Krane L Spencer, Wambi Christel, Bhandari Akshay, Stricker Hans J
Vattikuti Urology Institute, Henry Ford Health Systems, Detroit, Michigan, USA.
Can J Urol. 2009 Oct;16(5):4836-40.
Posterior urethrovesical anastomotic support has been reported to improve early return of urinary continence following radical prostatectomy. We adapted this technique to evaluate enhancement of early urinary control in patients undergoing robotic radical prostatectomy.
Forty-two consecutive men undergoing radical prostatectomy by a single surgeon between September and December 2007 received a posterior urethrovesical supporting stitch prior to the standard urethrovesical anastomosis (group 1). Operative data, postoperative complications, and follow up data were compared with those of the 42 consecutive men who underwent robotic radical prostatectomy by the same surgeon between March and August 2007 with a standard urethrovesical anastomosis (group 2). Continence was assessed at routine follow up visit 6 to 8 weeks following catheter removal. Continence was defined as zero pads or small security liner for infrequent urinary leakage in 24 hours.
Thirty-four (81%) and 37 (88%) men in groups 1 and 2 respectively had follow up available between 45 and 75 days following prostatectomy. Preoperative demographics were similar between the two groups. At a mean follow up of 60 and 53 days following surgery, 29/34 (85%) of men in group 1 and 32/37 (86%) of men in group 2 were continent. On multivariate logistic regression analysis, no factors were associated with improved continence between the two groups.
Posterior urethrovesical anastomotic support did not result in improved early urinary control following radical prostatectomy. Excellent urinary control can be achieved in the patients undergoing robotic radical prostatectomy without posterior urethrovesical anastomotic support.
据报道，后尿道膀胱吻合术支持可改善根治性前列腺切除术后尿失禁的早期恢复。我们采用了这项技术来评估接受机器人辅助根治性前列腺切除术患者的早期尿控改善情况。
2007年9月至12月间，由同一位外科医生连续为42名男性实施根治性前列腺切除术，在标准尿道膀胱吻合术前进行后尿道膀胱支持缝合（第1组）。将手术数据、术后并发症及随访数据与2007年3月至8月间由同一位外科医生为42名男性实施标准尿道膀胱吻合术的机器人辅助根治性前列腺切除术患者（第2组）进行比较。在拔除导尿管后6至8周的常规随访中评估尿控情况。尿控定义为24小时使用零片尿垫或偶尔漏尿时使用小的安全衬垫。
第1组和第2组分别有34名（81%）和37名（88%）男性在前列腺切除术后45至75天内可进行随访。两组术前人口统计学特征相似。在术后平均60天和53天的随访中，第1组29/34名（85%）男性和第2组32/37名（86%）男性实现了尿控。多因素逻辑回归分析显示，两组间无因素与尿控改善相关。
后尿道膀胱吻合术支持并未改善根治性前列腺切除术后的早期尿控。在未进行后尿道膀胱吻合术支持的情况下，接受机器人辅助根治性前列腺切除术的患者也可实现良好的尿控。
