Canvasser Noah E, Lay Aaron H, Koseoglu Ersin, Morgan Monica S C, Cadeddu Jeffrey A
Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
J Endourol. 2016 Oct;30(10):1089-1094. doi: 10.1089/end.2016.0220. Epub 2016 Sep 8.
Early urinary control is a major goal for patients undergoing robot-assisted radical prostatectomy (RARP). We report our technique of posterior urethral suspension (PUS) performed at the time of urethrovesical anastomosis.
We prospectively followed men with localized prostate cancer undergoing RARP by a single surgeon from August 2012 to October 2015. Patients before April 2014 underwent only bladder neck preservation (controls), while patients after April 2014 also underwent PUS. Patients were given a modified Expanded Prostate Cancer Index Composite questionnaire, along with questions depicting objective measures of urinary control (type of pad, number of pads, wetness of pad). Time points queried were preoperatively and postoperatively at weeks 1, 2, 4, and 12. Our primary outcome was pad-free survival.
Questionnaire response rate was 52% (56/107) for controls and 43% (36/83) for PUS. There were no differences in baseline demographics, preoperative urinary control, intraoperative variables, or postoperative complications between groups. There were few subjective improvements in urinary control for PUS compared with controls. More notable, PUS patients had significantly improved objective measures of urinary control, including less protective incontinence products at 1 and 2 weeks after catheter removal (p < 0.03). They also wore fewer pads and had less leakage on each pad that lasted from week 1 to week 4 after catheter removal (p < 0.01). PUS patients had pad-free rates of 37%, 47%, 54%, and 60% compared with controls 15%, 18%, 24%, and 36%, at weeks 1, 2, 4, and 12 after catheter removal (p = 0.07).
PUS may improve objective measures of early urinary control compared with controls. With no increase in operative time and no change in complication rates, further work in a randomized setting would provide additional weight to our findings.
早期尿控是接受机器人辅助根治性前列腺切除术（RARP）患者的主要目标。我们报告在尿道膀胱吻合术时进行后尿道悬吊术（PUS）的技术。
我们前瞻性地随访了2012年8月至2015年10月由单一外科医生进行RARP的局限性前列腺癌男性患者。2014年4月之前的患者仅接受膀胱颈保留术（对照组），而2014年4月之后的患者还接受了PUS。患者接受了改良的前列腺癌指数综合问卷，以及描述尿控客观指标（尿垫类型、尿垫数量、尿垫湿润情况）的问题。询问的时间点为术前以及术后第1、2、4和12周。我们的主要结局是无尿垫生存。
对照组的问卷回复率为52%（56/107），PUS组为43%（36/83）。两组之间在基线人口统计学、术前尿控、术中变量或术后并发症方面无差异。与对照组相比，PUS组在尿控方面的主观改善较少。更值得注意的是，PUS组患者在尿控客观指标方面有显著改善，包括拔除导尿管后1周和2周时使用的保护性失禁用品减少（p<0.03）。在拔除导尿管后第1周持续至第4周期间，他们使用的尿垫也更少，且每个尿垫的渗漏也更少（p<0.01）。拔除导尿管后第1、2、4和12周时，PUS组患者的无尿垫率分别为37%、47%、54%和60%，而对照组分别为15%、18%、24%和36%（p=0.07）。
与对照组相比，PUS可能会改善早期尿控的客观指标。在不增加手术时间且并发症发生率不变的情况下，在随机对照研究中开展进一步研究将为我们的研究结果提供更多支持。
