Urology Unit University of Pisa, Pisa, Italy.
Urology University Unit, Cisanello Hospital, Via Paradisa 2, 56124, Pisa, Italy.
BMC Urol. 2017 Dec 15;17(1):119. doi: 10.1186/s12894-017-0308-1.
To evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP).
Two-hundred ninety-two patients who previously underwent radical prostatectomy were retrospectively selected for a case-control study, excluding those with anastomotic strictures and significant perioperative complications and re-called for a medical follow-up visit after their consent to participate the study. They were divided in 3 different groups according to the surgical technique previously received: radical retropubic prostatectomy (RRP) combined with bladder neck preservation (BNP), RARP with bladder neck resection, and RARP combined with BNP and posterior musculofascial reconstruction (PRec). Functional and oncologic outcomes evaluation were integrated by a questionnaire on urinary continence status, abdominal ultrasound scan, uroflowmetry and post-void urine volume measurement. Urinary continence definition included the terms "no pad" or "safety pad".
Two hundred thirty-two patients responded to the phone call interview and were enrolled in the study. They presented comparable age, prostate volume and BMI. Differences in comorbidities, ASA score and medications, did not influence the postoperative functional results, focused on continence outcome. Early urinary continence was achieved in 49.38% and 24.73% of patients who previously underwent RARP + BNP + PRec and simple RARP respectively (p = 0.000)as well as late 12-months urinary continence was obtained in 92.59% and 79.56% of patients.(p = 0.01). Late urinary continence in the RRP + BNP group was comparable to the result obtained in the simple RARP group. The potential effects of nerve sparing technique on urinary continence have not been evaluated.
The combined technique of RARP + BNP + PRec seems to be effective to determine early and long term significant effects on urinary continence of patients with comparable body mass index, age and prostate volume. No statistically significant differences were found between the simple RARP and the RRP + BNP groups.
评估在机器人辅助根治性前列腺切除术（RARP）治疗中采用联合膀胱颈保留和后重建技术对早期和长期尿控的影响。
回顾性选择 292 例接受根治性前列腺切除术的患者进行病例对照研究，排除吻合口狭窄和围手术期严重并发症的患者，并在获得他们参与研究的同意后，召回进行医学随访。他们根据之前接受的手术技术分为 3 个不同组：经耻骨后前列腺切除术（RRP）联合膀胱颈保留（BNP）、RARP 联合膀胱颈切除和 RARP 联合 BNP 和后肌肉筋膜重建（PRec）。通过尿控状态问卷、腹部超声扫描、尿流率和残余尿测量来评估功能和肿瘤学结果。尿控定义包括“无垫”或“安全垫”。
232 例患者接听了电话采访并被纳入研究。他们的年龄、前列腺体积和 BMI 相似。合并症、ASA 评分和药物的差异并没有影响术后功能结果，重点是尿控结果。以前接受 RARP+BNP+Prec 的患者中有 49.38%和 24.73%的患者早期获得尿控，而以前接受单纯 RARP 的患者中有 92.59%和 79.56%的患者在 12 个月时获得晚期尿控（p=0.000）。RRP+BNP 组的晚期尿控与单纯 RARP 组的结果相当。神经保留技术对尿控的潜在影响尚未评估。
RARP+BNP+Prec 联合技术似乎能够有效地确定 BMI、年龄和前列腺体积相似的患者的早期和长期尿控的显著影响。在单纯 RARP 和 RRP+BNP 组之间未发现统计学上的显著差异。
