Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
J Endourol. 2011 Mar;25(3):441-5. doi: 10.1089/end.2010.0251.
Reapproximation of Denonvilliers' fascia adjacent to bladder neck to the rectourethralis, or posterior reconstruction (PR), has been suggested to improve continence in postprostatectomy patients. We examined the impact of the PR on postoperative urinary and other quality-of-life (QoL) outcomes in patients undergoing robot-assisted laparoscopic prostatectomy (RALP).
We identified 89 patients who underwent RALP for prostate cancer between 2006 and 2009 by a single surgeon (R.G.), consented to participate in our prospective QoL study, which collects RAND-UCLA QoL and AUA symptom scores for all patients undergoing treatment for prostate cancer, and completed a baseline and a 3- or 6-month questionnaire. Of these, 31 patients had PR before vesicourethral anastomosis. We compared return to baseline function percentage at 3 and 6 months by PR group. Differences found in univariate analysis were further investigated using multiple linear regression models adjusting for demographics, clinical variables, and nerve-sparing status.
While most patients had both 3- and 6-month follow-up (n = 74, 83%), sample size at 3 months was n = 86 and at 6 months was n = 77. Groups were comparable by preoperative characteristics, pathologic stage, nerve-sparing status, and baseline QoL/AUA symptom scores. At 3-months, there was a statistically significant improvement comparing PR to non-PR groups in return to baseline score for urinary bother (72% vs. 53%; p = 0.008) and urinary function (64% vs. 50%; p = 0.05), as well as change in absolute AUA symptom score (+0.2 vs. +3.8; p = 0.005). Differences in urinary bother (+20%; 95% confidence interval 5%, 34%) and AUA symptom score (-2.8; 95% confidence interval, -5.4, -0.2) persisted after multivariate adjustment. Groups had similar scores for all parameters by 6 months postprostatectomy.
PR in patients undergoing RALP has a significant impact on early return to baseline parameters relating to urinary bother, urinary function, and AUA symptom score.
Denonvilliers 筋膜毗邻膀胱颈部的再接近，即后重建（PR），被认为可以改善前列腺切除术后患者的控尿能力。我们检查了 PR 对接受机器人辅助腹腔镜前列腺切除术（RALP）的患者术后尿和其他生活质量（QoL）结果的影响。
我们通过一位外科医生（R.G.）识别了 89 名在 2006 年至 2009 年间接受 RALP 治疗前列腺癌的患者，他们同意参加我们的前瞻性 QoL 研究，该研究为所有接受前列腺癌治疗的患者收集 RAND-UCLA QoL 和 AUA 症状评分，并完成基线和 3 或 6 个月的问卷。其中，31 名患者在进行膀胱尿道吻合术之前进行了 PR。我们通过 PR 组比较了 3 个月和 6 个月时功能恢复的百分比。通过单变量分析发现的差异进一步通过调整人口统计学、临床变量和神经保护状态的多元线性回归模型进行了研究。
虽然大多数患者都有 3 个月和 6 个月的随访（n = 74，83%），但 3 个月时的样本量为 n = 86，6 个月时的样本量为 n = 77。两组在术前特征、病理分期、神经保护状态和基线 QoL/AUA 症状评分方面具有可比性。在 3 个月时，PR 组与非 PR 组相比，在恢复基线排尿困扰评分方面有统计学意义的改善（72%对 53%；p = 0.008）和恢复基线排尿功能评分（64%对 50%；p = 0.05），以及绝对 AUA 症状评分的变化（+0.2 对+3.8；p = 0.005）。在多变量调整后，排尿困扰（+20%；95%置信区间 5%，34%）和 AUA 症状评分（-2.8；95%置信区间，-5.4，-0.2）的差异仍然存在。两组在前列腺切除术后 6 个月时所有参数的评分相似。
在接受 RALP 的患者中进行 PR 对与排尿困扰、排尿功能和 AUA 症状评分相关的早期恢复基线参数有显著影响。
