Frühkontinenz nach radikaler Prostatektomie unter Berücksichtigung des Zeitpunktes der postoperativen Entfernung des transurethralen Dauerkatheters

In der vorliegenden Arbeit wurde an 139 konsekutiven Patienten, die im Jahr 2008 radikal prostatektomiert wurden, prospektiv untersucht, ob sich die verzögerte Katheterentfernung bei Anastomoseninsuffizienz nachteilig auf die Frühkontinenz auswirkt. Das mittlere Alter betrug in beiden Gruppen 65 Jah...

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Bibliographic Details
Main Author: Simonis, Kathrin
Contributors: Olbert, Peter (Dr.) (Thesis advisor)
Format: Dissertation
Language:German
Published: Philipps-Universität Marburg 2012
Medizin
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Table of Contents: The purpose of this study was to examine if early catheter removal after radical retropubic prostatectomy adversely affects urinary continence. A total of 139 consecutive patients undergoing radical retropubic prostatectomy in 2008 was evaluated. Mean patient age was 65 years. A cystogram was performed routinely on POD 5. In case of a watertight anastomosis the catheter was removed before the 7th postoperative day (group I, 69,1 %, n=96). The remaining 30,9 % (group II, n=43) showed urine extravasation. In this group the catheter was left in situ for another 8 days or longer if indicated (mean 15,2 days). Continence was examined by a standardized pad test, the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF) and the use of pads/24h preoperative, before discharge the patient from the hospital and at 3 months later. The weight of lost urine (pad-test) was reported and subdivided into 4 groups defined according to the weight of lost urine (continent: urine loss < 2 g). Besides, we investigated if age, body mass index and nerve-sparing technique have an impact on urinary continence. The results of ICIQ-SF we evaluated descriptively by histograms and median. For statistical analysis of pad test we used the Mann-Whitney U-test as non-parametric test for two independent samples. Pearson´s correlation was used to calculate the correlation between urine loss in pad test with age and body mass index. We applied the Mann-Whitney U-test to analyse if there is a statistically significant difference between the urine loss in pad test and nerve-sparing surgery. The significance level was defined as p < 0,05. In the interpretation of ICIQ-SF the group with delayed catheter removal (group II) experienced more severe incontinence before discharge home than group I. After 3 months the results in both groups were comparable: 91,2 % (group I) vs. 93,3 % (group II) had no or mild urine loss. Postoperatively 68,1 % (group I) vs. 60,6 % (group II) experienced continence in pad test or fit in the minimal incontinence category (urine loss in pad test < 9 g). At 3 months 71 % of patients in both groups showed continence. Statistically there was no significant difference. 93,1 % (group I) vs. 90,4 % (group II) experienced continence or mild incontinence (urine loss in pad test < 9 g). Postoperatively mean use of pads/24h was comparable: 3,2 (group I) vs. 3,3 (group II). In summary, in our patient cohort we could show that delayed catheter removal in patients with anastomotic urine leak may affect continence postoperatively but 3 months later the outcomes are comparable (pad test, ICIQ-SF).