Evaluation of urodynamic parameters after sling surgery in men with post-prostatectomy urinary incontinence

Specific nursing improves postoperative urine control function and the self-efficacy of patients undergoing radical prostatectomies

BACKGROUND

Radical prostatectomy is a treatment for prostate cancer (PC), but most patients suffer urinary incontinence, decreased urinary control function, and poor prognoses after the surgery. Specific nursing intervention is a nursing model based on the patients' individual conditions and disease progression.

OBJECTIVE

To investigate the effects of specific nursing intervention on the urinary control functions and self-efficacy of radical prostatectomy patients.

METHODS

From April 1, 2016 to June 30, 2019, 149 patients who underwent radical prostatectomies in our hospital were retrospectively selected for this observational study and assigned to two groups in accordance with the different nursing intervention method each patient underwent. Seventy-six patients who underwent specific nursing intervention were included in the observation group (OG), and 73 patients who underwent routine nursing intervention were included in the control group (CG). The clinical symptoms, the urodynamic indexes, the recoveries of urinary control function, the incidences of urinary incontinence, and the complications were observed in both groups. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores were used to evaluate the unhealthy emotions. The self-efficacy scale (GSES) and SF-36 were used to evaluate the self-efficacy and the quality of life (QOL), respectively.

RESULTS

After the nursing, the improvement in the clinical symptoms in the OG was significantly better than it was in CG. The improvement in the postoperative urodynamic indexes in the OG was significantly better than it was in the CG. The recovery of urinary control function in the OG was significantly higher than it was in the CG. The incidence of urinary incontinence in OG was significantly lower than it was in the CG. The incidence of complications in the OG was significantly lower than it was in the CG. The SAS and SDS scores in the OG were significantly lower than they were in the CG. After the intervention, the patients' GSES and SF-36 scores in the OG were significantly higher than they were in the CG.

CONCLUSION

Specific nursing intervention can ameliorate the urinary control functions and self-efficacy, reduce unhealthy emotions, and improve the QOL of radical prostatectomy patients.

[Urodynamic evaluation of patients cured of their post-radical prostatectomy stress urinary incontinence following transobturator male sling implantation]

INTRODUCTION

The mechanism(s) responsible(s) for continence recovery after male sling implantation for post-radical prostatectomy incontinence are imperfectly known. The goal of this study was to evaluate urodynamic parameters before and after male sling insertion, only in patients cured of their stress urinary incontinence.

PATIENTS AND METHODS

In total, 10 continent patients after transobturator male sling, with no history of urethral stenosis or pelvic radiation, were randomly selected from a database for urodynamic studies. Urodynamic parameters included urethral pressure profiles (UPP), with measurements of maximal urethral closure pressure (MUCP) and functional urethral length (FUL), and were compared with preoperative urodynamic data. Paired sampled were compared with the use of the Wilcoxon signed-rank test (StatPlus®).

RESULTS

Urodynamic studies were performed after a median time of 9months (min 4 - max 34) following sling implantation. Postoperatively, a rise of 11cm H₂O in median MUCP (P=0.09) and an increase of 14mm in median FUL (P=0.13) were observed. None of the urodynamic changes was statistically significant.

CONCLUSIONS

Following sling implantation, modifications in UPPs were observed, with increases in MUCP and FUL but these increments were not statistically significant. Limitations to our study include biases inherent to the interpretation and reproducibility of urethral profilometry, the sample size, and the variable delay between sling implantation and postoperative urodynamic studies.

LEVEL OF EVIDENCE

4.