Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
J Urol. 2020 Jan;203(1):137-144. doi: 10.1097/JU.0000000000000461. Epub 2019 Jul 26.
We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy.
Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome.
After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001).
Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.
我们比较了保留耻骨后间隙的机器人辅助前列腺癌根治术和传统机器人辅助前列腺癌根治术治疗前列腺癌后早期控尿恢复情况。
2005 年 10 月至 2018 年 5 月，一位外科医生使用传统和保留耻骨后间隙技术分别对 1150 例和 713 例患者进行了机器人辅助前列腺癌根治术。为了比较两组之间的控尿结果，使用了 9 项术前变量进行倾向评分匹配，包括年龄、体重指数、前列腺特异性抗原、前列腺活检 Gleason 分级、临床 T 分期、经直肠超声前列腺体积以及国际前列腺症状评分（I-PSS）、I-PSS 生活质量评分和国际勃起功能指数-5 评分。术后每月通过尿垫计数评估控尿情况，直至术后 6 个月，并将其转换为二分类结果。
在进行倾向评分匹配后，每组各有 609 例病例，9 项变量无显著差异。Kaplan-Meier 曲线分析显示，在 6 个月的研究期间，保留耻骨后间隙的机器人辅助前列腺癌根治术与传统机器人辅助前列腺癌根治术相比，控尿恢复率显著更高（p<0.001）。
基于多变量倾向评分匹配和大样本系列研究，保留耻骨后间隙的机器人辅助前列腺癌根治术可以作为未来机器人辅助前列腺癌根治术的候选术式。与传统机器人辅助前列腺癌根治术相比，它能更早地恢复控尿功能，缩短手术时间，更快地恢复。
