Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Department of Urology, Nagoya East Medical Center, Nagoya, Aichi, Japan.
J Endourol. 2021 Mar;35(3):296-304. doi: 10.1089/end.2020.0463. Epub 2020 Nov 5.
To elucidate factors contributing to early urinary continence recovery after retzius-sparing robot-assisted radical prostatectomy (RS-RARP) by evaluating postoperative pelvic anatomical features between RS-RARP and conventional RARP (CON-RARP). We retrospectively examined 50 men who underwent RS-RARP ( = 25; the RS-RARP group) and CON-RARP ( = 25; the CON-RARP group) between October 2017 and June 2018. Perioperative outcomes and postoperative urinary continence were assessed in both groups. Anatomical features including the bladder neck-to-pubic symphysis ratio (determined from cystograms) and membranous urethral length (MUL) (determined from magnetic resonance imaging) were evaluated. The daily urinary incontinence rate at discharge was significantly lower in the RS-RARP group than in the CON-RARP group (0.046 [range: 0.014-0.160] 0.357 [range: 0.139-0.616], < 0.001). Postoperative urinary continence at 1, 3, 6, and 12 months was 80%, 92%, 96%, and 96% in the RS-RARP group and 24%, 40%, 68%, and 84% in the CON-RARP group, respectively ( < 0.001). The urgency scores in the international prostate symptom score (IPSS) questionnaire at 1 and 3 months were significantly lower in the RS-RARP than in the CON-RARP group ( = 0.028 and 0.033, respectively). The quality of life (QOL) indices were more significantly improved in the RS-RARP group than in the CON-RARP group 1 month ( = 0.027) and 3 months ( = 0.045) postoperatively. Receiver operating characteristic analysis revealed that a postoperative MUL of 12.1 mm (area under the curve: 0.852) was the optimal cutoff value predictive of continence recovery after 1 month. Multivariate analysis demonstrated that RS-RARP (odds ratio [OR]: 23.6; < 0.001) and prostate volume (OR: 0.926; = 0.049) were the independent factors of a longer MUL. RS-RARP results in an early continence recovery and a better urgency score in the IPSS by suppressing the descent of the bladder and maintaining a long MUL. RS-RARP may contribute to a better QOL recovery after RARP.
为了通过评估 Retzius 保留机器人辅助根治性前列腺切除术 (RS-RARP) 后骨盆解剖特征来阐明导致术后早期尿控恢复的因素，我们回顾性地检查了 50 名于 2017 年 10 月至 2018 年 6 月期间接受 RS-RARP（ = 25；RS-RARP 组）和常规 RARP（CON-RARP； = 25；CON-RARP 组）的男性。对两组患者的围手术期结果和术后尿控情况进行评估。评估了包括膀胱颈耻骨联合比（通过膀胱造影确定）和膜性尿道长度（MUL）（通过磁共振成像确定）在内的解剖特征。RS-RARP 组患者出院时的每日尿失禁率明显低于 CON-RARP 组（0.046 [范围：0.014-0.160] vs. 0.357 [范围：0.139-0.616]， < 0.001）。RS-RARP 组术后 1、3、6 和 12 个月的尿控率分别为 80%、92%、96%和 96%，CON-RARP 组分别为 24%、40%、68%和 84%（ < 0.001）。RS-RARP 组的国际前列腺症状评分（IPSS）问卷中的紧迫性评分在 1 个月和 3 个月时明显低于 CON-RARP 组（ = 0.028 和 0.033）。1 个月（ = 0.027）和 3 个月（ = 0.045）时，RS-RARP 组的生活质量（QOL）指数明显改善。受试者工作特征分析显示，术后 MUL 为 12.1 mm（曲线下面积：0.852）是预测术后 1 个月内恢复控尿的最佳截断值。多变量分析表明，RS-RARP（比值比 [OR]：23.6； < 0.001）和前列腺体积（OR：0.926； = 0.049）是 MUL 较长的独立因素。RS-RARP 通过抑制膀胱下降和保持较长的 MUL，导致早期尿控恢复和 IPSS 中的紧迫性评分降低。RS-RARP 可能有助于 RARP 后更好地恢复 QOL。
