1 Division of Urology, Perelman School of Medicine, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania.
J Endourol. 2014 Jan;28(1):48-55. doi: 10.1089/end.2013.0290. Epub 2013 Nov 12.
To describe our bladder neck dissection during robot-assisted radical prostatectomy (RARP), to describe the degrees of robot-assisted bladder neck preservation (R-BNP) we have encountered, and to determine the effect of increasing R-BNP on postoperative continence and positive surgical margin (PSM) rates.
We performed a retrospective analysis of 599 patients who underwent robot-assisted radical prostatectomy (RARP) by a single surgeon (DIL). All bladder neck dissections were graded between 1 and 4; higher grades corresponded to an increasing degree of robot-assisted bladder neck preservation (R-BNP). After grouping patients by R-BNP grade, postoperative continence and positive surgical margin (PSM) rates were compared. The association between R-BNP and continence was also assessed using multivariate binary logistic regression models.
Similar outcomes were seen for two definitions of continence (0 pads per day [ppd]; 0 ppd or security pad, respectively). A higher proportion of patients were continent at 3 months postoperatively who received grade 4 compared with grade 1 (P=0.043; P=0.001) and grade 2 (P=0.006; P=0.009); and grade 3 compared with grade 1 (P=0.048; P=0.002) and grade 2 (P=0.009; P=0.030) R-BNP. There was no difference between grade 1 and 2 (P=0.541; P=0.064), and grade 3 and 4 (P=0.898; P=0.584) R-BNP. At 1 year postoperatively, there was no difference among the four groups in continence rate (P=0.771; P=0.411). R-BNP was an independent predictor of continence at 3 months (odds ratio [OR] [95% confidence interval (CI)]=1.33 [1.06-1.67]; OR [95% CI]=1.45 [1.1-1.82]), but not at 1 year (OR [95% CI]=1.07 [0.82-1.39]; OR (95% CI)=1.30 [0.92-1.85]). There was no difference among the four groups in PSM rates (P=0.946).
R-BNP is a graded, rather than all-or-none outcome. An increasing degree of R-BNP is associated with an earlier return to continence, without compromising oncologic outcomes.
描述我们在机器人辅助根治性前列腺切除术（RARP）中进行的膀胱颈解剖，描述我们遇到的不同程度的机器人辅助膀胱颈保留（R-BNP），并确定增加 R-BNP 对术后控尿和阳性手术切缘（PSM）率的影响。
我们对 599 名由一位外科医生（DIL）进行机器人辅助根治性前列腺切除术（RARP）的患者进行了回顾性分析。所有膀胱颈解剖均分级为 1 至 4 级；更高的等级对应于机器人辅助膀胱颈保留（R-BNP）程度的增加。根据 R-BNP 分级对患者进行分组后，比较术后控尿和阳性手术切缘（PSM）率。还使用多变量二项逻辑回归模型评估 R-BNP 与控尿的相关性。
对于两种控尿定义（每天 0 片尿垫[ppd]；每天 0 片尿垫或安全垫），术后 3 个月有更高比例的患者保持控尿。与分级 1 相比，分级 4 的患者更有可能保持控尿（P=0.043；P=0.001）和分级 2（P=0.006；P=0.009）；与分级 3 相比，分级 1（P=0.048；P=0.002）和分级 2（P=0.009；P=0.030）的 R-BNP 患者更有可能保持控尿。分级 1 和 2 之间（P=0.541；P=0.064）和分级 3 和 4 之间（P=0.898；P=0.584）没有差异。术后 1 年，四组患者的控尿率无差异（P=0.771；P=0.411）。R-BNP 是术后 3 个月控尿的独立预测因素（优势比[OR] [95%置信区间（CI）]=1.33 [1.06-1.67]；OR [95% CI]=1.45 [1.1-1.82]），但不是术后 1 年（OR [95% CI]=1.07 [0.82-1.39]；OR [95% CI]=1.30 [0.92-1.85]）。四组患者的 PSM 率无差异（P=0.946）。
R-BNP 是分级的，而不是全有或全无的结果。R-BNP 程度的增加与更早恢复控尿有关，而不会影响肿瘤学结果。
