Urology Department, University Hospital of Tours, Tours, France.
BJU Int. 2012 Sep;110(6):875-83. doi: 10.1111/j.1464-410X.2011.10849.x. Epub 2012 Jan 19.
What's known on the subject? and What does the study add? Urinary incontinence is one of the major drawbacks of radical prostatectomy, regardless of the procedure used (i.e. open, laparoscopic or robotic-assisted). Several technical modifications have been described to improve postoperative continence, highlighting the role of puboprostatic ligaments and posterior reconstruction of the rhabdomyosphincter. The results obtained are inconsistent when applied to robotic surgery. The present multicentre randomized study shows that anterior suspension combined with posterior reconstruction is a safe and easy-to-perform technique for improving early continence after robotic-assisted laparoscopic prostatectomy.
To assess the impact on urinary continence of anterior retropubic suspension with posterior reconstruction during robot-assisted laparoscopic prostatectomy (RALP).
In total, 72 patients who were due to undergo prostatectomy between July 2009 and July 2010 were prospectively randomized into two groups: group A underwent a standard RALP procedure and group B had anterior suspension and posterior reconstruction during RALP. The primary outcome measure was urinary continence, assessed using the University of California Los Angeles Prostate Cancer Index questionnaire at 15 days, and at 1, 3 and 6 months, after surgery. Other data recorded were operation duration, blood loss, length of hospital stay, duration of bladder catheterization, complications and positive margin rate.
The continence rates at 15 days, and at 1, 3 and 6 months, after surgery were 3.6%, 7.1%, 15.4% and 57.9%, respectively, in group A, and 5.9%, 26.5%, 45.2% and 65.4%, respectively, in group B. The continence rates differed statistically between groups at 1 and 3 months (P = 0.047 and P = 0.016, respectively). There was no significant difference between groups regarding complications (P = 0.8) or positive margin rate (P = 0.46).
Anterior suspension associated with posterior reconstruction during RALP improved the early return of continence, without increasing complications.
评估机器人辅助腹腔镜前列腺切除术（RALP）中前耻骨后悬吊联合后重建对尿控的影响。
2009 年 7 月至 2010 年 7 月期间，72 例拟行前列腺切除术的患者前瞻性随机分为两组：A 组行标准 RALP 手术，B 组在 RALP 中行前耻骨后悬吊联合后重建。主要观察指标为术后 15 天及 1、3、6 个月时采用加利福尼亚大学洛杉矶前列腺癌指数问卷评估尿控情况。记录的其他数据包括手术时间、失血量、住院时间、导尿管留置时间、并发症和阳性切缘率。
A 组术后 15 天及 1、3、6 个月的尿控率分别为 3.6%、7.1%、15.4%和 57.9%，B 组分别为 5.9%、26.5%、45.2%和 65.4%。两组在术后 1 和 3 个月时的尿控率差异有统计学意义（P = 0.047 和 P = 0.016）。两组间并发症（P = 0.8）或阳性切缘率（P = 0.46）差异无统计学意义。
RALP 中前耻骨后悬吊联合后重建可改善早期尿控恢复，而不增加并发症。
