Division of Urology Clinic, Department of Surgical and Biomedical Sciences, University Hospital of Perugia, Perugia, Italy.
Int Urol Nephrol. 2019 Apr;51(4):609-615. doi: 10.1007/s11255-019-02107-3. Epub 2019 Feb 23.
Urinary incontinence (UI) is one of the most bothersome surgical side effects after robot-assisted radical prostatectomy (RARP). Alteration of both smooth and striate urethral sphincter occurs after RARP. Since the contraction of perineal muscles is involved in the complex mechanism of urinary continence, the uroflow stop test (UST) seems to predict early continence recovery after RARP. The UST was added of perineal surface electromyography (EMG) evaluation to evaluate the latency time (LT) between muscular contraction and the complete stop of urine flow. Our aim was to present UST-EMG as a new tool in the investigation of UI, implying pelvic floor integrity, and to evaluate whether an early return (≤ 3 months) to preoperative LT could be associated with early recovery of UC (≤ 3 months).
After prospectively enrolling 137 patients who underwent RARP with a minimum follow-up of 6 months, we identified two groups: Group 1 (93 patients) with early (≤ 3 months) pre-surgical LT recovery and Group 2 (44 patients) with late > 3 months or not able to reach pre-surgical LT recovery.
Between the two groups, there were significant differences in terms of different surgical technique (nerve-sparing versus non-nerve-sparing) and pads use at 3 and 6 months after RARP (p < 0.05). No differences were recorded neither in postoperative maximum flow-rate, nor in postoperative symptoms score.
UST with EMG can be considered as a noninvasive, reproducible and easily performable tool. LT is applicable in the clinical evaluation to predict urinary continence recovery after RARP.
尿失禁（UI）是机器人辅助根治性前列腺切除术（RARP）后最麻烦的手术副作用之一。RARP 后，平滑肌和横纹肌尿道括约肌均发生改变。由于会阴部肌肉收缩参与了控尿的复杂机制，尿流停止试验（UST）似乎可以预测 RARP 后早期控尿的恢复。UST 增加了会阴部表面肌电图（EMG）评估，以评估肌肉收缩和尿液完全停止之间的潜伏期（LT）。我们的目的是将 UST-EMG 作为一种新工具用于调查 UI，提示盆底完整性，并评估早期（≤3 个月）恢复术前 LT 是否与 UC（≤3 个月）的早期恢复相关。
前瞻性纳入 137 例接受 RARP 治疗且随访至少 6 个月的患者，我们将其分为两组：LT 早期（≤3 个月）恢复的组 1（93 例）和 LT 晚期（>3 个月或无法恢复术前 LT）的组 2（44 例）。
两组患者在不同手术技术（神经保留与非神经保留）和 RARP 后 3 个月和 6 个月使用尿垫方面存在显著差异（p<0.05）。术后最大尿流率和术后症状评分无差异。
UST 结合 EMG 可被视为一种非侵入性、可重复和易于操作的工具。LT 适用于临床评估，以预测 RARP 后尿控的恢复。
