Alnazari Mansour, Zanaty Marc, Ajib Khaled, El-Hakim Assaad, Zorn Kevin C
Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal; Montreal, QC, Canada.
Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal; Montreal, QC, Canada.
Can Urol Assoc J. 2018 Mar;12(3):E121-E125. doi: 10.5489/cuaj.4649. Epub 2017 Dec 22.
We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes.
The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated.
The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months.
While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.
我们旨在评估机器人辅助根治性前列腺切除术（RARP）后急性尿潴留（AUR）的危险因素，以及AUR与早期控尿结果的关系。
从一个前瞻性收集的数据库中，对我们机构两位经验丰富的外科医生连续进行RARP手术的740例患者的记录进行回顾性分析。采用单因素和多因素分析，评估包括年龄、体重指数（BMI）、国际前列腺症状评分（IPSS）、前列腺体积、中叶情况、神经保留状态、吻合时间以及拔管时间（第4天与第7天）等多个因素作为AUR的危险因素。同时评估AUR与RARP术后早期控尿恢复（1个月和3个月）之间的关系。
临床上显著的膀胱尿道吻合口（VUA）漏和拔管后AUR的发生率分别为0.9%和2.2%（17/740）。在发生AUR的男性中，年龄、BMI、IPSS、前列腺体积、中叶情况、神经保留或吻合时间方面均无显著关系；然而，第4天拔管的男性AUR发生率（4.5% [16/351]）显著高于第7天拔管的男性（0.2% [1/389]）（p = 0.004）。此外，第4天早期拔管且发生AUR的患者1个月时0片卫生巾控尿恢复率为87.5%（14/16），高于未发生AUR的患者45.6%（153/335），3个月时无显著差异。
虽然AUR是RARP的一种不常见并发症，但其发生率远高于VUA漏。此外，术前患者咨询时对此往往讨论不足。而且，仅在第4天拔管的RARP术后发生AUR的患者尿失禁恢复更早。未来有必要开展研究以验证AUR对控尿结果的长期影响。
