Ogawa Soichiro, Hoshi Seiji, Koguchi Tomoyuki, Hata Junya, Sato Yuichi, Akaihata Hidenori, Kataoka Masao, Haga Nobuhiro, Kojima Yoshiyuki
Department of Urology, Fukushima Medical University School of Medicine , Fukushima, Japan .
J Endourol. 2017 Dec;31(12):1251-1257. doi: 10.1089/end.2017.0410. Epub 2017 Nov 20.
We present our experience with a novel three-layer two-step posterior reconstruction (PR) technique using peritoneum during robot-assisted radical prostatectomy (RARP) to improve recovery of postoperative urinary continence.
Forty-eight patients with localized prostate cancer were enrolled in this study and were divided randomly into two groups, which were treated by the standard PR technique (standard PR group; n = 24) or the three-layer PR technique using peritoneum (three-layer PR group; n = 24) during RARP. We prospectively analyzed the continence rate by the 1-hour pad test. All patients underwent urethrocystography at 6 days postoperatively to evaluate position of vesicourethral junction. Pelvic MRI was also performed at 6 months postoperatively for anatomical evaluation.
Four weeks after RARP, the urinary continence rate was significantly higher in the three-layer PR group (57%) than in the standard PR group (26%, p = 0.036). Urethrocystography demonstrated that the postoperative craniocaudal distance from the symphysis pubis to the level of the vesicourethral junction was significantly shorter in the three-layer PR group than in the standard PR group (p < 0.01), suggesting that there was less tension on the vesicourethral anastomosis after three-layer PR. MRI confirmed that three-layer PR provided firmer reinforcement of the structures, supporting the posterior aspect of the urethral sphincter complex.
This prospective comparative study might suggest that three-layer two-step PR using peritoneum during RARP is a simple and feasible method seeming to improve early recovery of postoperative continence compared with standard two-step PR, although larger multicenter randomized controlled trials will be needed.
我们介绍了一种新型的三层两步法后入路重建（PR）技术，即在机器人辅助根治性前列腺切除术（RARP）中使用腹膜，以促进术后尿失禁的恢复。
本研究纳入了48例局限性前列腺癌患者，随机分为两组，在RARP期间分别采用标准PR技术（标准PR组；n = 24）或使用腹膜的三层PR技术（三层PR组；n = 24）。我们通过1小时尿垫试验前瞻性分析了控尿率。所有患者在术后6天进行尿道膀胱造影，以评估膀胱尿道连接部的位置。术后6个月还进行了盆腔MRI检查以进行解剖学评估。
RARP术后4周，三层PR组的尿失禁率（57%）显著高于标准PR组（26%，p = 0.036）。尿道膀胱造影显示，三层PR组术后从耻骨联合到膀胱尿道连接部水平的颅尾距离明显短于标准PR组（p < 0.01），这表明三层PR后膀胱尿道吻合处的张力较小。MRI证实三层PR为结构提供了更牢固的加强，支撑了尿道括约肌复合体的后部。
这项前瞻性比较研究可能表明，在RARP期间使用腹膜的三层两步法PR是一种简单可行且似乎比标准两步法PR能改善术后控尿早期恢复的方法，尽管还需要更大规模的多中心随机对照试验。
