关键词:

前列腺癌, 前列腺癌根治术, 尿道后筋膜重建, 尿控功能, 影响因素, 列线图

Abstract:

Objective　To explore the influence of reconstruction of posterior urethral fascia during radical prostatectomy (RP) on postoperative urinary control. Methods　A retrospective study was conducted. One hundred and twenty patients with prostate cancer taking reconstruction of posterior urethral fascia during RP at Yan'an Hospital of Traditional Chinese Medicine from September 2020 to September 2023 were selected as the study objects. According to the postoperative recovery of urinary control function, the patients were divided into a recovered group (97 cases) and an unrecovered group (23 cases). The baseline data and perioperative indicators were compared between the two groups by t and χ² tests. The binary logistic regression analysis was used to examine the influencing factors of urinary control function recovery after urethral posterior fascia reconstruction during RP. A nomogram model was constructed based on the regression analysis results and internally validated. Results　The length of urethral stricture in the unrecovered group was longer than that in the recovered group [(2.69±0.54) cm vs. (2.08±0.51) cm]; the distance from stenosis to bladder neck in the unrecovered group was shorter than that in the recovered group [(2.46±0.59) cm vs. (3.15±0.62) cm; the proportions of the patients who underwent laparoscopic radical prostatectomy (LRP) and had a history of transurethral prostatectomy (TURP) in the unrecovered group were higher than those in the recovered group [69.57% (16/23) vs. 28.90% (29/97) and 78.26% (18/23) vs. 37.11% (36/97)]; the proportions of the patients who retained the bladder neck and nerve and vascular bundles and underwent regular anal lifting training after surgery in the unrecovered group were lower than those in the recovered group [30.43% (7/23) vs. 62.89% (61/97), 17.39% (4/23) vs. 60.82% (59/97), and 39.13% (9/23) vs. 70.10% (68/97)]; there were statistical differences (t=5.117 and -4.801; χ²=12.482, 12.718, 7.973, 14.064, and 7.757; all P<0.05). The logistic regression analysis showed that LRP surgery method, history of TURP, and length of urethral stricture were independent risk factors affecting the recovery of urinary control function in the patients (all P<0.05); the distance from stricture to bladder neck, preservation of bladder neck, and preservation of neurovascular bundles were protective factors for postoperative recovery of urinary control function in the patients (all P<0.05). Based on the above influencing factors, a nomogram was constructed; the C-index value was 0.973, indicating good discrimination of the model. The receiver operating characteristic curve was drawn to internally validate the model, and the results showed that the area under the curve of the model in the prediction of urinary control function recovery in the patients was 0.973 (95% CI 0.941-1.000, P<0.05); the model had certain predictive value the specificity, sensitivity, and Jordan index were 0.948%, 0.913%, and 0.861%, respectively. Conclusion　Surgical methods, history of TURP, length of urethral stricture, distance from stricture to bladder neck, preservation of bladder neck, and preservation of neurovascular bundles are important influencing factors for the recovery of urinary control function in patients with prostate cancer undergoing posterior urethral fascia reconstruction during RP. Building a nomogram model based on these factors can effectively predict the recovery of urinary control function in these patients.

Key words:

Prostate cancer, Radical prostatectomy for prostate cancer, Reconstruction of posterior urethral fascia, Urinary control function,  , Influencing factors, Nomogram