Kwon Se Yun, Lee Jun Nyung, Kim Hyun Tae, Kim Tae-Hwan, Kim Bup Wan, Choi Gyu-Seog, Kwon Tae Gyun
Departments of Urology.
Scand J Urol. 2014 Dec;48(6):506-12. doi: 10.3109/21681805.2014.913259. Epub 2014 Jul 10.
Urinary incontinence has a significant impact on the quality of life after radical prostatectomy. This study aimed to determine whether preserving the endopelvic fascia influences subsequent urinary incontinence.
Consecutive patients (n = 138) who underwent robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer between October 2010 and June 2012 with a minimum of 1 year follow-up were retrospectively analysed. The subjects were divided into two groups: the non-preserved endopelvic fascia group (nPE group) and the preserved endopelvic fascia group (PE group). Continence was defined as not using any pads and having no urine leakages. Continence rates at set time-points after RALP were compared using the chi-squared test. Continence recovery rates were analysed with the Kaplan-Meier method and the log-rank test. Prognostic factors of incontinence were identified using the Cox proportional hazards model.
The age, body mass index, preoperative prostate-specific antigen levels, prostate volume, estimated blood loss, mean operative time, Gleason score and pathological stage were not significantly different between the two study groups. The continence rate of the nPE group and PE group was 88.4% and 97.1%, respectively, at 12 months after surgery (p = 0.049), which was also significant according to the Kaplan-Meier analysis (p < 0.001). Preservation of endopelvic fascia was the only significant prognostic factor for urinary incontinence (p = 0.002, hazard ratio = 1.867) according to the multivariate analysis.
Endopelvic fascia preservation during RALP significantly enhances postoperative continence and is related to the speed of recovery of continence.
尿失禁对根治性前列腺切除术后的生活质量有重大影响。本研究旨在确定保留盆腔内筋膜是否会影响随后的尿失禁情况。
回顾性分析2010年10月至2012年6月期间接受机器人辅助腹腔镜根治性前列腺切除术（RALP）治疗前列腺癌且随访至少1年的连续患者（n = 138）。将研究对象分为两组：未保留盆腔内筋膜组（nPE组）和保留盆腔内筋膜组（PE组）。控尿定义为不使用任何尿垫且无尿液渗漏。采用卡方检验比较RALP术后设定时间点的控尿率。采用Kaplan-Meier法和对数秩检验分析控尿恢复率。使用Cox比例风险模型确定尿失禁的预后因素。
两个研究组之间的年龄、体重指数、术前前列腺特异性抗原水平、前列腺体积、估计失血量、平均手术时间、Gleason评分和病理分期无显著差异。术后12个月时，nPE组和PE组的控尿率分别为88.4%和97.1%（p = 0.049），根据Kaplan-Meier分析也具有显著性差异（p < 0.001）。多因素分析显示，保留盆腔内筋膜是尿失禁唯一显著的预后因素（p = 0.002，风险比 = 1.867）。
RALP术中保留盆腔内筋膜可显著提高术后控尿能力，并与控尿恢复速度有关。
