Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy.
Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy.
Eur Urol. 2021 Apr;79(4):530-536. doi: 10.1016/j.eururo.2021.01.028. Epub 2021 Feb 4.
Urinary continence recovery after radical prostatectomy is a major issue even in the robotic era. Surgical techniques aimed at improving earlier return to continence are continuously sought.
To describe our novel surgical technique of urethral fixation during robot-assisted radical prostatectomy (RARP) and to assess early urinary continence recovery and perioperative complications.
DESIGN, SETTING, AND PARTICIPANTS: A prospective, single-center, single-surgeon cohort of 70 consecutive patients undergoing RARP between January and December 2019 was analyzed. A study group of 35 patients operated on with the urethral fixation technique was compared with a control group of 35 patients receiving standard vesicourethral anastomosis.
Urethral fixation versus standard vesicourethral anastomosis during RARP was evaluated. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of the levator ani muscle posterolaterally. The same posterior musculofascial reconstruction incorporating the vesicourethral anastomosis was performed in both groups.
Urinary continence recovery, perioperative complications, operating room time, and estimated blood loss were recorded and compared between the two groups.
The two groups were comparable with regard to all demographic, clinical, and pathological variables. Recovery of urinary continence at 3 mo after catheter removal was reported by 34 (97.1%) patients in the study and 28 (80%) patients in the control group (p = 0.02). Patients in the study group reported significantly higher rates of urinary continence even at 1 wk and 1 mo after catheter removal compared with the control group (68.6% vs 45.7%, p = 0.04, and 80% vs 54.3%, p = 0.04, respectively). No differences were observed in operating room time (p = 0.7) or estimated blood loss (p = 0.65). Ninety-day postoperative complications were observed in one (2.9%) patient in the study and in four (11.4%) in the control group (p = 0.3). The main limitation is the nonrandomized comparison of relatively small cohorts.
In our study, we observed a significant improvement in early urinary continence recovery, with no increase in operating room time or perioperative complications, using the novel urethral fixation technique compared with the standard vesicourethral anastomosis during RARP.
We describe our novel surgical technique of urethral fixation during robot-assisted radical prostatectomy. Compared with the standard technique, utilization of our technique was found to be associated with an improved early recovery of urinary continence, with no increase in operating room time or perioperative complications.
即使在机器人时代，根治性前列腺切除术后的尿控恢复仍然是一个主要问题。人们一直在寻求旨在改善早期尿控恢复的手术技术。
描述我们在机器人辅助根治性前列腺切除术（RARP）中进行尿道固定的新手术技术，并评估早期尿控恢复和围手术期并发症。
设计、地点和参与者：对 2019 年 1 月至 12 月期间进行 RARP 的 70 例连续患者进行了前瞻性、单中心、单外科医生队列分析。将 35 例接受尿道固定技术手术的研究组与 35 例接受标准膀胱尿道吻合术的对照组进行比较。
评估 RARP 期间的尿道固定与标准膀胱尿道吻合术。在研究组中，尿道残端向后固定在后正中嵴上，并向后外侧固定在肛提肌的内侧部分。两组均进行了相同的包括膀胱尿道吻合术的后部肌肉筋膜重建。
记录并比较两组患者的尿控恢复情况、围手术期并发症、手术室时间和估计失血量。
两组在所有人口统计学、临床和病理变量方面均具有可比性。研究组中有 34 例（97.1%）患者在拔除导尿管后 3 个月恢复尿控，对照组中有 28 例（80%）患者恢复尿控（p=0.02）。与对照组相比，研究组患者在拔除导尿管后 1 周和 1 个月时报告尿控的比例明显更高（68.6%比 45.7%，p=0.04 和 80%比 54.3%，p=0.04）。两组手术室时间（p=0.7）或估计失血量（p=0.65）无差异。研究组有 1 例（2.9%）患者和对照组有 4 例（11.4%）患者在术后 90 天发生术后并发症（p=0.3）。主要限制是相对较小队列的非随机比较。
与标准膀胱尿道吻合术相比，我们在 RARP 中使用新的尿道固定技术观察到早期尿控恢复显著改善，而手术时间和围手术期并发症无增加。
我们描述了我们在机器人辅助根治性前列腺切除术期间进行尿道固定的新手术技术。与标准技术相比，我们的技术的应用被发现与早期尿控恢复的改善相关，而手术时间和围手术期并发症没有增加。
