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Belastungsinkontinenz nach Prostatektomie in der Versorgungswirklichkeit

Ergebnisse einer Reha-Klinik

Stress incontinence after prostatectomy in treatment reality

Results from a rehabilitation clinic

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Zusammenfassung

Hintergrund

In der aktuellen Diskussion über die operative Therapie beim Prostatakarzinom spielt nicht nur das Ob, sondern auch das Wie eine große Rolle. Beide Fragestellungen hängen insofern eng zusammen, als z. B. eine mögliche Übertherapie durch eine Belastungsinkontinenz zusätzliche beschwert wird. Bei der häufigsten, lästigsten und teuersten Konsequenz einer Prostatektomie interessiert daher, welche Faktoren in der Versorgungswirklichkeit hierzu beitragen und möglicherweise zu vermeiden sind.

Patienten und Methode

Ausgewertet wurden die Krankenakten aller Patienten, die im Jahre 2009 in der Klinik am Kurpark in Bad Wildungen-Reinhardshausen nach einer radikalen Prostatektomie eine Anschlussheilbehandlung (AHB) erhielten nach den relevanten Ausgangs- und Endpunktdaten.

Ergebnisse

Von den 1750 Patienten waren bei der Aufnahme und bei der Entlassung 405 (23,1 %) kontinent. Weitere 189 (10,8 %) wurden es bis zur Entlassung. Insgesamt wurden 594 (33,9 %) Patienten kontinent entlassen. Von den 1155 (66,0 %) Patienten, die bei der Aufnahme und bei der Entlassung inkontinent waren, blieb dies während der AHB bei 727 (62,9 %) am Tage und bei 659 (57,1 %) in der Nacht gleich. Bei 387 (33,5 %) Betroffenen nahm die Inkontinenz am Tage und bei 370 (32,0 %) in der Nacht ab, bei 34 (3,4 %) nahm die Inkontinenz am Tage und bei 45 (3,9 %) in der Nacht zu. Ein Lebensalter von < 60 Jahren wirkte sich auf den Kontinenzerhalt vorteilhaft, eines von > 70 Jahren dagegen nachteilig aus. Ein Nervenerhalt förderte den Kontinenzerhalt signifikant. Ein statistisch signifikanter Unterschied zwischen den Ergebnissen der Operationsverfahren bestand nicht. Auch zwischen den Ergebnissen der Klinikarten [kommunale, konfessionelle, private Kliniken (KKPK), universitäre Kliniken (UK)] war ein statistisch signifikanter Unterschied nicht festzustellen. Allerdings war das Ergebnis eines Kontinenzerhalts (bis zum Abschluss der Reha-Behandlung) bei 594 (33,9 %) der Patienten nur von 94 (51,4 %) aller 183 Kliniken erzielt worden und zwar von 78 (49,7 %) der KKPK und von 14 (53,9 %) der UK. Von den zertifizierten Prostatazentren der KKPK bzw. der UK waren es 17 (81,0 %) bzw. 5 (83,3 %).

Schlussfolgerungen

In der Versorgungswirklichkeit einer AHB-Klinik wird bei etwa einem Drittel (33,9 %) aller Patienten nach einer Prostatektomie bis zur Entlassung ein Kontinenzerhalt erreicht. Ein Lebensalter < 60 Jahren wirkt sich hierbei als vorteilhaft, ein Lebensalter > 70 Jahren als nachteilig aus. Ein beid-/einseitiger Nervenerhalt verbesserte den Kontinenzerhalt signifikant. Das Operationsverfahren oder die Klinikart beeinflussen die Ergebnisse dagegen nicht signifikant. Allerdings wird der Kontinenzerhalt bei etwa einem Drittel (33,9 %) aller Patienten nur von etwa der Hälfte (51,4 %) aller Kliniken erzielt. Dies beweist, dass eine Belastungsinkontinenz nach einer Prostatektomie in der Versorgungswirklichkeit vermeidbar unterentwickelt und durch geeignete Operationstechniken der Sphinkterschonung nachweislich steigerungsfähig ist.

Abstract

Background

In the current discussion on the operative therapy of prostate cancer, not only“if” but also“how” play a major role. Both questions are closely related as, e.g. a possible excessive therapy will result in additional suffering due to stress incontinence. For the most common, troublesome and expensive consequences of prostatectomy it is of interest to know which factors play a role in treatment reality and which could possibly be avoided.

Patients and methods

The hospital records of all patients who underwent follow-up treatment after prostatectomy in 2009 at the clinic in the spa park in Bad Wildungen-Reinhardshausen were evaluated with respect to relevant data on outcome and clinical endpoints.

Results

Of the 1,750 patients 405 (23.1 %) were continent on admission and discharge and a further 189 (10.8 %) were continent on discharge so that a total of 594 patients (33.9 %) were continent on discharge. Of the 1,155 patients (66.0 %) who were incontinent on admission and discharge, this remained the same during the rehabilitation period for 727 (62.9 %) who were diurnally incontinent and 659 (57.1 %) who were nocturnally incontinent. For 387 patients (33.5 %) the incontinence decreased during the day and for 370 (32.0 %) during the night, for 34 (3.4 %) the incontinence increased during the day and for 45 (3.9 %) during the night. An age < 60 years was advantageous for maintaining continence and in contrast > 70 years was disadvantageous. Retention of nerves showed a significant effect on maintaining continence. Statistically significant differences between the results of operative procedures and the results of the type of clinic (KKP communal, confessional and private or UK university clinic) were not observed. However, the results of maintaining continence (up to termination of rehabilitation treatment) for the 594 patients (33.9 %) was only achieved by 94 (51 %) of all 183 clinics, i.e. 78 (49.7 %) of the KKP clinics and 14 (53.9 %) of UK clinics. For the certified prostate centers of KKP and UK clinics this amounted to 17 (81 %) and 5 (83.3 %), respectively.

Conclusions

In treatment reality of follow-up treatment of patients after prostatectomy in rehabilitation clinics approximately one third (33.9 %) achieved retention of continence up to discharge. An age < 60 years was advantageous and > 70 years disadvantageous. Bilateral and unilateral retention of nerves significantly improved retention of continence. The operative procedure and type of clinic did not significantly affect the results. However, in approximately one third of patients (33.9 %) retention of continence was achieved by only approximately one half (51.4 %) of all clinics. This shows that in treatment reality, stress incontinence following prostatectomy is avoidably underdeveloped and can be demonstrably increased by suitable operative techniques for sphincter protection.

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Authors and Affiliations

  1. Bergstraße 19, 53498, Bad Breisig, Deutschland

    V. Lent

  2. Klinik am Kurpark, Urologisches Zentrum für Anschlussheilbehandlung Bad Wildungen-Reinhardshausen, Bad Wildungen-Reinhardshausen, Deutschland

    H.M. Schultheis, L. Strauß & S. Buntrock

  3. Klinik und Poliklinik für Urologie, Universität Bonn, Bonn, Deutschland

    M.K. Laaser

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  1. V. Lent
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  2. H.M. Schultheis
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Lent, V., Schultheis, H., Strauß, L. et al. Belastungsinkontinenz nach Prostatektomie in der Versorgungswirklichkeit. Urologe 52, 1104–1109 (2013). https://doi.org/10.1007/s00120-013-3201-x

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