肛門括約肌的長度和力量與攝護腺癌根除術後患者之早期排尿控制有相關性

謝享宸、李建儀、裘坤元

台中榮民總醫院 外科部 泌尿外科

Anal sphincter length and power are associated with early continent

after radical prostatectomy

Hsiang-Chen Hsieh, Jian-Ri Li, Kun-Yuan Chiu

Taichung Veterans General Hospital, Division of Urology, Department of Surgery, Taichung.

Purpose:

Urinary incontinence is a common complication after radical prostatectomy (RP). Loss of the prostate support and urethral incompetence were the major causes. Pelvic floor muscles play an important role in the post RP continence. Several studies showed the association of predicted value of pelvic floor muscle or urethral length. Herein we prospectively collected post-RP patients to understand the risk factor of post-RP incontinence.

Materials and Methods:

Between January 2019 and October 2020, patients who received robotic or laparoscopic RP were included in this study. The protocol was reviewed and approved by the Institute of Review Board. Patients were follow-up at post-RP 1-month, 3-month, 6 -month and 12-month at most or continence reached. At each visit, patients were asked about the continence status. The definition of continence was pad free or a safety pad daily. Patients received digital rectal examination (DRE) to measure the functional anal sphincter length by the same surgeon. Additional anal sphincter strength was measured through manometry and scaled by the modified Oxford scale (MOS). The patient basic demography and MRI pelvic floor parameters were also recorded. Variants analysis were then performed.

Results:

Total 86 patients included. The baseline were listed as table 1. The 1-month and 3-month continent rate was 46.51% and 81.4% respectively. Patients overall continent rate at 12-month was 93.02%. Variants analysis showed the longer anal sphincter length increased the 1-month and 3-month continence (OR=2.05, 95% CI=1.17-3.61, p=0.012; OR=2.84, 95% CI=1.33-6.08, p=0.007 respectively). The anal sphincter length was cut off as 3.7cm by receiver operating characteristic (ROC) curve (figure 1).

Conclusions:

Anal sphincter length by DRE could act as an predictor of post-RP continence.