Lijun ZHONG1,Congyu CHEN1,Yunxiang XIAO1,Yanbo HUANG1,Yang YANG1,*(),Xinyan CHE1,*()   

  1. 1. Department of Urology, Peking University First Hospital, Beijing 100034, China
    2. School of Nursing, Peking University, Beijing 100191, China
  • Received:2024-03-16 Online:2024-08-18 Published:2024-07-23
  • Contact: Yang YANG,Xinyan CHE E-mail:goldflamingo@pku.org.cn;che850626@126.com
  • Supported by:
    the Beijing Natural Science Foundation(7244419);the National High Level Hospital Clinical Research Funding (Scientific Research Seed Fund of Peking University First Hospital)(2024SF80)

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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

CLC Number: 

  • R737.25

Table 1

Univariate analysis of urinary incontinence after early prostate cancer surgery"

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)

Table 2

Logistic regression analysis of urinary incontinence after early prostate cancer surgery"

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

Figure 1

Receiver operating characteristic (ROC) curve based on fast muscle score"

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