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研究生:賴育宏
研究生(外文):Allen Yu-Hung Lai
論文名稱:術前下尿路症狀與攝護腺根除術後禁尿回復之相關性探討
論文名稱(外文):Association between Preoperative Lower Urinary Tract Symptoms and Continence Return after Radical Prostatectomy
指導教授:賴美淑賴美淑引用關係
指導教授(外文):Mei-Shu Lai
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:預防醫學研究所
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:英文
論文頁數:78
中文關鍵詞:攝護腺癌攝護腺根除術禁尿回復尿失禁下尿路症狀
外文關鍵詞:prostate cancerradical prostatectomycontinence returnincontinencelower urinary tract symptoms
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研究目的:吾人研究在攝護腺癌病人施行攝護腺根除術時,術前下尿路症狀(頻尿、急尿、夜尿、用力解尿、尿柱細小、間歇排尿、排尿排不乾淨)的有無是否與術後禁尿回復相關,並探討造成禁尿回復延後的危險因子。
研究題材及方法:本研究將民國八十九年一月到九十五年十二月期間,在台大醫院因侷限性攝護腺癌施行攝護腺根除術的一百零三位病患為研究群體。所有研究資料中的相關變項及下尿路症狀皆是由病歷紀錄中回溯方式取得。禁尿回復的定義為沒有使用任何棉墊或是已經獲得良好的禁尿控制,完全達到乾爽的程度稱之。禁尿回復的時程是由病歷紀錄中尿管拔除時到達成禁尿之間的時間。禁尿狀態的紀錄是由攝護腺根除術後三個月、六個月、九個月及十二個月分別評估。吾人使用單變項,多變項,存活分析並危險比例模式回溯分析所有收集的資料及變項,並進一步檢視攝護腺根除術病患造成禁尿回復延後的危險因子。
研究結果:針對攝護腺根除術前病患是否具有下尿路症狀的有無分組,所有臨床及病理相關變項,兩組間都沒有顯著差異。所有病患在術後三個月、六個月、九個月及十二個月的禁尿回復佔所有病患的比例分別是25.2%, 46.6%, 57.3% and 70.9%。術前沒有儲尿症狀(頻尿、急尿、夜尿)病人分別在術後三個月和六個月有較快的禁尿回復(p = 0.007,p = 0.02),並且在術後禁尿回復程度上也有差別(p = 0.04)。術前頻尿症狀是所有儲尿症狀中,與術後禁尿回復最為相關的症狀(p = 0.02)。
研究結論:這個研究發現指出對於侷限性攝護腺癌病患施行攝護腺根除術時,若是病患在術前具有儲尿症狀,那麼這群病人在術後禁尿機制的回復會有延遲的情形發生。然而,對於長達一年的統計來說,術前儲尿症狀與否並不會影響禁尿回復的速度。
Objectives: We investigated the association between preoperative lower urinary tract symptoms (frequency, urgency, nocturia, straining, slow stream, intermittency, incomplete emptying) and continence return after radical prostatectomy (RP) and identified risk factors associated with delay return of continence after RP.
Material and Methods: The present study included 103 patients who underwent radical prostatectomy between January 2000 to December 2006 in National Taiwan Univeristy Hospital. Data of lower urinary tract symptoms were retrieved from the medical chart. In our study, continence was defined as use of no pad daily or successful control of voiding. The time from removal of urethral catheter to urinary continence achieved was determined by chart review in these patients. Continence was evaluated by a patient interview 3, 6, 9 and 12 months after RP. Using univariate, multivariate, survival analysis and proportional odds model, we retrospectively examined risk factors associated with continence return in these patients.
Results: There were no significant differences in clinicopathological characteristics between patients with and without preoperative lower urinary tract symptoms. The percentage of urinary continent patients at 3, 6, 9 and 12 months was 25.2%, 46.6%, 57.3% and 70.9%, respectively and there was a significant difference of continence return between patients with and without storage symptoms at 3 months (p = 0.007) and 6 months (p = 0.02) after RP. Presence of preoperative storage symptoms are associated with degree of continence return (p = 0.04). Frequency was significantly associated with continence return after RP (p = 0.02). Among several factors examined, presence of preoperative storage symptoms was an independent risk factor that delayed recovery from urinary incontinence 3 and 6 months after RP.
