原位新膀胱术后患者尿失禁发展轨迹及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.02.012

摘要/Abstract

摘要：

目的探讨膀胱癌患者行原位新膀胱术后尿失禁现状及发展轨迹，分析不同发展轨迹类别的特征差异，为实施针对性干预提供依据。方法采用便利抽样法，选取南京市某三级甲等医院泌尿外科2019年1月—2022年8月就诊的142例原位新膀胱术后患者作为调查对象，收集患者的人口学资料和临床资料。使用国际尿失禁咨询委员会尿失禁问卷调查患者术后1个月、3个月、6个月、1年的尿失禁情况，并收集患者术后体力状况评分、盆底肌训练和定时排尿情况。利用组基轨迹模型分析尿失禁发展轨迹类别，采用Logistic回归分析尿失禁发展轨迹的影响因素。结果最终纳入142例患者，日间和夜间尿失禁分别呈现出明显改善组（21.83%、29.58%）、缓慢缓解组（52.82%、48.59%）和风险波动组（25.35%、21.83%）3类发展轨迹。Logistic回归分析显示，年龄、是否保留性神经、是否坚持定时排尿是原位新膀胱术后患者尿失禁发展轨迹的影响因素（P<0.05）。结论原位新膀胱术后1年内患者尿失禁的发展轨迹总体呈改善趋势，群体间存在差异性，临床应重视高龄、未保留性神经、未坚持定时排尿患者的术后尿失禁动态评估，并制订针对性的术后康复方案，以改善患者的控尿水平。

关键词: 膀胱癌, 原位新膀胱术, 尿失禁, 发展轨迹, 影响因素分析, 护理

Abstract:

Objective To explore the status and trajectory of urinary incontinence in patients with bladder cancer after orthotopic neobladder surgery，and analyze the characteristics of different trajectory categories，to provide references for the intervention and management of urinary incontinence in patients after orthotopic neobladder surgery. Methods A prospective study design was adopted，and the convenience sampling was used to select 142 eligible patients who underwent in orthotopic neobladder surgery in a tertiary hospital from January 2019 to August 2022. Demographic and clinical data of the patients were collected. The continence status of patients was evaluated by the International Consultation on Incontinence Questionnaire-Short Form（ICI-Q-SF） at 1 month after surgery，3 months after surgery，6 months after surgery and 1 year after surgery. Additionally，postoperative physical condition scores，pelvic floor muscle training，and timed urination information were collected. The Group-Based Trajectory Model was used to identify the development trajectory of urinary incontinence，and the logistic regression was conducted to identify influencing factors of urinary incontinence trajectories. Results 142 cases were included. There are 3 distinct daytime and nocturnal incontinence trajectory groups that were respectively identified：the significantly improved group（21.83%，29.58%），the slowly alleviated group（52.82%，48.59%），and the risk fluctuation group（25.35%，21.83%）. Multivariate logistic regression analysis indicated that age，preservation of neurovascular bundles，and adherence to timed voiding were factors significantly influencing urinary incontinence trajectory categories（P<0.05）. Conclusion The trajectory of urinary incontinence in patients undergoing orthotopic neobladder surgery showed an overall improvement trend within a year，with group differences. Clinical attention should be paid to the dynamic evaluation of postoperative urinary incontinence in older，unreserved nerves，and those who did not adhere to scheduled urination，and a phased matching postoperative rehabilitation plan should be developed to improve the urinary control level of patients.

Key words: Bladder Cancer, Orthotopic Neobladder Surgery, Urinary Incontinence, Trajectory, Root Cause Analysis, Nursing Care

丁佳蓉, 陈慧, 王雪瑞, 孙小玲, 张银. 原位新膀胱术后患者尿失禁发展轨迹及影响因素研究[J]. 中华护理杂志, 2025, 60(2): 208-214.

DING Jiarong, CHEN Hui, WANG Xuerui, SUN Xiaoling, ZHANG Yin. Study on the trajectory and influencing factors of urinary incontinence in patients after orthotopic neobladder surgery[J]. Chinese Journal of Nursing, 2025, 60(2): 208-214.

图/表 4

表1 原位新膀胱术后患者尿失禁ICIQ-SF得分潜类别增长模型拟合结果（n=142）

Table 1 Results of the latent category growth model for urinary incontinence ICIQ-SF scores in patients after orthotopic neobladder surgery（n=142）

图1 原位新膀胱术后患者中文版国际尿失禁咨询委员会尿失禁问卷得分日间、夜间不同潜类别发展轨迹图

Figure 1 Different latent classes of ICIQ-SF scores （daytime and nighttime） trajectories in patients after orthotopic neobladder surgery

表2 原位新膀胱术后患者尿失禁发展轨迹类别的单因素分析结果（n=142）

Table 2 Results of univariate analysis on the developmental trajectories of urinary incontinence in patients after orthotopic neobladder surgery（n=142）

表3 原位新膀胱术后患者尿失禁发展轨迹类别的Logistic回归分析结果（n=142）

Table 3 Results of multivariate logistic regression analysis of the classes of urinary incontinence development trajectory in patients after orthotopic neobladder surgery（n=142）

