Nguyen Lang, Jhaveri Jay, Tewari Ashutosh
New York-Presbyterian Hospital, Weill Cornell's Institute of Prostate Cancer and Robotic Surgery, New York, New York, USA.
J Urol. 2008 May;179(5):1907-11. doi: 10.1016/j.juro.2008.01.036. Epub 2008 Mar 18.
Shorter urethral sphincter length on preoperative endorectal magnetic resonance imaging has been associated with an increased risk of postoperative urinary incontinence as well as longer time to achieve continence. We determined that our techniques of anatomical reconstruction for restoring the continence mechanism could markedly improve continence outcomes, especially in patients with a shorter urethral sphincter.
Our cohort consisted of 274 patients who underwent robotic radical prostatectomy, as performed by a single surgeon, and for whom preoperative magnetic resonance imaging and postoperative evaluations were available. All sphincter lengths were measured on T2-weighted images as the distance from the prostatic apex to the penile bulb, cross-referencing all 3 planes. Continence was defined as zero pads or a liner used for security reasons only.
The 2 surgical modifications considerably hastened the return of continence at 6 months. The continence rate in the shorter sphincter group (less than 14 mm) was 47% for the control technique, 81% for anterior reconstruction and 90% for total reconstruction. The continence rate in the longer sphincter group (more than 14 mm) was 80% for the control technique and 83% for anterior reconstruction, while it approached 99% for total reconstruction. With the control technique the average time to achieve continence was significantly different between the shorter and longer sphincter groups (25 vs 12 weeks, p = 0.037). The significance disappeared for anterior reconstruction (7.4 vs 6.2 weeks, p = 0.27) and total reconstruction (3.6 vs 2.7 weeks, p = 0.13).
The results of this study are encouraging for patients with a short urethral sphincter who are considering radical prostatectomy.
术前直肠内磁共振成像显示尿道括约肌长度较短与术后尿失禁风险增加以及恢复控尿所需时间延长有关。我们确定，我们用于恢复控尿机制的解剖重建技术可显著改善控尿结果，尤其是对于尿道括约肌较短的患者。
我们的队列包括274例行机器人根治性前列腺切除术的患者，均由同一位外科医生实施手术，且有术前磁共振成像和术后评估资料。所有括约肌长度均在T2加权图像上测量，即从前列腺尖到阴茎球部的距离，并在所有三个平面上进行交叉对照。控尿定义为无需使用尿垫或仅出于安全原因使用衬垫。
两种手术改良方法显著加快了6个月时控尿功能的恢复。较短括约肌组（小于14毫米）中，对照技术的控尿率为47%，前路重建为81%，全重建为90%。较长括约肌组（大于14毫米）中，对照技术的控尿率为80%，前路重建为83%，全重建接近99%。采用对照技术时，较短和较长括约肌组实现控尿的平均时间有显著差异（25周对12周，p = 0.037）。前路重建（7.4周对6.2周，p = 0.27）和全重建（3.6周对2.7周，p = 0.13）时，这种差异消失。
本研究结果对于考虑行根治性前列腺切除术的尿道括约肌较短的患者而言是令人鼓舞的。
