Marchioni Michele, Primiceri Giulia, Castellan Pietro, Schips Luigi, Mantica Guglielmo, Chapple Christopher, Papalia Rocco, Porpiglia Francesco, Scarpa Roberto M, Esperto Francesco
Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. d'Annunzio University, Chieti, Italy -
Department of Urology, ASL Abruzzo 2, Chieti, Italy -
Minerva Urol Nefrol. 2020 Oct;72(5):555-562. doi: 10.23736/S0393-2249.20.03782-0. Epub 2020 May 20.
Robotic assisted radical prostatectomy (RARP) is getting more and more popular becoming the most common radical prostatectomy technique. Unfortunately, a not negligible proportion of patients in whom RARP is performed experience urinary incontinence. We aimed to systematically review the current literature evidence on urinary incontinence conservative treatment after RARP.
A systematic literature review search using PubMed (Medline), Scopus, and Web of Science databases was performed in December 2019. PRISMA guidelines have been adopted. Population consisted of patients with urinary incontinence after RARP (P), conservative intervention was considered of interest (I). No comparator was considered mandatory (C). Outcomes of interest were the recovery of continence and quality of life (O).
Six studies were included. Four of them investigated the use of pelvic floor muscle training (PFMT). PFMT improved pelvic muscle strength. Continence recovery was faster when guided PFMT was adopted. Moreover, two studies tested the effect of solifenacin on urinary incontinence. One of them, a randomized clinical trial, failed to show shorter time to continence in solifenacin group compared to placebo.
The use of pads is associated with a detrimental effect on quality of life thus active treatments for UI post-RARP are warranted. PFMT has the main advantage to shorten the time for recovery. The use of solifenacin seems to not offer striking advantages in UI following RARP. Future studies should focus on testing the efficacy of these treatments when used after robotic vs. open radical prostatectomy.
机器人辅助根治性前列腺切除术（RARP）越来越受欢迎，成为最常见的根治性前列腺切除技术。不幸的是，接受RARP手术的患者中有相当一部分出现尿失禁。我们旨在系统回顾目前关于RARP术后尿失禁保守治疗的文献证据。
2019年12月，使用PubMed（Medline）、Scopus和Web of Science数据库进行了系统的文献综述检索。采用了PRISMA指南。研究对象为RARP术后尿失禁患者（P），感兴趣的保守干预措施为（I）。未将对照视为必需条件（C）。感兴趣的结果是控尿恢复和生活质量（O）。
纳入了六项研究。其中四项研究调查了盆底肌训练（PFMT）的使用情况。PFMT可提高盆底肌肉力量。采用指导性PFMT时，控尿恢复更快。此外，两项研究测试了索利那新对尿失禁的影响。其中一项随机临床试验未显示索利那新组与安慰剂组相比控尿时间更短。
使用尿垫对生活质量有不利影响，因此RARP术后尿失禁的积极治疗是必要的。PFMT的主要优点是缩短恢复时间。索利那新在RARP术后尿失禁治疗中似乎没有显著优势。未来的研究应侧重于测试这些治疗方法在机器人辅助与开放性根治性前列腺切除术后使用时的疗效。
