期刊
EUROPEAN UROLOGY FOCUS
卷 8, 期 3, 页码 674-689出版社
ELSEVIER
DOI: 10.1016/j.euf.2021.04.020
关键词
Systematic review; Evidence synthesis; Prostate cancer; Urinary incontinence; Prognostic factors; Patient-related factors; Tumour-related factors
资金
- Janssen
- IPSEN
- European Association of Urology
- Bayer
- Astellas
- Cancer Australia
- Cancer Research UK
- Medical Research Council
- National Institute of Health
- Pierre Fabre Oncologie
- Amgen
- AstraZeneca
- Bristol-Myers Squibb
- Celgene
- Dendreon
- Ferring
- GSK
- Incyte
- Janssen Cilag
- Merck
- MSD
- Novartis
- Pfizer
- Roche
- Sanofi Aventis
- SeaGen
- Shionogi
- Synthon
- Takeda
- Teva/OncoGenex
- Sanofi
This study systematically reviewed patient- and tumor-related prognostic factors for post-radical prostatectomy urinary incontinence (UI). The results showed that increasing age, shorter length of the membranous urethra, greater prostate volume, and higher Charlson comorbidity index were independent prognostic factors for UI within 3 months after radical prostatectomy. These factors remained predictive at 3-12 months post-surgery.
Context: While urinary incontinence (UI) commonly occurs after radical prostatectomy (RP), it is unclear what factors increase the risk of UI development.Objective: To perform a systematic review of patient-and tumour-related prognostic factors for post-RP UI. The primary outcome was UI within 3 mo after RP. Secondary outcomes included UI at 3-12 mo and >12 mo after RP.Evidence acquisition: Databases including Medline, EMBASE, and CENTRAL were searched between January 1990 and May 2020. All studies reporting patient-and tumour-related prognostic factors in univariable or multivariable analyses were included. Surgical factors were excluded. Risk of bias (RoB) and confounding assess-ments were performed using the Quality In Prognosis Studies (QUIPS) tool. Random -effects meta-analyses were performed for all prognostic factor, where possible. Evidence synthesis: A total of 119 studies (5 randomised controlled trials, 24 prospective, 88 retrospective, and 2 case-control studies) with 131 379 patients were included. RoB was high for study participation and confounding; moderate to high for statistical analysis, study attrition, and prognostic factor measurement; and low for outcome measurements. Significant prognostic factors for postoperative UI within 3 mo after RP were age (odds ratio [OR] per yearly increase 1.04, 95% confidence interval [CI] 1.03- 1.05), membranous urethral length (MUL; OR per 1-mm increase 0.81, 95% CI 0.74-0.88), prostate volume (PV; OR per 1-ml increase 1.005, 95% CI 1.000-1.011), and Charlson comorbidity index (CCI; OR 1.28, 95% CI 1.09-1.50).Conclusions: Increasing age, shorter MUL, greater PV, and higher CCI are independent prognostic factors for UI within 3 mo after RP, with all except CCI remaining prognostic at 3-12 mo. Patient summary: We reviewed the literature to identify patient and disease factors associated with urinary incontinence after surgery for prostate cancer. We found increasing age, larger prostate volume, shorter length of a section of the urethra (membranous urethra), and lower fitness were associated with worse urinary inconti-nence for the first 3 mo after surgery, with all except lower fitness remaining predictive at 3-12 mo. (c) 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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