リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

リケラボ 全国の大学リポジトリにある学位論文・教授論文を一括検索するならリケラボ論文検索大学・研究所にある論文を検索できる

大学・研究所にある論文を検索できる 「最小膜様部尿道長と膜様部尿道長が前立腺全摘術後の尿禁制獲得に与える影響についての研究」の論文概要。リケラボ論文検索は、全国の大学リポジトリにある学位論文・教授論文を一括検索できる論文検索サービスです。
リケラボ

コピーが完了しました

URLをコピーしました

論文の公開元へ論文の公開元へ
書き出し

最小膜様部尿道長と膜様部尿道長が前立腺全摘術後の尿禁制獲得に与える影響についての研究

大原 英一郎 東北大学

2022.03.25

概要

【背景】
限局性前立腺癌に対する標準治療として前立腺全摘除術が行われる。癌制御と同時に尿禁制や勃起機能に代表される機能的結果も重要であり、特に術後尿失禁 (Post-prostatectomy urinary incontinence: PUI) は長期に渡り患者の Quality Of Life (QOL) を低下させることから PUI のリスク因子の解明が望まれているが、未だ明らかではない。PUI の要因は、手術による尿禁制機構の損傷によるものと術前患者リスク因子によるものに分けられる。本研究では、ロボット支援下前立腺全摘除術（Robot-assisted Radical Prostatectomy: RARP）と開腹前立腺全摘除術（Open Radical Prostatectomy: ORP）症例において、尿道機能を反映する尿道長に着目し、最小膜様部尿道長（minimal residual membranous urethral length: mRUL）と膜様部尿道長（membranous urethral length: MUL）を測定し、PUI と尿禁制回復に与える影響について研究を行った。

【目的】
本研究の目的は、前立腺癌に対する前立腺全摘術後の尿失禁のリスク因子を解析することにより、術前の重症度分類を尿道機能に着目し構築することである。

【方法】
対象は、2007 年 8 月から 2016 年 2 月まで、東北大学病院で前立腺全摘出術が施行された ORP 121 例、RARP 213 例のうち、術前に骨盤磁気共鳴画像検査（Magnetic Resonance imaging: MRI）が施行され Expanded Prostate Cancer Index Composite (EPIC)が回収可能であった、ORP 群 110 名と RARP 群 190 名である。

全ての症例で術前に前立腺癌評価目的の MRI が施行され、限局性前立腺癌患者の QOL を測定する質問票である EPIC の記入を術前、術後 1 ヶ月、術後 3 ヶ月、術後 6ヶ月、術後 12 ヶ月に行い回収した。パラメーターである、mRUL と MUL は MRI を用いて測定し、年齢、body mass index (BMI)、陰茎海綿体神経温存の有無も含めて検討を行った。

【結果】
mRUL と MUL の中央値は、RARP 群で 7.81mm と 14.27mm であった。一方、ORP群では 7.15mm と 13.57mm であった。RARP 群と ORP 群の前立腺全摘術術後の尿禁制獲得率は同様の傾向を示した。多変量解析の結果、mRUL は術前尿禁制の予測因子であり、短い MUL は術後の尿失禁が遷延する高リスク群であった。RARP 群と ORP 群いずれにおいても、mRUL と MUL が共に短い群は長い群と比較し有意に尿禁制回復率が悪い傾向を示した。

【結論】
mRUL は基礎的な尿禁制を反映し、MUL は術後尿禁制獲得の予測因子であった。術前 MRI を用いて測定した mRUL と MUL を組み合わせる事で、術後尿失禁の重症度を予測し得る。

論文の公開元へ

この論文で使われている画像

関連論文

関連論文をもっと見る

参考文献

1. 国立がん研究センターがん情報サービス「がん登録・統計」2021 人口動態統計. http://ganjoho.jp/public/cancer/prostate/about.html : accessed on January 15, 2022.

2. Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370:932-942.

3. Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med. 2012;367:203-213.

