江苏地区腹腔镜下前列腺癌根治术后一年夜尿症发生率及相关危险因素多中心回顾性研究

doi:10.3877/cma.j.issn.1674-3253.2024.02.004

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (02) : 141 -145. doi: 10.3877/cma.j.issn.1674-3253.2024.02.004

临床研究

江苏地区腹腔镜下前列腺癌根治术后一年夜尿症发生率及相关危险因素多中心回顾性研究

张铭星¹, 刘文倩², 王以然³, 赵泽恬¹, 袁欣怡³, 丁留成⁴^,^†(

)

^1. 211166　江苏，南京医科大学第二临床医学院
^2. 211166　江苏，南京医科大学第四临床医学院
^3. 211166　江苏，南京医科大学第一临床医学院
^4. 221000　江苏，南京医科大学第二附属医院泌尿外科

收稿日期:2023-11-10 出版日期:2024-04-01
通信作者: 丁留成
基金资助:
江苏省自然科学基金青年项目(BK20181093); 江苏省卫生厅科研基金(2022-0149)

Incidence of nocturia and associated risk factors in Jiangsu province 1 year after laparoscopic radical prostate cancer surgery: a multicenter retrospective study

Mingxing Zhang¹, Wenqian Liu², Yiran Wang³, Zetian Zhao¹, Xinyi Yuan³, Liucheng Ding⁴^,^†()

^1. The Second Clinical Medical College of Nanjing Medical University, Jiangsu 211166, China
^2. Fourth Clinical Medical College of Nanjing Medical University, Jiangsu 211166, China
^3. First Clinical Medical College of Nanjing Medical University, Jiangsu 211166, China
^4. Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Jiangsu 221000, China

Received:2023-11-10 Published:2024-04-01
Corresponding author: Liucheng Ding

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引用本文：

张铭星, 刘文倩, 王以然, 赵泽恬, 袁欣怡, 丁留成. 江苏地区腹腔镜下前列腺癌根治术后一年夜尿症发生率及相关危险因素多中心回顾性研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(02): 141-145.

Mingxing Zhang, Wenqian Liu, Yiran Wang, Zetian Zhao, Xinyi Yuan, Liucheng Ding. Incidence of nocturia and associated risk factors in Jiangsu province 1 year after laparoscopic radical prostate cancer surgery: a multicenter retrospective study[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(02): 141-145.

目的

了解江苏地区腹腔镜前列腺癌根治术（LRP）术后1年夜尿症的发生率，并分析相关的危险因素。

方法

纳入2019年1月至2020年3月江苏地区10家医院共634例进行LRP患者，评估其临床特征。采用膀胱过度活动症（OABSS）及国际尿失禁问卷短卷（ICIQ-SF）评估患者LRP术后1年夜尿发生情况，并根据夜尿次数分为两组：正常组（0～1次)，观察组（≥2次）。比较两组患者夜尿发生情况，并采用logistic回归分析LRP术后夜尿症及夜尿次数增多的危险因素。

结果

634例患者中共有380例患者参与了本研究，夜尿症的总体发生率为76.1％，其中每晚2次排尿144例（37.9％）、3次及以上145例（38.2％）。多因素分析结果显示Gleason评分≤6分是LRP术后发生夜尿症的保护因素（P<0.05），前列腺体积较大是LRP术后夜尿次数增多的危险因素（P<0.05）。术后ICIQ评分、OABSS严重程度与患者术后夜尿症发生率相关（P<0.05）。

结论

江苏地区LRP术后夜尿症的发生率高达76.1％，较小的前列腺体积和Gleason评分≤6分是LRP术后发生夜尿症的保护因素，为临床治疗提供参考。

关键词: 腹腔镜, 前列腺癌, 前列腺切除术, 夜尿, 膜性尿道长度, 前列腺体积, Gleason评分

Objective

To investigate the incidence of nocturia after laparoscopic radical prostatectomy (LRP) in Jiangsu region, and analyze the relevant risk factors.

