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

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