Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy.
BJU Int. 2019 Sep;124(3):477-486. doi: 10.1111/bju.14716. Epub 2019 Mar 15.
To present the functional and oncological outcomes after ≥1 year of follow-up, following an experience of >1000 robot-assisted radical prostatectomies (RARPs) with our standardised total anatomical reconstruction (TAR) technique. To evaluate which factors influence postoperative continence recovery in order to obtain a nomogram to predict the risk of postoperative urinary incontinence (UI).
The enrolment phase began in June 2013 and ended in May 2017. Patients were prospectively included in the study with the following inclusion criteria: (i) localised prostate cancer (clinical stages cT1-3, cN0, cM0); (ii) indication for RP; and (iii) preoperative multiparametric prostate magnetic resonance imaging. All patients underwent RARP with the TAR technique done at the end of the demolitive phase. The continence rates were assessed at 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal. Patients were defined as continent if they answered 'zero pad' or 'one safety pad' per day. A logistic regression model was used to evaluate the potential impact of some pre- and intraoperative factors on postoperative urinary continence recovery. Model discrimination was assessed using an area under (AUC) the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of postoperative UI after RARP with the TAR technique was generated based on the logistic model.
In all, 1008 patients were enrolled in our study. At 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal, 621 (61.61%), 594 (58.93%), 803 (79.66%), 912 (90.48%), 950 (94.25%) and 956 (94.84%) patients were continent, respectively. In the logistic regression model, the variables analysed had a higher impact on continence recovery at 4 and 12 weeks. At 4 weeks, the postoperative odds of urinary continence recovery increased with the absence of diabetes [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.41-5.41] and D'Amico low vs high risk (OR 2.01, 95% CI 1.01-3.99). At 12 weeks, urinary continence increased with the absence of diabetes (OR 3.01, 95% CI 1.23-7.35), D'Amico low vs high risk (OR 4.04, 95% CI 1.56-10.47), and D'Amico intermediate vs high risk (OR 3.33, 95% CI 1.66-6.70). ROC curves were drawn and an AUC value of 61.9% (95% CI 57.49-66.36) at 4 weeks and 63.8% (95% CI 58.03-69.65) at 12 weeks were computed. Based on these parameters, two nomograms (at 4 and 12 weeks postoperatively) were generated.
The TAR technique conferred excellent results in the early recovery of urinary continence. Two nomograms were created, to predict preoperatively the postoperative odds of urinary continence recovery at 4 and 12 weeks after RARP by integrating the presence of diabetes and D'Amico risk classification.
介绍 1000 多例机器人辅助根治性前列腺切除术（RARP）后≥1 年的功能和肿瘤学结果，以及我们标准化的全解剖重建（TAR）技术。评估哪些因素会影响术后控尿恢复，以便获得预测术后尿失禁（UI）风险的列线图。
纳入阶段于 2013 年 6 月开始，2017 年 5 月结束。符合以下纳入标准的患者前瞻性纳入研究：（i）局限性前列腺癌（临床分期 cT1-3、cN0、cM0）；（ii）RP 指征；（iii）术前多参数前列腺磁共振成像。所有患者均接受 RARP 治疗，采用 TAR 技术在破坏性阶段结束时进行。在导管拔除后 24 小时、1 周、4 周、12 周、24 周和 48 周评估控尿率。如果患者回答每天“零垫”或“一个安全垫”，则定义为控尿。使用逻辑回归模型评估一些术前和术中因素对术后尿控恢复的潜在影响。使用受试者工作特征（ROC）曲线下面积（AUC）评估模型的区分能力。基于逻辑模型生成预测 TAR 技术后 RARP 术后 UI 风险的列线图。
共有 1008 例患者纳入本研究。导管拔除后 24 小时、1 周、4 周、12 周、24 周和 48 周时，621（61.61%）、594（58.93%）、803（79.66%）、912（90.48%）、950（94.25%）和 956（94.84%）例患者控尿。在逻辑回归模型中，分析的变量对 4 周和 12 周时的控尿恢复有更高的影响。4 周时，术后尿控恢复的可能性随着糖尿病的缺失而增加[优势比（OR）2.76，95%置信区间（CI）1.41-5.41]和 D'Amico 低风险与高风险（OR 2.01，95% CI 1.01-3.99）。12 周时，尿控随着糖尿病的缺失而增加（OR 3.01，95% CI 1.23-7.35）、D'Amico 低风险与高风险（OR 4.04，95% CI 1.56-10.47）和 D'Amico 中风险与高风险（OR 3.33，95% CI 1.66-6.70）而增加。绘制 ROC 曲线，计算出 4 周时 AUC 值为 61.9%（95% CI 57.49-66.36），12 周时 AUC 值为 63.8%（95% CI 58.03-69.65）。基于这些参数，生成了两个列线图（术后 4 周和 12 周）。
TAR 技术在早期恢复尿控方面取得了优异的结果。创建了两个列线图，以在 RARP 术后 4 周和 12 周时，通过整合糖尿病和 D'Amico 风险分类，预测术后尿控恢复的可能性。
