Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Urology, Dong-A University College of Medicine, Busan, Republic of Korea.
PLoS One. 2020 Jan 13;15(1):e0227744. doi: 10.1371/journal.pone.0227744. eCollection 2020.
To evaluate early recovery of urinary continence after robot-assisted radical prostatectomy (RARP) with urethral realignment using bladder neck preservation (BNP) and maximal urethral length preservation (MULP).
Patients who underwent RARP between 2014 and 2017 owing to prostate cancer with a Gleason score ≤ 7 (3+4), ≤ cT2c stage, and prostate-specific antigen level < 20 ng/ml were investigated. Patients with tumors of the bladder neck or apex on magnetic resonance imaging were excluded. A total of 266 patients underwent the operation using the standard method between 2014 and 2015 (group 1), while 305 patients underwent urethral realignment between 2016 and 2017 (group 2). Continence was defined as wearing no pad or one security pad.
The continence rates immediately after Foley catheter removal, at 2 weeks, and at 1, 3, 6, and 12 months after operation in group 2 were 46.9%, 63.0%, 73.4%, 90.1%, 94.8%, and 98.7%, respectively. The continence rate at 1 month in group 2 was significantly higher than that in group 1 (65.4% versus 73.4%, p = 0.037). The multivariate regression analysis showed that age and surgical method were factors affecting early continence recovery. The positive surgical margin rates were 18.0% and 14.8% in groups 1 and 2, respectively (p = 0.288). Biochemical recurrence occurred in 14.7% and 8.2% in groups 1 and 2, respectively (p = 0.015).
Urethral realignment using BNP and MULP resulted in rapid continence recovery and good oncological results after RARP in young patients with a Gleason score ≤ 7 and organ-confined disease.
评估保留膀胱颈（BNP）和最大尿道长度（MULP）的尿道重新排列在机器人辅助根治性前列腺切除术后（RARP）早期恢复尿控的作用。
对 2014 年至 2017 年间因前列腺癌（Gleason 评分≤7（3+4）、cT2c 期和前列腺特异性抗原水平<20ng/ml）而行 RARP 的患者进行了研究。排除磁共振成像上有膀胱颈或顶点肿瘤的患者。2014 年至 2015 年期间，266 例患者采用标准方法进行手术（组 1），2016 年至 2017 年期间，305 例患者行尿道重新排列（组 2）。控尿定义为不佩戴或仅佩戴一个安全垫。
组 2 患者在拔除 Foley 导尿管后即刻、2 周以及术后 1、3、6 和 12 个月时的控尿率分别为 46.9%、63.0%、73.4%、90.1%、94.8%和 98.7%。组 2 患者在术后 1 个月的控尿率明显高于组 1（65.4%比 73.4%，p=0.037）。多因素回归分析显示，年龄和手术方法是影响早期控尿恢复的因素。组 1 和组 2 的阳性切缘率分别为 18.0%和 14.8%（p=0.288）。生化复发率分别为 14.7%和 8.2%（p=0.015）。
在 Gleason 评分≤7 且器官局限性疾病的年轻患者中，保留膀胱颈和最大尿道长度的尿道重新排列可使 RARP 术后早期控尿恢复迅速，并获得良好的肿瘤学结果。
