Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
Division of Urology, Department of Oncology, School of Medicine, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
Minerva Urol Nephrol. 2021 Apr;73(2):165-177. doi: 10.23736/S2724-6051.20.04146-6. Epub 2020 Nov 17.
Urinary incontinence is one of the most scared sequelae of robot assisted radical prostatectomy (RARP). Therefore, different surgical modifications, aimed to restore the original anatomy, were proposed to overcome this issue. The purpose of this study is to assess which is the best reconstruction technique (posterior only: PR; anterior only: AR; total: TR) compared to the standard approach for continence recovery after RARP in a tertiary care center.
After establishing an a priori protocol, a systematic electronic literature search was conducted in May 2019. The article selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO registry number 131667). The risk of bias and the quality assessment of the included studies were performed. Simple pooled analysis was performed for continence rates according to the definition of continence (0 pad vs. 0-1 pad) and the different types of reconstruction at 1, 4, 12, 24, 52 weeks after RARP. Complication rate, operative and console time and estimated blood loss were pooled. Two-side test of proportion and T-test were used to compare rates and mean, respectively.
Six studies meeting the inclusion criteria were found and included in the analysis. All the included studies were of "poor" or "good" quality. A high or moderate risk of bias was recorded. TR showed higher continence recovery rates, compared to their anterior reconstruction counterpart at 1, 4, 12, 24, 52 weeks (P<0.001 at all time-points). At 12 weeks TR showed the highest continence rates (P<0.001), followed by AR and PR. No statistically significant differences were recorded regarding anastomosis-related complication rates (anastomosis stricture P=0.08; urine leakage P=0.1).
In patients undergoing RARP, TR facilitates a faster and higher continence recovery compared to standard approach or PR or AR only.
尿失禁是机器人辅助根治性前列腺切除术（RARP）后最令人恐惧的后遗症之一。因此，为了克服这个问题，提出了不同的手术改良方法，旨在恢复原始解剖结构。本研究的目的是评估在三级护理中心，哪种重建技术（仅后位：PR；仅前位：AR；总位：TR）在 RARP 后恢复控尿方面优于标准方法。
在建立了一个预先协议之后，于 2019 年 5 月进行了系统的电子文献检索。文章选择符合系统评价和荟萃分析的首选报告项目（PRISMA）指南，并进行了登记（PROSPERO 注册号 131667）。对纳入研究的偏倚风险和质量进行了评估。根据控尿定义（0 垫与 0-1 垫）和 RARP 后 1、4、12、24、52 周不同重建类型，对控尿率进行简单的汇总分析。汇总了并发症发生率、手术和控制台时间以及估计失血量。使用双侧检验和 T 检验分别比较比率和平均值。
发现并纳入了符合纳入标准的六项研究。所有纳入的研究质量均为“差”或“好”。记录了高或中度偏倚风险。与前重建相比，TR 在 1、4、12、24、52 周时显示出更高的控尿恢复率（所有时间点均 P<0.001）。在 12 周时，TR 显示出最高的控尿率（P<0.001），其次是 AR 和 PR。吻合口相关并发症发生率无统计学差异（吻合口狭窄 P=0.08；尿漏 P=0.1）。
在接受 RARP 的患者中，与标准方法或仅 PR 或 AR 相比，TR 可更快地恢复更高的控尿能力。
