前列腺癌患者根治术后尿失禁危险因素的meta分析

张浩永; 许方蕾

doi:10.13201/j.issn.1001-1420.2024.08.012

前列腺癌患者根治术后尿失禁危险因素的meta分析

张浩永¹,
许方蕾^2, ,

- 1.
  同济大学医学院(上海，200092)
- 2.
  同济大学附属同济医院护理部
基金项目:
上海市普陀区卫生健康系统护理课题重点项目(No：2023PTHL01)；上海申康医院发展中心临床科技创新项目(No：SHDC12021604)

详细信息

通讯作者: 许方蕾，E-mail：13501792610@163.com

中图分类号: R737.25

收稿日期: 2023-07-11

修回日期: 2024-07-01

刊出日期: 2024-08-06

Meta-analysis of risk factors in urinary incontinence for patients with prostate cancer after radical surgery

ZHANG Haoyong¹,
XU Fanglei^2, ,

- 1.
  School of Medicine, Tongji University, Shanghai, 200092, China
- 2.
  Nursing Department, Affiliated Tongji Hospital of Tongji University

More Information

Corresponding author: XU Fanglei, E-mail: 13501792610@163.com

Received Date: 11 July 2023

Revised Date: 01 July 2024

Publish Date: 06 August 2024

摘要

摘要: 目的系统评价前列腺癌患者根治术后尿失禁的危险因素。方法系统检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普、万方、中国生物医学文献数据库中有关前列腺癌根治术后尿失禁的危险因素的研究，检索时限为建库至2023年4月。2名研究员使用Endnote 20独立进行文献筛选、数据提取、质量评价后使用Stata 12.0和R 4.3.2进行统计分析。结果最终纳入17篇文献，结果显示：年龄(OR=1.03，95%CI：1.02~1.05，P＜0.01)、前列腺体积(OR=1.01，95%CI：1.00~1.02，P＜0.05)、病理分期>T3a(OR=2.69，95%CI：1.88~3.83，P＜0.01)、前列腺手术史(OR=2.81，95%CI：1.93~4.10，P＜0.01)、国际前列腺症状评分(OR=1.03，95%CI：1.02~1.05，P＜0.01)、术前尿失禁(OR=2.86，95%CI：1.95~4.20，P＜0.01)、膀胱功能失代偿(OR=5.09，95%CI：1.10~23.58，P＜0.05)是前列腺癌患者根治术后发生尿失禁的危险因素，术前膜尿道长度(OR=0.74，95%CI：0.58~0.95，P＜0.05)、保留神经(OR=0.45，95%CI：0.27~0.75，P＜0.01)、保留膀胱颈(OR=0.33，95%CI：0.23~0.48，P＜0.01)是前列腺癌患者根治术后发生尿失禁的保护因素。结论前列腺癌根治术后患者发生尿失禁与患者自身情况、病理相关因素及手术相关因素有关，临床应早期识别高危人群并及时采取干预措施，从而改善患者的预后。
- 前列腺癌根治术 /
- 尿失禁 /
- 危险因素 /
- meta分析
Abstract: Objective To systematically evaluate the risk factors in urinary incontinence for prostate cancer patients after radical surgery.Methods PubMed, Cochrane Library, Web of Science, Embase, CNKI, VIP, Wanfang and China Biology Medicine Disc were systematically searched for studies on the factors associated with urinary incontinence in patients who have undergone radical prostatectomy. The search period was from establishment to April 2023. Literature screening, data extraction, and quality evaluation were performed independently by 2 researchers using Endnote 20 followed by statistical analysis using Stata 12.0 and R 4.3. 2.Results A total of 17 articles were included. Age(OR=1.03, 95%CI: 1.02-1.05, P<0.01), prostate volume(OR=1.01, 95%CI: 1.00-1.02, P<0.05), pathological staging >T3a(OR=2.69, 95%CI: 1.88-3.83, P<0.05), prostate surgery history(OR=2.81, 95%CI: 1.93-4.10, P<0.01), IPSS(OR=1.03, 95%CI: 1.02-1.05, P<0.01), preoperative urinary incontinence(OR=2.86, 95%CI: 1.95-4.20, P<0.01), bladder decompensation(OR=5.09, 95%CI: 1.10-23.58, P<0.05) served as the risk factors in urinary incontinence for patients following radical prostatectomy. Preoperative membranous urethra length(OR=0.74, 95%CI: 0.58-0.95, P<0.05), nerve preservation(OR=0.45, 95%CI: 0.27-0.75, P<0.01), bladder neck preservation(OR=0.33, 95%CI: 0.23-0.48, P<0.01) served as the protective factors in urinary incontinence for patients following radical prostatectomy.Conclusion Urinary incontinence in patients after radical prostatectomy is related to the patient's own condition, pathology-related factors and surgery-related factors.Clinicians should early identify the high-risk patients and take timely measures to improve the patient's prognosis.
- radical prostatectomy /
- urinary incontinence /
- risk factors /
- meta-analysis

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图 1 文献筛选流程图

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图 2 前列腺区域解剖图像

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图 3 前列腺癌患者根治术后尿失禁各因素meta分析的森林图

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表 1 纳入研究的基本特征及质量评价结果

作者	年份	国家	研究类型	样本量/例	危险因素	质量评价/分
陈路等^[9]	2022	中国	队列研究	200	④⑪	7
黄俊等^[10]	2022	中国	病例对照	102	④⑤⑩⑪	6
高雪松等^[11]	2021	中国	队列研究	37	④⑦⑨	7
高瞻^[12]	2021	中国	队列研究	110	③	8
王婷等^[13]	2020	中国	病例对照	125	①⑨⑬	7
刘爽等^[14]	2020	中国	队列研究	100	⑫⑬	5
Zhang等^[15]	2023	中国	队列研究	170	⑤⑦	6
Kim^[16]	2022	韩国	队列研究	118	①④⑥⑧	6
Lamberg等^[17]	2022	美国	队列研究	586	①②⑤⑥⑧	6
Reichert等^[18]	2022	德国	队列研究	109	③	6
De Nunzio等^[19]	2019	意大利	队列研究	4603	①③⑩	7
Kitamura等^[20]	2019	日本	队列研究	320	①②⑤⑥	6
Sugi等^[21]	2018	日本	队列研究	187	③	7
Satake等^[22]	2018	日本	队列研究	113	①⑥⑫	7
Skeldon等^[23]	2014	加拿大	队列研究	61	③⑥	6
Peterson等^[24]	2012	美国	队列研究	4374	①③	7
Novara等^[25]	2010	意大利	队列研究	304	①	7
注：①年龄；②BMI；③保留神经；④保留膀胱颈；⑤术前MUL；⑥前列腺体积；⑦病理分期；⑧前列腺特异性抗原(prostate-specific antigen，PSA)；⑨前列腺手术史；⑩国际前列腺症状评分(international prostate symptom score，IPSS)；⑪术前尿路感染；⑫术前尿失禁；⑬膀胱功能失代偿。

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