经尿道前列腺电切术后并发尿失禁的影响因素分析-现代医学

经尿道前列腺电切术后并发尿失禁的影响因素分析

单位：南京医科大学第二附属医院盆底外科中心, 江苏南京 210028

分类号：R697+.3

出版年·卷·期（页码）：2025·53·第五期（785-790）

摘要：

目的： 分析经尿道前列腺电切术(TURP)后并发尿失禁(UI)的影响因素，并探讨其防范策略。方法： 回顾性选取2019年2月至2024年2月本院TURP术后并发UI的患者49例为UI组，TURP术后未并发UI的患者141例为非UI组。收集患者临床资料，采用Logistic回归分析TURP术后并发UI的影响因素，依据影响因素构建预测模型，受试者工作特征(ROC)曲线评估模型的预测价值，Hosmer-Lemeshow检验评估模型拟合度，Bootstrap法进行内部验证。结果： Logistic多因素结果显示，年龄(OR=3.911，95%CI 1.648～9.286)、合并糖尿病(OR=3.233，95%CI 1.408～7.425)、前列腺体积(OR=1.081，95%CI 1.014～1.154)、术前盆底肌训练(OR=0.221，95%CI 0.084～0.582)、术前膜性尿道长度(OR=0.713，95%CI 0.591～0.859)、导尿管气囊注水量(OR=1.204，95%CI 1.112～1.304)是TURP术后并发UI的影响因素(P＜0.05)。构建预测模型Logit(P)＝-11.762+1.364×年龄(＜65岁=0，≥65岁=1)+1.173×合并糖尿病(否=0，是=1)+0.078×前列腺体积(mL)-1.508×术前盆底肌训练(否=0，是=1)-0.339×术前膜性尿道长度(mm)+0.186×导尿管气囊注水量(mL)。ROC曲线显示，该模型预测TURP术后并发UI的曲线下面积(AUC)为0.943；H-L检验显示，χ²＝11.521，P＝0.174，模型不存在过度拟合；Bootstrap法内部验证显示，C指数为0.940，内部验证一致性较高。结论： 年龄、合并糖尿病、前列腺体积、术前盆底肌训练、术前膜性尿道长度、导尿管气囊注水量均可影响TURP术后UI的发生，据此构建的模型具有良好的预测效能，临床可根据上述因素制定UI预防策略。

Objective: To analyze the influencing factors of urinary incontinence(UI) after transurethral resection of prostate(TURP), and explore the preventive strategies. Methods: From February 2019 to February 2024, 49 patients with UI after TURP operation in our hospital were retrospectively selected as UI group, and 141 patients without UI after TURP operation were selected as non-UI group. Clinical data were collected, and Logistic regression analysis was used to analyze the influencing factors of post-TURP UI. A prediction model was constructed based on these factors and evaluated using receiver operating characteristic(ROC) curve analysis, with Hosmer-Lemeshow test for model fitness assessment and Bootstrap method for internal validation. Results: Multivariate Logistic regression analysis revealed that age(OR=3.911, 95%CI 1.648-9.286), comorbid diabetes(OR=3.233, 95%CI 1.408-7.425), prostate volume(OR=1.081, 95%CI 1.014-1.154), preoperative pelvic floor muscle training(OR=0.221,95%CI 0.084-0.582), preoperative membranous urethral length(OR=0.713, 95%CI 0.591-0.859), and catheter balloon water volume(OR=1.204,95%CI 1.112-1.304) were influencing factors for post-TURP UI(P<0.05). The prediction model was constructed as: Logit(P)=-11.762+1.364×age(<65=0，≥65=1)+1.173×diabetes(no=0, yes=1)+0.078×prostate volume(mL)-1.508×preoperative pelvic floor muscle training(no=0, yes=1)-0.339×preoperative membranous urethral length(mm)+0.186×catheter balloon water volume(mL). ROC curve analysis showed an area under the curve(AUC) of 0.943; Hosmer-Lemeshow test showed χ²=11.521, P=0.174, indicating no overfitting; Bootstrap internal validation showed a C-index of 0.940, demonstrating high internal consistency. Conclusion: Age, comorbid diabetes, prostate volume, preoperative pelvic floor muscle training, preoperative membranous urethral length, and catheter balloon water volume all affect the occurrence of post-TURP UI. The prediction model based on these factors demonstrates good predictive performance, and clinical prevention strategies can be developed based on these factors.

