Duljina funkcionalne uretre prije radikalne prostatektomije kao pokazatelj ranije kontinentnosti nakon operacije

doctoral thesis

• Title (english): Urethral functional profile length before radical prostatectomy as an early postoperative continence predictor
• Author: Mirko Bakula; MBZ: 81505203284
• Mentor: Tvrtko Hudolin (mentor)
• Committee member: Borislav Spajić (predsjednik povjerenstva)
• Committee member: Nikola Knežević (član povjerenstva)
• Committee member: Goran Štimac (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2022-03-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Urology
• Universal decimal classification (UDC): 616 - Pathology. Clinical medicine

Abstract

Urinarna inkontinencija (UI) jedna je od najčešćih neželjenih posljedica radikalne prostatektomije (RP). Jednim od glavnih uzroka se smatra oštećena funkcija uretralnog sfinktera, no mehanizam nastanka te oporavka urinarne kontinentnosti nije u potpunosti razjašnjen. U ovom istraživanju korištena je urodinamska metoda profilometrije za procjenu duljine funkcionalne uretre (DFU) i maksimalnog uretralnog tlaka zatvaranja (MUTZ). Cilj ovog istraživanja je odrediti odnos DFU i MUTZ te brzine oporavka kontrole mokrenja nakon otvorene retropubične RP (ORRP).
Istraživanje je provedeno u Klinici za urologiju KBC-a Zagreb na skupini od 43 bolesnika u razdoblju od 01. srpnja 2019. godine do 31. svibnja 2021. godine. Težina UI procijenjena je validiranim upitnikom ICIQ-UI SF (prema eng. International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form) i brojem uložaka korištenih u 24 sata, prije te 2, 8, 16 i 24 tjedna nakon ORRP.
Medijan vrijednosti DFU (mm) i MUTZ (cmH2O) je bio 69 (28 – 94) odnosno 76 (16 – 223). Korelacijom i linearnom regresijom je dokazana statistički značajna negativna povezanost između preoperativnih vrijednosti DFU i MUTZ te ICIQ zbroja bodova i broja uložaka u svim tjednima praćenja (p < 0,05). Takav rezultat pokazuje da bolesnici s većim preoperativnim vrijednostima DFU i MUTZ imaju veću vjerojatnost ranijeg oporavka funkcije mokrenja. Vrijednost od 65 mm za DFU i 80 cmH2O za MUTZ se pokazala kao najmanja granična vrijednost za oporavak kontinentnosti u 24 tjedna nakon RP.
Prema našim rezultatima, DFU i MUTZ su vrijedni prognostički čimbenici za rani oporavak kontinentnosti nakon ORRP. Potrebna su daljnja istraživanja na većoj skupini bolesnika kako bi se procijenila uloga profilometrije u preoperativnoj obradi bolesnika s karcinomom prostate.

Abstract (english)

Urinary incontinence (UI) is one of the most common side effects of radical prostatectomy (RP). Impaired urethral sphincter function is considered to be one of the main causes, but the mechanism of occurrence and recovery of urinary continence has not been fully elucidated. In this research, the urodynamic method of Urethral Pressure Profile (UPP) was used to estimate Functional Profile Length (FPL) and Maximal Urethral Closure Pressure (MUCP). The aim of this research was to determine the relationship of FPL and MUCP with the rate of a continence recovery after open retropubic RP (ORRP).
The research was conducted at the Department of Urology of the University Hospital Centre Zagreb on a group of 43 patients in the period from July 01st, 2019 to May 31st, 2021. The severity of UI was assessed using the fully validated International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and the number of pads used in 24 hours, before and 2, 8, 16 and 24 weeks after ORRP.
The median values of FPL (mm) and MUCP (cmH2O) were 69 (28 - 94) and 76 (16 - 223), respectively. Correlation and linear regression showed a statistically significant negative correlation between preoperative values of FPL and MUCP with ICIQ symptom score and the number of pads used per day, in the four observed time intervals (p < 0.05). Such a result shows that patients with higher preoperative FPL and MUCP values are more likely to recover urinary function earlier. A value of 65 mm for FPL and 80 cmH2O for MUCP proved to be the cut-off for a continence recovery in 24 weeks after ORRP. According to our results, FPL and MUCP are valuable prognostic factors for the early continence recovery after ORRP. Further investigation on a larger patient cohort is needed to asses the role of UPP in the preoperative management of patients with prostate cancer.

• Keywords: urinarna inkontinencija; radikalna prostatektomija; uretra; rana kontinentnost
• Keywords (english): urinary incontinence; radical prostatectomy; urethra; early continence
• Language: croatian
• URN:NBN: urn:nbn:hr:105:204491
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstvo (doktor/doktorica znanosti, područje biomedicine i zdravstvo)
• Type of resource: Text
• Extent: 87 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-29 08:47:53