Methods

A total of 634 LRP patients from 10 hospitals in Jiangsu Province from January 2019 to March 2020 were included to evaluate their clinical characteristics. The occurrence of nocturia after LRP surgery in patients was evaluated using OABSS and ICIQ-SF, and they were divided into two groups based on the frequency of nocturia: control group (0-1 times) and observation group (≥ 2 times). Compare the occurrence of nocturia between two groups of patients, and use Logistic regression analysis to identify risk factors for postoperative nocturia and increased nocturia frequency after LRP surgery.

Results

A total of 380 out of 634 patients participated in this study. The overall incidence of nocturia was 76.1%, with 144 cases (37.9%) urinating twice a night and 145 cases (38.2%) urinating three or more times a night. The results of multivariate analysis showed that Gleason score ≤ 6 was a protective factor for nocturia after LRP surgery (P<0.05), and a larger prostate volume was a risk factor for increased nocturia frequency after LRP surgery (P<0.05). The postoperative ICIQ score, severity of OABSS, and incidence of nocturia in patients were correlated (P<0.05).

Conclusions

The incidence of nocturia after LRP surgery in Jiangsu region is as high as 76.1%. A smaller prostate volume and Gleason score ≤ 6 are protective factors for nocturia after LRP surgery, providing reference for clinical treatment.

Key words: Laparoscopy, Prostate cancer, Prostatectomy, Nocturia, membranous urethral length (MUL), Prostate volume, Gleason score

表1 前列腺癌根治术后有无夜尿症患者临床资料比较

组别	例数	年龄[例(%)]		BMI[例(%)]		Gleason评分[例(%)]
组别	例数	<70岁	≥70岁	<25 kg/m²	≥25 kg/m²	≤6分	（3+4）分	（4+3）分	8～10分
无夜尿症组	91	39(42.9)	52(57.1)	55(60.4)	36(39.6)	11(12.1)	24(26.4)	34(37.4)	22(24.2)
有夜尿症组	289	128(44.3)	161(55.7)	183(63.3)	106(36.7)	37(12.8)	76(26.3)	72(24.9)	104(36.0)
统计值		χ²=0.159		χ²=0.290		χ²=7.370
P值		0.812		0.623		0.081
组别	病理分期[例(%)]		PSA[ng/ml，M(Q)]	膜性尿道长度(MUL)[mm，M(Q)]	前列腺体积[ml，M(Q)]
组别	≤T2	≥T3	PSA[ng/ml，M(Q)]	膜性尿道长度(MUL)[mm，M(Q)]	前列腺体积[ml，M(Q)]
无夜尿症组	74(81.3)	17(18.7)	13.9(10.2，25.0)	16.4(14.9，17.6)	35.8(26.2，51.3)
有夜尿症组	209(72.3)	80(27.7)	16.7(10.0，36.7)	16.2(14.2，17.9)	40.0(28.4，57.9)
统计值	χ²=3.283		Z=1.311	Z=-0.920	Z=1.725
P值	0.090		0.132	0.290	0.061

表1 前列腺癌根治术后有无夜尿症患者临床资料比较

组别	例数	年龄[例(%)]		BMI[例(%)]		Gleason评分[例(%)]
组别	例数	<70岁	≥70岁	<25 kg/m²	≥25 kg/m²	≤6分	（3+4）分	（4+3）分	8～10分
无夜尿症组	91	39(42.9)	52(57.1)	55(60.4)	36(39.6)	11(12.1)	24(26.4)	34(37.4)	22(24.2)
有夜尿症组	289	128(44.3)	161(55.7)	183(63.3)	106(36.7)	37(12.8)	76(26.3)	72(24.9)	104(36.0)
统计值		χ²=0.159		χ²=0.290		χ²=7.370
P值		0.812		0.623		0.081
组别	病理分期[例(%)]		PSA[ng/ml，M(Q)]	膜性尿道长度(MUL)[mm，M(Q)]	前列腺体积[ml，M(Q)]
组别	≤T2	≥T3	PSA[ng/ml，M(Q)]	膜性尿道长度(MUL)[mm，M(Q)]	前列腺体积[ml，M(Q)]
无夜尿症组	74(81.3)	17(18.7)	13.9(10.2，25.0)	16.4(14.9，17.6)	35.8(26.2，51.3)
有夜尿症组	209(72.3)	80(27.7)	16.7(10.0，36.7)	16.2(14.2，17.9)	40.0(28.4，57.9)
统计值	χ²=3.283		Z=1.311	Z=-0.920	Z=1.725
P值	0.090		0.132	0.290	0.061

