Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Endourol. 2020 Jun;34(6):663-670. doi: 10.1089/end.2020.0064. Epub 2020 May 5.
To evaluate the feasibility of three bladder neck reconstruction (BNR) techniques in laparoscopic radical prostatectomy (laparoscopic RP) and their effects on urinary continence. We retrospectively analyzed 121 patients with organ-confined prostate cancer, who underwent laparoscopic RP in our center from March to December 2018. Three BNR techniques-zero o'clock reconstruction (ZOR), six o'clock reconstruction (SOR), and three/nine o'clock reconstruction (T/NOR)-applied in patients with large bladder opening after prostate resection are described comprehensively. Demographic and perioperative data were collected and analyzed using Pearson's chi-square and one-way analysis of variance test. Multivariate analysis was performed to explore predictors that affected continence recovery in 24 hours, 1 month, 3 months, and 6 months after catheter removal. Laparoscopic RP was performed in all patients, wherein 37, 35, 34, and 15 patients underwent bladder neck preservation, ZOR, SOR, and T/NOR techniques, respectively. There were more high-risk patients and larger mean prostate volume in groups with BNR techniques. Perioperatively, patients with reconstruction techniques had longer operation and anastomosis time, more estimated blood loss, and more positive margin status. Nevertheless, there was no significant difference among four groups regarding continence recovery in 24 hours, 1 month, 3 months, and 6 months after catheter removal. On multivariable analysis, positive apical margin and long anastomosis time were independent adverse predictors of continence recovery in 24 hours. Large prostate volume and positive apical margin were adverse factors of continence recovery at 1, 3, and 6 months. Three different kinds of BNR techniques were safe and feasible in laparoscopic RP and had no different impact on continence recovery. Positive apical margin, large prostate volume, and long anastomosis time were independent adverse predictors of continence.
评估三种膀胱颈重建（BNR）技术在腹腔镜前列腺根治性切除术（腹腔镜 RP）中的可行性及其对尿控的影响。我们回顾性分析了 2018 年 3 月至 12 月在我院行腹腔镜 RP 的 121 例局限于器官的前列腺癌患者。详细描述了三种 BNR 技术——零点重建（ZOR）、六点重建（SOR）和三点/九点重建（T/NOR）——在前列腺切除术后膀胱开口较大的患者中的应用。收集并分析了人口统计学和围手术期数据，使用 Pearson 卡方检验和单因素方差分析进行分析。使用多变量分析探讨影响拔除导尿管后 24 小时、1 个月、3 个月和 6 个月尿控恢复的预测因素。所有患者均行腹腔镜 RP，其中 37、35、34 和 15 例患者分别行膀胱颈保留术、ZOR、SOR 和 T/NOR 技术。重建组患者中高危患者和前列腺体积较大的患者较多。围手术期，重建组患者的手术和吻合时间较长，估计出血量较多，阳性切缘状态较多。然而，在拔除导尿管后 24 小时、1 个月、3 个月和 6 个月时，四组患者的尿控恢复情况无显著差异。多变量分析显示，阳性顶端切缘和长吻合时间是拔除导尿管后 24 小时尿控恢复的独立不良预测因素。大前列腺体积和阳性顶端切缘是 1、3 和 6 个月时尿控恢复的不良因素。三种不同的 BNR 技术在腹腔镜 RP 中是安全可行的，对尿控恢复没有不同的影响。阳性顶端切缘、大前列腺体积和长吻合时间是尿控的独立不良预测因素。
