腹腔鏡下前立腺全摘除術々後尿失禁についての臨床的検討 : 問診表による横断的評価を中心として

Abstract

2002年4月～2005年3月に腹腔鏡下前立腺全摘除術を行った104例(平均年齢64.6歳)中70例(67.3%)を対象に術後尿失禁実態調査の回答を得て検討した。70例中ほとんどが術後6ヵ月以内に尿失禁は消失しており, そのうち3ヵ月以内の早期消失は40.0%であった。早期消失群と3ヵ月目持続群における患者要因パラメーターでは両群間に有意差はなく9.5%例を認め, 神経温存手技は早期消失群42.8%, 3ヵ月持続群59.5%に行われた。さらに尿失禁持続群42例中36例を経過観察期間で3～11ヵ月(S群), 12ヵ月～23ヵ月(IM群), 24ヵ月以上(L群)に分類し検討した。尿失禁の誘因項目数は1症例あたりS群の平均5.0で5例全例が複数誘因を持っており, IM群は平均1.6項目で複数誘因は47.1%, L群は平均1.2項目で複数誘因は14.3%と経時的に減少した。パット使用状況における各群のパットフリー症例はS群0%, IM群29.4%, L群83.3%と術後経過に伴い増加した。腹圧性尿失禁に認められる誘引については経時的に減少したが切迫性, 反射性尿失禁に認められる誘因はS群では0%であるがIM群5.9%, L群28.6%と増加した。極少量の尿失禁であっても患者のQOLは著しく損なわれ, 医師側のそれとは必ずしも一致しておらず正確に把握することが重要と考えられた。

A cross-sectional study for certain symptoms of postoperative incontinence was done for patients who underwent laparoscopic radical prostatectomy (LRP) using our original self-administered questionnaire. A total of 104 patients, who underwent LRP from April 2002 to March 2005 in our institute and related hospitals, participated in our questionnaire study. Mean age and median observation period was 64.6 years old (range 51-74) and 18 months (range 3-36). The patients were classified into "D group" (disappearance of incontinence during 3 months after LRP) and "C group" (continuous incontinence more than 3 months). Then age, body mass index, preoperative PSA level, status of voiding, defecation and potency were compared. Patients with incontinence were divided according to observation period into "short period group" (S group; 3-11 months), "intermediate period group" (IM group; 12-23 months) and "long period group" (L group; more than 23 months). Incitant factors of incontinence, status of taking pads and QOL score were compared. There were no differences between the D and C groups at any measurements. About 40% of incontinence patients were pad-free, although most of these patients did not satisfy the status of voiding. The incitant factor in 90% of the S group was "cough or sneeze", but that in the L group was "without notice" (about 40%) and "too late to toilet (voiding)" (about 25%). After all, postoperative QOL score was still lower in the patients with incontinence regardless of its volume. Further study to revolutionary improve incontinence is required.