Abstract

Objective

To investigate the association between surgeon volume and urinary incontinence after radical prostatectomy.

Methods

A total of 8326 men in The National Prostate Cancer Register of Sweden (NPCR) underwent robot-assisted radical prostatectomy (RARP) between 2017 and 2019 of whom 56% (4668/8 326) had responded to a questionnaire one year after RARP. The questionnaire included the question: ‘How much urine leakage do you experience?’ with the response alternatives ‘Not at all’, ‘A little’, defined as continence and ‘Moderately’, ‘Much/Very much’ as incontinence. Association between incontinence and mean number of RARPs/year/surgeon was analysed with multivariable logistic regression including age, Charlson Comorbidity Index (CCI), PSA, prostate volume, number of biopsy cores with cancer, cT stage, Gleason score, lymph node dissection, nerve sparing intent and response rate to the questionnaire.

Results

14% (659/4 668) of the men were incontinent one year after RARP. There was no statistically significant association between surgeon volume and incontinence. Older age (>75 years vs. < 65 years, OR 2.29 [95% CI 1.48–3.53]), higher CCI (CCI 2+ vs. CCI 0, OR 1.37 [95% CI 1.04–1.80]) and no nerve sparing intent (no vs. yes OR 1.53 [95% CI 1.26–1.85]) increased risk of incontinence. There were large differences in the proportion of incontinent men between surgeons with similar annual volumes, which remained after adjustment.

Conclusions

The lack of association between surgeon volume and incontinence and the wide range in outcome between surgeons with similar volumes underline the importance of individual feedback to surgeons on functional results.

中文翻译：

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根治性前列腺切除术后外科医生的体积和患者报告的尿失禁。瑞典基于人口的登记研究

摘要

客观的

调查根治性前列腺切除术后手术体积与尿失禁之间的关系。

方法

瑞典国家前列腺癌登记处 (NPCR) 共有 8326 名男性在 2017 年至 2019 年期间接受了机器人辅助根治性前列腺切除术 (RARP)，其中 56% (4668/8 326) 在 RARP 一年后回答了问卷。调查问卷包括以下问题：“您经历过多少尿漏？” 选项“完全没有”、“有点”被定义为失禁，“中等”、“很多/非常”被定义为失禁。使用多变量逻辑回归分析失禁与 RARP 平均数/年/外科医生之间的关联，包括年龄、Charlson 合并症指数 (CCI)、PSA、前列腺体积、癌症活检核心数、cT 分期、格里森评分、淋巴结清扫、神经保护意向和对问卷的回答率。

结果

14% (659/4 668) 的男性在 RARP 一年后出现大小便失禁。外科医生手术量和尿失禁之间没有统计学上的显着关联。年龄较大（>75 岁vs. < 65 岁，OR 2.29 [95% CI 1.48–3.53]），CCI 较高（CCI 2+ vs. CCI 0，OR 1.37 [95% CI 1.04–1.80]）且无神经保留意图（否与是 OR 1.53 [95% CI 1.26–1.85]）增加失禁风险。年处理量相似的外科医生之间失禁男性的比例存在很大差异，调整后仍然存在。

结论

外科医生手术量与尿失禁之间缺乏关联，以及具有相似手术量的外科医生之间的结果差异很大，强调了向外科医生提供个人反馈对功能结果的重要性。