目的:探讨术前盆底肌电图(EMG)参数对前列腺癌术后尿失禁风险的预测价值。
方法:回顾性分析2020年1月至2022年10月北京大学第一医院泌尿外科271例前列腺癌根治术患者的病历。数据包括患者年龄,体重指数(BMI),国际前列腺症状评分(IPSS),前列腺特异性抗原(PSA)水平,格里森得分,手术类型,尿道重建,淋巴结清扫术,神经保护,导管插入持续时间,D\'Amico风险分类,美国麻醉医师协会(ASA)评分,Charlson合并症指数,术后持续时间,前列腺体积,和盆底肌电图参数(休息前平均值,快速肌肉意味着,和缓慢的肌肉平均得分)。通过多因素Logistic回归分析确定影响术后早期尿失禁的独立危险因素。通过计算受试者工作特征(ROC)曲线下面积评估盆底肌电图结果的预测效能,并根据Youden指数和临床意义确定术后早期尿失禁的最佳阈值。
结果:该研究包括271名前列腺癌患者,术后自愿控尿率为81.9%。快速盆底肌的中位数评分为23.5(18.2,31.6),对于缓慢的肌肉,它是12.5(9.6,17.3)。在患者中,179(66.1%)没有保留神经,110例(40.6%)行尿道重建术。高龄和低快肌评分被确定为尿失禁的独立危险因素。年龄≤60岁的患者自愿排尿控制率是年龄≥70岁的患者的5.482倍(95CI:1.532~19.617,P<0.05)。快肌评分与尿失禁恢复有显著相关性(OR=1.209,95CI:1.132~1.291,P<0.05)。当术前快速肌肉评分的最佳阈值设定为18.5时,ROC敏感性和特异性分别为80.6%和61.2%。分别。
结论:术前盆底肌电图参数对前列腺癌术后尿失禁的风险显示出良好的预测准确性和临床适用性。这些参数可用于早期识别尿失禁风险,年龄和快速肌肉得分是重要的预测因子。
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.
CONCLUSIONS: 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.