Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Urol Oncol. 2020 Jan;38(1):1.e11-1.e16. doi: 10.1016/j.urolonc.2019.09.005. Epub 2019 Oct 2.
Previous studies reported improved continence recovery by bladder neck sparing (BNS) in prostate cancer patients treated with robot-assisted laparoscopic radical prostatectomy (RALP), without compromising biochemical recurrence (BCR). We compared the continence outcomes, surgical margin rates, and BCR risk of BNS vs. bladder neck reconstruction (BNR) patients during RALP.
Overall, 1,512 patients who underwent RALP with BNS or BNR between 2010 and 2017 in a single high-volume center, were identified. Logistic regression models tested the effect of BNS on continence and surgical margin rates. Cox regression models tested the effect of BNS on BCR. Continence was defined as the use of 0 or 1-safety pad per day.
Three hundred and eighty-two vs. 1,130 patients underwent BNS vs. BNR. The median time to catheter removal was significantly shorter (5 vs. 8 days) in patients with BNS. Pad-free rates at 7 days after catheter removal were 60.0% vs. 54.5%, continence rates were 80.1% vs. 78.3% after 3 months and 85.3% vs. 89.6% after 1 year for BNS and BNR, respectively. Multivariable models revealed that BNS is an independent predictor to be pad-free at 7 days after catheter removal (OR: 1.39, P = 0.04), but no predictor for continence at 3 months (OR: 1.02, P = 0.9) and 1 year (OR: 0.78, P = 0.4) after RALP, as well as for positive surgical margin (OR: 0.95, P = 0.8) and BCR (Hazard ratio: 0.95, P = 0.9).
Patients with BNS had a better chance to be pad-free at 7 days after catheter removal and had a significant shorter time to catheter removal. However, this beneficial effect disappeared with time and no differences in continence rates at 3 months and 1 year were recorded. Moreover, BNS did not negatively affect positive margin or BCR rates.
先前的研究报告称，在接受机器人辅助腹腔镜前列腺癌根治术（RALP）治疗的前列腺癌患者中，通过保留膀胱颈（BNS）可以提高控尿功能的恢复，而不会影响生化复发（BCR）。我们比较了 RALP 中 BNS 与膀胱颈重建（BNR）患者的控尿结果、切缘阳性率和 BCR 风险。
我们在一家高容量中心确定了 2010 年至 2017 年间接受 RALP 并进行 BNS 或 BNR 的 1512 例患者。逻辑回归模型测试了 BNS 对控尿和切缘阳性率的影响。Cox 回归模型测试了 BNS 对 BCR 的影响。控尿定义为每天使用 0 或 1 个安全垫。
382 例患者行 BNS，1130 例患者行 BNR。BSN 患者的导管拔除时间明显缩短（5 天 vs. 8 天）。导管拔除后 7 天无尿垫率分别为 60.0% vs. 54.5%，3 个月时的控尿率分别为 80.1% vs. 78.3%，1 年后分别为 85.3% vs. 89.6%，BSN 和 BNR。多变量模型显示，BSN 是导管拔除后 7 天无尿垫的独立预测因素（OR：1.39，P=0.04），但不是 3 个月（OR：1.02，P=0.9）和 1 年（OR：0.78，P=0.4）时控尿的预测因素，以及阳性切缘（OR：0.95，P=0.8）和 BCR（危险比：0.95，P=0.9）。
BSN 患者在导管拔除后 7 天无尿垫的几率更高，拔管时间明显缩短。然而，这种有益的效果随着时间的推移而消失，3 个月和 1 年的控尿率没有差异。此外，BSN 不会对阳性切缘或 BCR 率产生负面影响。
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