Conclusions: These findings suggest that it would be important for the prostate cancer patients with preoperative storage symptoms that a delay restoration of continence would be expected after radical prostatectomy.
口試委員會審定書…………………………I
Acknowledgement .………………...……………….. III
Abstract in Chinese.............IV
Abstract.…………………….…………...V
Chapter 1. Introduction…..………………1
Chapter 2. Literature Review……………….3
2.1 The epidemiology of incontinence after radical prostatectomy.…..3
2.2 The mechanism of continence return after radical prostatectomy…………………3
2.3 The importance of continence return in prostate cancer patients………………….4
2.4 The association between lower urinary tract symptoms (LUTS) and continence return……………….4
2.5 Measurement of LUTS…………………..5
2.6 Risk factors for delay in continence return after RP..……………………………..8
2.7 Summary………………….17
2.8 Limitation of previous studies………….17
Chapter 3. Study purpose and hypothesis……………19
3.1 Framework of the study………………..19
3.2 Purpose of the study……………………19
Chapter 4. Material and Method……….……………20
4.1 Study design and study subjects……………………….20
4.2 Definition of variables…………………………22
4.3 Outcome assessment…………………...22
4.4 Statistical analysis………………….……..23
Chapter 5. Results……………………………………….25
5.1 Demographic description and enrollment flow chart………….25
5.2 Patient characteristics…………………………………………..25
5.3 Association between LUTS and continence return………………………….…….27
5.4 Factors associated with continence return…………………………………………28
5.5 Survival analysis in patients with preoperative storage symptoms………………..30
5.6 Risk factors for surgical techniques ……………………………………..……….30
Chapter 6. Discussion……………………………….………..31
6.1 Summary of results……………………………………....31
6.2 Comparison with other studies……………...31
6.3 Clinical implications…………………………………………38
6.4 Limitation of our study……………………...40
Chapter 7. Conclusions……………….………………..43
References………………………….……………….……...44
Tables………………………………………………………54
Table 1. Patient characteristics ...………………………54
Table 2. Univariate analysis of patients with preoperative storage symptoms……..….55
Table 3. Univariate analysis of patients with preoperative obstructive symptoms…….56
Table 4. Association between preoperative lower urinary tract symptoms (LUTS) and continent return at different postoperative time points…………………………………57
Table 5. Association between preoperative frequency and continence return…………58
Table 6. Continence rate 3, 6, 9 and 12 months after radical prostatectomy (RP) ...…..59
(Definition of continence: no pad use per day or completely dry)
Table 7. Continence rate 3, 6, 9 and 12 months after RP………………………………59
(Definition of continence: one or less than pad use per day)
Table 8. Continence rate 3, 6, 9 and 12 months after RP………………………………59
(Definition of continence: no pad use per day or completely dry)
Table 9. Univariate analysis of earlier continence return and risk factors……………..60
Table 10. Univariate analysis of significant risk factors and odds ratio………….……61
Table 11. Univariate and multivariate analysis of risk factors for continence …..…….62
Table 12. Risk factors for surgical techniques………………………………………....63
Table 13. Proportional odds model for different degree of continence return…………64

Figures…………………………………………..…………65
Figure 1. Enrollment flow chart……………..……...65
Figure 2. Mean time to continence among individual LUTS..66
Figure 3. Continence rate 6 months after radical prostatectomy…67
Figure 4. Actuarial probabilities of achieving continence rate 12 months after RP……68

Appendix……………………………………….…….69
Appendix 1. Incidence of incontinence after RP…….69
Appendix 2. Measurement of LUTS………………………..70
Appendix 3. Risk factors for delay of continence return after RP.....………………….75
Appendix 4. IPSS questionnaire..………………78
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