4. Gershman B, Van Houten HK, Herrin J, et al. Impact of prostate-specific antigen (PSA) screening trials and revised PSA screening guidelines on rates of prostate biopsy and postbiopsy complications. Eur Urol. 2017;71:55-65.

5. D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. Jama. 1998;280:969-974.

6. Mitsuzuka K, Narita S, Koie T, et al. Pathological and biochemical outcomes after radical prostatectomy in men with low-risk prostate cancer meeting the Prostate Cancer International: Active surveillance criteria. BJU International. 2013;111:914-920.

7. Iremashvili V, Pelaez L, Manoharan M, et al. Pathologic prostate cancer characteristics in patients eligible for active surveillance: a head-to-head comparison of contemporary protocols. Eur Urol. 2012;62:462-468.

8. Hashimoto T, Yoshioka K, Nagao G, et al. Prediction of biochemical recurrence after robot-assisted radical prostatectomy: Analysis of 784 Japanese patients. Int J Urol. 2015;22:188-193.

9. Abdollah F, Sood A, Sammon JD, et al. Long-term cancer control outcomes in patients with clinically high-risk prostate cancer treated with robot-assisted radical prostatectomy: results from a multi-institutional study of 1100 patients. Eur Urol. 2015;68:497-505.

10. Bach C, Pisipati S, Daneshwar D, et al. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol. 2014;11:342-351.

11. Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62:405-417.

12. Yaxley JW, Coughlin GD, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388:1057-1066.

13. Haglind E, Carlsson S, Stranne J, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: A prospective, controlled, nonrandomised trial. Eur Urol. 2015;68:216-225.

14. Arai Y, Kaiho Y, Takei M, et al. Burden of male stress urinary incontinence: a survey among urologists in Japan. Int J Urol. 2009;16:915-917.

15. Arroyo C, Martini A, Wang J, et al. Anatomical, surgical and technical factors influencing continence after radical prostatectomy. Ther Adv Urol. 2019;11:1756287218813787.

16. Sayyid RK, Simpson WG, Lu C, et al. Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: A safe surgical technique with superior continence outcomes. J Endourol. 2017;31:1244-1250.

17. Lee DS, Lee SJ. Urodynamic evaluation of patients with localized prostate cancer before and 4 months after robotic radical prostatectomy. Sci Rep. 2021;11:3632.

18. Chang JI, Lam V, Patel MI. Preoperative pelvic floor muscle exercise and postprostatectomy incontinence: A systematic review and meta-analysis. Eur Urol. 2016;69:460-467.

19. Novara G, Ficarra V, D'Elia C, et al. Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol. 2010;184:1028-1033.

20. Reeves F, Everaerts W, Murphy DG, et al. Stimulation of the neurovascular bundle results in rhabdosphincter contraction in a proportion of men undergoing radical prostatectomy. Urology. 2016;87:133-139.

21. Mungovan SF, Sandhu JS, Akin O, et al. Preoperative membranous urethral length measurement and continence recovery following radical prostatectomy: A systematic review and meta-analysis. Eur Urol. 2017;71:368-378.

22. Satake Y, Kaiho Y, Saito H, et al. Estimated minimal residual membranous urethral length on preoperative magnetic resonance imaging can be a new predictor for continence after radical prostatectomy. Urology. 2018;112:138- 144.

23. Rocco B, Cozzi G, Spinelli MG, et al. Posterior musculofascial reconstruction after radical prostatectomy: a systematic review of the literature. Eur Urol. 2012;62:779-790.

24. Wallerstedt A, Nyberg T, Carlsson S, et al. Quality of life after open radical prostatectomy compared with robot-assisted radical prostatectomy. Eur Urol Focus. 2019;5:389-398.

25. Ferrer M, Suárez JF, Guedea F, et al. Health-related quality of life 2 years after treatment with radical prostatectomy, prostate brachytherapy, or external beam radiotherapy in patients with clinically localized prostate cancer. Int. J. Radiat. Oncol. Biol. Phys. 2008;72:421-432.