参考文献 20

[1]	Witjes JA, Bruins HM, Carrión A, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer:summary of the 2023 guidelines[J]. Eur Urol, 2024, 85(1):17-31.
[2]	Grimm T, Grimm J, Buchner A, et al. Health-related quality of life after radical cystectomy and ileal orthotopic neobladder:effect of detailed continence outcomes[J]. World J Urol, 2019, 37(11):2385-2392.
[3]	Kim SH, Ryu E, Kim EJ. A narrative inquiry into the adjustment experiences of male bladder cancer survivors with a neobladder[J]. Int J Environ Res Public Health, 2020, 17(21):8260.
[4]	Hautmann RE, Volkmer B, Egghart G, et al. Functional outcome and complications following ileal neobladder reconstruction in male patients without tumor recurrence. More than 35 years of experience from a single center[J]. J Urol, 2021, 205(1):174-182.
[5]	Erdogan B, Berg S, Noldus J, et al. Early continence after ileal neobladder:objective data from inpatient rehabilitation[J]. World J Urol, 2021, 39(7):2531-2536. DOI PMID
[6]	Miura H, Hatakeyama S, Tanaka T, et al. Oncological and functional outcomes of female reproductive organ-sparing radical cystectomy and ileal neobladder construction[J]. Urol Oncol, 2023, 41(5):254.e17-254.e24.
[7]	Yang JM, Ye H, Long Y, et al. Effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy:an umbrella review of meta-analysis and systematic review[J]. Clin Rehabil, 2023, 37(4):494-515.
[8]	蒋知俭. 统计分析在医学课题中的应用[M]. 北京: 人民卫生出版社, 2008.
	Jiang ZJ. Statistical analysis in medical research projects[M]. Beijing: People’s Medical Publishing House, 2008.
[9]	Furrer MA, Studer UE, Gross T, et al. Nerve-sparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution,which becomes even more apparent over time[J]. BJU Int, 2018, 121(6):935-944. DOI PMID
[10]	Kretschmer A, Grimm T, Buchner A, et al. Prognostic features for objectively defined urinary continence after radical cystectomy and ileal orthotopic neobladder in a contemporary cohort[J]. J Urol, 2017, 197(1):210-215. DOI PMID
[11]	顾婕, 马倩云, 高旭, 等. 前列腺癌术后尿失禁患者康复护理方案的构建及应用[J]. 中华护理杂志, 2023, 58(9):1029-1036. DOI URL
	Gu J, Ma QY, Gao X, et al. Construction and application of a rehabilitation management programme for urinary incontinence after prostate cancer surgery[J]. Chin J Nurs, 2023, 58(9):1029-1036. DOI URL
[12]	Kelly CM, Shahrokni A. Moving beyond karnofsky and ECOG performance status assessments with new technologies[J]. J On-col, 2016, 2016:6186543.
[13]	杨成才. 原位新膀胱术后患者尿失禁危险因素研究及预测模型的建立与验证[D]. 昆明: 昆明医科大学, 2022.
	Yang CC. Study on risk factors of urinary incontinence in patients after orthotopic neobladder surgery and establishment and verification of prediction model[D]. Kunming: Kunming Medical University, 2022.
[14]	Flaig TW, Spiess PE, Abern M, et al. NCCN guidelines insights:bladder cancer,version 2.2022[J]. J Natl Compr Canc Netw, 2022, 20(8):866-878.
[15]	Powles T, Bellmunt J, Comperat E, et al. Bladder cancer:ESMO clinical practice guideline for diagnosis,treatment and follow-up[J]. Ann Oncol, 2022, 33(3):244-258.
[16]	中国抗癌协会泌尿男生殖系肿瘤专业委员会微创学组. 中国泌尿男生殖系肿瘤手术后随访方案专家共识[J]. 现代泌尿外科杂志, 2021, 26(5):369-375.
	Chinese Anti-Cancer Association,Urological and Male Reproductive System Tumor Professional Committee,Minimally Invasive Group. Expert consensus on postoperative follow-up scheme for urogenital tumors in China[J]. J Mod Urol, 2021, 26(5):369-375.
[17]	杜玥玥, 冯霞, 张晓丽. 前列腺癌根治术后尿失禁病人居家锻炼动机的质性研究[J]. 循证护理, 2023, 9(5):914-919.
	Du YY, Feng X, Zhang XL. Qualitative study on motivation of exercise at home in patients with urinary incontinence after radical prostatectomy[J]. Chin Evid Based Nurs, 2023, 9(5):914-919.
[18]	唐惠艳. 女性尿失禁患者心理社会适应评估工具的研制及概念模型的构建与验证[D]. 沈阳: 中国医科大学, 2022.
	Tang HY. Development of psychosocial adaptation assessment tool for female urinary incontinence patients and construction and verification of conceptual model[D]. Shenyang: China Medical University, 2022.
[19]	司龙妹, 张佩英, 张萌, 等. 盆底肌训练防治前列腺癌根治术后尿失禁的最佳证据总结[J]. 中华护理杂志, 2020, 55(12):1859-1863. DOI URL
	Si LM, Zhang PY, Zhang M, et al. Evidence summary of pelvic floor muscle training applied in prevention and treatment of post-prostatectomy incontinence[J]. Chin J Nurs, 2020, 55(12):1859-1863. DOI URL
[20]	彭丽仁, 王惠芬, 刘玥, 等. 盆底肌训练联合电刺激生物反馈用于原位新膀胱术后患者尿失禁干预[J]. 护理学杂志, 2022, 37(19):17-20.
	Peng LR, Wang HF, Liu Y, et al. Pelvic floor muscle training combined with electrical stimulation and biofeedback for urinary incontinence in patients after orthotopic ileal neobladder reconstruction[J]. J Nurs Sci, 2022, 37(19):17-20.