表2 前列腺癌根治术后夜尿症多因素Logistic回归分析

	有无夜尿症			夜尿次数
	OR	95%CI	P值	OR	95%CI	P值
前列腺体积	1.01	1.00～1.02	0.081	1.01	1.00～1.02	0.048
Gleason评分
≤6分	0.48	0.26～0.90	0.024	1.12	0.60～2.12	0.721
(3+4)分	0.80	0.41～1.58	0.521	1.01	0.54～1.89	0.990
(4+3)分	0.87	0.37～2.05	0.762	1.52	0.82～2.82	0.192
8～10分				参照组

表2 前列腺癌根治术后夜尿症多因素Logistic回归分析

	有无夜尿症			夜尿次数
	OR	95%CI	P值	OR	95%CI	P值
前列腺体积	1.01	1.00～1.02	0.081	1.01	1.00～1.02	0.048
Gleason评分
≤6分	0.48	0.26～0.90	0.024	1.12	0.60～2.12	0.721
(3+4)分	0.80	0.41～1.58	0.521	1.01	0.54～1.89	0.990
(4+3)分	0.87	0.37～2.05	0.762	1.52	0.82～2.82	0.192
8～10分				参照组

表3 其他因素和前列腺癌根治术后夜尿症相关性分析

双变量相关		尿垫使用	有尿急症状	OABSS评分	ICIQ评分
有无夜尿症	相关系数	0.13	0.16	0.46	0.16
有无夜尿症	P值	0.009	<0.001	<0.001	<0.001
夜尿次数	相关系数	0.21	0.16	0.51	0.21
夜尿次数	P值	0.016	0.058	0.013	0.003

表3 其他因素和前列腺癌根治术后夜尿症相关性分析

双变量相关		尿垫使用	有尿急症状	OABSS评分	ICIQ评分
有无夜尿症	相关系数	0.13	0.16	0.46	0.16
有无夜尿症	P值	0.009	<0.001	<0.001	<0.001
夜尿次数	相关系数	0.21	0.16	0.51	0.21
夜尿次数	P值	0.016	0.058	0.013	0.003

