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大学医院早期经验中机器人根治性前列腺切除术中膀胱尿道吻合术结果的前瞻性评估。

Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital.

作者信息

Burttet Lucas Medeiros, Varaschin Gabrielle Aguiar, Berger Andre Kives, Cavazzola Leandro Totti, Berger Milton, Silva Brasil

机构信息

Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil.

Universidade Federal do Rio Grande do Sul, RS, Brasil.

出版信息

Int Braz J Urol. 2017 Nov-Dec;43(6):1176-1184. doi: 10.1590/S1677-5538.IBJU.2016.0466.

Abstract

PURPOSE

Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature.

MATERIALS AND METHODS

We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature.

RESULTS

Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status.

CONCLUSION

Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.

摘要

目的

机器人辅助根治性前列腺切除术(RARP)给外科医生带来了挑战,尤其是在最初的学习曲线阶段。我们旨在评估在一所学术医院的初期经验中,接受RARP的患者与膀胱尿道吻合术(VUA)相关的早期和中期功能结局及并发症。我们还评估了术后尿失禁的可能预测因素,并将这些结果与文献进行比较。

材料与方法

我们前瞻性地收集了连续接受RARP患者的数据。对至少随访6个月的患者进行以下结局分析:完成VUA的时间、尿失禁情况以及与吻合术相关的并发症。评估保留神经状态、年龄、体重指数、术中出血量、病理肿瘤分期和前列腺大小作为预测早期和中期尿失禁的可能因素。将结果与当前文献进行比较。

结果

评估了60例患者的数据。完成VUA的平均时间为34分钟,控制台操作时间为247分钟。6个月时的尿失禁率为90%。尿漏发生率为3.3%,无患者发生膀胱颈挛缩或术后尿潴留。多因素分析显示,年龄和病理分期与3个月时的尿失禁状态相关。

结论

我们的数据表明,在一所公立大学医院开展RARP的早期经验中,在尿失禁及与VUA相关的其他结局方面有可能取得良好结果。我们还发现年龄和病理分期与早期尿失禁状态相关。

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