参考文献：

[1] MIERNIK A,GRATZKE C.Current treatment for benign prostatic hyperplasia[J].Dtsch Arztebl Int,2020,117(49):843-854.
[2] 单勇,徐汉军,刘仁杰,等.TUPKP和TURP治疗良性前列腺增生患者临床效果的对比观察[J].现代医学,2020,48(12):1598-1601.
[3] 许文景,陈明.经尿道前列腺电切术疗效与良性前列腺增生患者术前非手术因素关系的研究进展[J].东南大学学报(医学版),2019,38(4):737-741.
[4] JOHNSON E E,MAMOULAKIS C,STONIUTE A,et al.Conservative interventions for managing urinary incontinence after prostate surgery[J].Cochrane Database Syst Rev,2023,4(4):CD014799.
[5] 雷艳,张夏柔,余宵,等.前列腺电切术后尿失禁患者新护理管理模式[J].解放军医院管理杂志,2021,28(S1):84-87.
[6] 哈姆,雪艳,喻定钢,等.影响经前列腺切除术后尿失禁的危险因素分析[J].解放军预防医学杂志,2019,37(3):174-176.
[7] 胡建明,蒯留牛,戴弋,等.低功率HoLEP与TURP对BPH患者疗效的影响及术后应激性尿失禁的危险因素分析[J].国际泌尿系统杂志,2021,41(4):588-592.
[8] 王以然,刘文倩,张铭星,等.前列腺切除术后尿失禁的诊断与评估[J].医学综述,2024,30(16):1966-1970.
[9] 林春丽,李园园,侯诗箐,等.精准化护理模式预防经尿道前列腺电切术后膀胱过度活动症疗效及对焦虑抑郁情绪和护理质量的影响[J].现代中西医结合杂志,2020,29(28):3169-3173.
[10] 姚礼忠,葛妍,李九智,等.电生理技术联合盆底肌训练治疗前列腺增生电切术后尿失禁的疗效[J].现代泌尿外科杂志,2023,28(9):755-758.
[11] CHEN Y,HAO H,CHEN S,et al.Insights into urinary incontinence after robot-assisted radical prostatectomy:urgent urinary incontinence or stress urinary incontinence[J].World J Urol,2023,41(12):3635-3642.
[12] GONDOPUTRO W,THOMPSON J,EVANS M,et al.How does age affect urinary continence following robot-assisted radical prostatectomy? A prospective multi-institutional study using independently collected,validated questionnaires[J].J Urol,2022,207(5):1048-1056.
[13] CANO GARCIA C,WENZEL M,HUMKE C,et al.Impact of age on long-term urinary continence after robotic-assisted radical prostatectomy[J].Medicina(Kaunas),2023,59(6):1153.
[14] 李坚.塞来昔布治疗老年前列腺患者电切术后压力性尿失禁的疗效[J].中国性科学,2022,31(10):27-31.
[15] 李灿,徐松,巫海娣,等.住院2型糖尿病患者尿失禁现状及影响因素分析[J].护理学杂志,2022,37(7):26-28,54.
[16] OLIVEIRA I K B,DA SILVA CALISTO S L,FERREIRA C W S,et al.Occult urinary incontinence,diabetes,obesity,prolapse severity,and type of surgical repair as risk factors for de novo stress urinary incontinence in women undergoing surgical repair of pelvic organ prolapse:a systematic review and meta-analysis[J].Neurourol Urodyn,2025,44(1):194-206.
[17] 王娟,刘蓉蓉,高雪.良性前列腺增生等离子前列腺剜除术后尿失禁的Nomogram预测模型构建及临床指导价值[J].中华男科学杂志,2023,29(7):602-608.
[18] 司龙妹,张佩英,张萌,等.盆底肌训练防治前列腺癌根治术后尿失禁的最佳证据总结[J].中华护理杂志,2020,55(12):1859-1864.
[19] 张帆,陈曲,郝一昌,等.术前及术后膜性尿道长度与腹腔镜根治性前列腺切除术后控尿功能恢复的相关性[J].北京大学学报(医学版),2022,54(2):299-303.
[20] 李素琼,刘翔宇,肖川,等.经尿道前列腺激光汽化电切术后发生尿失禁危险因素分析及应对措施[J].实用医院临床杂志,2019,16(5):153-156.
[21] 王东,窦小亮,付晓亮,等.索利那新对2型糖尿病合并良性前列腺增生患者术后并发症和性功能的影响[J].中国性科学,2019,28(8):8-11.
[22] YAMASHITA K,KIJIMA Y,SEKIDO E,et al.Predictors of long-term urinary incontinence after robot-assisted laparoscopic prostatectomy[J].Res Rep Urol,2023,15:387-393.

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