26. 本間之夫, 柿崎秀宏, 後藤百万, 他；排尿に関する疫学的研究委員会. 排尿に関する疫学的研究. 日排尿機能会誌 14: 266-277, 2003

27. Milsom I, Irwin DE. A cross-sectional, population-based, multinational study of the prevalence of overactive bladder and lower urinary tract symptoms: results from the EPIC study. Eur Urol Suppl. 2007;6:4-9.

28. Berardelli M, De Rango F, Morelli M, et al. Urinary incontinence in the elderly and in the oldest old: correlation with frailty and mortality. Rejuvenation Res. 2013;16:206-211.

29. Matsushita T, Nishioka S, Taguchi S, et al. Effect of improvement in sarcopenia on functional and discharge outcomes in stroke rehabilitation patients. Nutrients. 2021;13.

30. Kadono Y, Ueno S, Yaegashi H, et al. Urodynamic evaluation before and immediately after robot-assisted radical prostatectomy. Urology. 2014;84:106- 111.

31. Chai TC, Huang L, Kenton K, et al. Association of baseline urodynamic measures of urethral function with clinical, demographic, and other urodynamic variables in women prior to undergoing midurethral sling surgery. Neurourol Urodyn. 2012;31:496-501.

32. Dubbelman YD, Bosch JL. Urethral sphincter function before and after radical prostatectomy: Systematic review of the prognostic value of various assessment techniques. Neurourol Urodyn. 2013;32:957-963.

33. Strączyńska A, Weber-Rajek M, Strojek K, et al. The impact of pelvic floor muscle training on urinary incontinence in men after radical prostatectomy (RP) - A systematic review. Clin Interv Aging. 2019;14:1997-2005.

34. Gilpin SA, Gosling JA, Smith AR, et al. The pathogenesis of genitourinary prolapse and stress incontinence of urine. A histological and histochemical study. Br J Obstet Gynaecol. 1989;96:15-23.

35. Centemero A, Rigatti L, Giraudo D, et al. Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study. Eur Urol. 2010;57:1039-1043.

36. MacDonald AJ, Greig CA, Baracos V. The advantages and limitations of cross-sectional body composition analysis. Curr Opin Support Palliative Care. 2011;5:342-349.

37. Paparel P, Akin O, Sandhu JS, et al. Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol. 2009;55:629-637.

38. Grivas N, van der Roest R, Tillier C, et al. Patterns of benign prostate hyperplasia based on magnetic resonance imaging are correlated with lower urinary tract symptoms and continence in men undergoing a robot-assisted radical prostatectomy for prostate cancer. Urology. 2017;107:196-201.

39. Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol. 2012;62:431-452.

40. O'Neil B, Koyama T, Alvarez J, et al. The comparative harms of open and robotic prostatectomy in population based samples. J Urol. 2016;195:321-329.

41. Song W, Kim CK, Park BK, et al. Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy. Can Urol Assoc J. 2017;11:E93-E99.

42. Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol. 2005;173:1701-1705.

43. Wei Y, Wu YP, Lin MY, et al. Impact of obesity on long-term urinary incontinence after radical prostatectomy: A meta-analysis. Biomed Res Int. 2018;2018:8279523.

44. Reeves F, Preece P, Kapoor J, et al. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta- analysis. Eur Urol. 2015;68:692-704.

45. Hoyland K, Vasdev N, A brof A, et al. Post-radical prostatectomy incontinence: etiology and prevention. Rev Urol. 2014;16:181-188.

46. NCCN Guideline, Prostate Cancer Version 3. https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf : accessed on January 15, 2022.

47. Ikarashi D, Kato Y, Kanehira M, et al. Appropriate preoperative membranous urethral length predicts recovery of urinary continence after robot-assisted laparoscopic prostatectomy. World J Surg Oncol. 2018;16:224.

参考文献をもっと見る

全国の大学の
卒論・修論・学位論文
を
一発検索！

この論文の関連論文を見る