机器人辅助根治性前列腺切除术前后的尿动力学评估。

Urodynamic evaluation before and immediately after robot-assisted radical prostatectomy.

机构信息

Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.

出版信息

Urology. 2014 Jul;84(1):106-11. doi: 10.1016/j.urology.2014.04.005.

DOI:10.1016/j.urology.2014.04.005

PMID:24976226

Abstract

OBJECTIVE

To evaluate continence status and mechanism of urinary incontinence immediately after robot-assisted radical prostatectomy (RARP) by performing urodynamic evaluation.

METHODS

A total of 87 patients with localized prostate cancer who underwent RARP were included. Filling cystometry, urethral pressure profilometry, and abdominal leak point pressure (ALPP) tests were performed before and immediately after RARP.

RESULTS

The mean urine loss ratio (ULR), calculated by dividing the total urine volume by the weight of urine loss after RARP, was 17.8%. Nerve-sparing (NS) surgery significantly affected ULR compared with non-NS surgery. In the comparison between preoperative and postoperative results, the mean maximal cystometric capacity (MCC) and maximal closure urethral pressure (MUCP) decreased from 341 mL and 84.6 cm H2O to 250 mL and 35.6 cm H2O, respectively. No urine leakage was observed in ALPP test preoperatively; however, urine leakage was observed postoperatively in 75 patients (86%), with a mean ALPP of 47.7 cm H2O. Multivariate analysis revealed that MCC, MUCP, and ALPP after RARP were predictive factors for ULR. Linear correlations were found between ULR and MUCP and between ULR and ALPP after RARP. NS status and MUCP after RARP (r=0.247; P=.021) and the ALPP (r=0.254; P=.018) were significantly correlated.

CONCLUSION

In urodynamic evaluation immediately after RARP, MCC, MUCP, and ALPP were found to predictive factors for urinary incontinence. The NS procedure contributed to continence status after RARP.

摘要

目的

通过尿动力学评估评价机器人辅助根治性前列腺切除术（RARP）后即刻的尿失禁状况和机制。

方法

纳入 87 例局限性前列腺癌患者，均行 RARP。术前和 RARP 后即刻进行充盈性膀胱测压、尿道压力描记和腹压漏点压（ALPP）检查。

结果

RARP 后总尿量除以尿失重量计算的平均尿失量比（ULR）为 17.8%。与非神经保留（NS）手术相比，NS 手术显著影响 ULR。与术前相比，术后平均最大膀胱容量（MCC）和最大尿道闭合压（MUCP）分别从 341 mL 和 84.6 cm H2O 下降至 250 mL 和 35.6 cm H2O。ALPP 术前检查未见尿漏，术后 75 例（86%）患者出现尿漏，平均 ALPP 为 47.7 cm H2O。多变量分析显示，RARP 后 MCC、MUCP 和 ALPP 是 ULR 的预测因素。RARP 后 ULR 与 MUCP 之间、ULR 与 ALPP 之间存在线性相关。RARP 后 NS 状态和 MUCP（r=0.247；P=.021）以及 ALPP（r=0.254；P=.018）与 ULR 显著相关。