[1]	Pernar CH, Ebot EM, Wilson KM, et al. The epidemiology of prostate cancer[J]. Cold Spring Harb Perspect Med, 2018, 8(12): a030361.
[2]	Liu X, Yu C, Bi Y, et al. Trends and age-period-cohort effect on incidence and mortality of prostate cancer from 1990 to 2017 in China[J]. Public Health, 2019, 172: 70-80.
[3]	Hashim H, Blanker MH, Drake MJ, et al. International Continence Society (ICS) report on the terminology for nocturia and nocturnal lower urinary tract function[J]. Neurourol Urodyn, 2019, 38(2): 499-508.
[4]	Haga N, Aikawa K, Hoshi S, et al. Postoperative urinary incontinence exacerbates nocturia-specific quality of life after robot-assisted radical prostatectomy[J]. Int J Urol, 2016, 23(10): 873-878.
[5]	贺全浩, 廖方通, 彭粲杰, 等. 机器人辅助腹腔镜前列腺癌根治术与腹腔镜前列腺癌根治术术后疗效对比分析：倾向性评分匹配队列研究[J]. 重庆医科大学学报, 2023, 48(08): 940-944.
[6]	Zhu Y, Mo M, Wei Y, et al. Epidemiology and genomics of prostate cancer in Asian men[J]. Nat Rev Urol, 2021, 18(5): 282-301.
[7]	Hur KJ, Lee KW, Kim SJ, et al. Changes in nocturia and lower urinary tract symptoms after radical prostatectomy[J]. World J Mens Health, 2015, 33(3): 194-201.
[8]	夜尿症临床诊疗中国专家共识编写组. 夜尿症临床诊疗中国专家共识[J]. 中华泌尿外科杂志, 2018, 39(8): 561-564.
[9]	Carbonara U, Srinath M, Crocerossa F, et al. Robot-assisted radical prostatectomy versus standard laparoscopic radical prostatectomy: an evidence-based analysis of comparative outcomes[J]. World J Urol, 2021, 39(10): 3721-3732.
[10]	Schuessler WW, Schulam PG, Clayman RV, et al. Laparoscopic radical prostatectomy: initial short-term experience[J]. Urology, 1997, 50(6): 854-857.
[11]	Ruan XH, Stacia Chun TT, Huang D, et al. Outcomes of radical prostatectomy in a 20-year localized prostate cancer single institution series in China[J]. Asian J Androl, 2023, 25(3): 345-349.
[12]	Zarraonandia Andraca A, Lombardo R, Carrion Valencia A, et al. Laparoscopic simple prostatectomy: a large single-center prospective cohort study[J]. Minerva Urol Nephrol, 2021, 73(1): 107-113.
[13]	Hamdy FC, Donovan JL, Lane JA, et al. Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT[J]. Health Technol Assess, 2020, 24(37): 1-176.
[14]	《腹腔镜前列腺癌手术规范专家共识》专家组. 腹腔镜前列腺癌手术规范专家共识[J]. 微创泌尿外科杂志, 2020, 9(3): 145-154.
[15]	Kan KM, Tin AL, Stearns GL, et al. De novo urinary storage symptoms are common after radical prostatectomy: incidence, natural history and predictors[J]. J Urol, 2022, 207(3): 601-608.
[16]	Lane JA, Donovan JL, Young GJ, et al. Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment[ProtecT]study)[J]. BJU Int, 2022, 130(3): 370-380.
[17]	Rahnama'i M S, Marcelissen T, Geavlete B, et al. Current management of post-radical prostatectomy urinary incontinence[J]. Front Surg, 2021, 8: 647656.
[18]	Bosch J L H R, Chapple C R, Mueller E R, et al. Differences in the prevalence of nocturnal polyuria in the U.S. by definition: results from the epidemiology of nocturnal polyuria study. reply[J]. J Urol, 2023, 209(1): 77-78.
[19]	Hutchinson RC, Thiel DD, Tavlarides AM, et al. The effect of robot-assisted laparoscopic prostatectomy on nocturia[J]. J Endourol, 2012, 26(7): 861-865.
[20]	Haga N, Hata, Matsuoka K, et al. The impact of nerve-sparing robot-assisted radical prostatectomy on lower urinary tract function: prospective assessment of patient-reported outcomes and frequency volume charts[J]. Neurourol Urodyn, 2018, 37(1): 322-330.
[21]	Misraï V, Peyronnet B, Charbonneau H, et al. Relationship between nocturia and mortality: are we missing the forest for the trees?[J]. Prostate Cancer Prostatic Dis, 2019, 22(1): 3-4.
[22]	Tienza A, Graham PL, Robles JE, et al. Daily pad usage versus the international consultation on incontinence questionnaire short form for continence assessment following radical prostatectomy[J]. Int Neurourol J, 2020, 24(2): 156-162.
[23]	Namiki S, Saito S, Ishidoya S, et al. Adverse effect of radical prostatectomy on nocturia and voiding frequency symptoms[J]. Urology, 2005, 66(1): 147-151.
[24]	Onoda M, Haga N, Kurimura Y, et al. Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot-assisted radical prostatectomy: a prospective observational study[J]. Neurourol Urodyn, 2019, 38(8): 2200-2208.

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