Liu Yong, Zhao Qinxin, Yang Feiya, Wang Mingshuai, Xing Nianzeng
Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China.
Department of Urology, Weihai Municipal Hospital, Weihai, 264200, People's Republic of China.
Cancer Manag Res. 2021 Mar 11;13:2341-2347. doi: 10.2147/CMAR.S299367. eCollection 2021.
Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the "Sandwich" urethra reconstruction technique on continence at the early stage after LRP.
During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the "Sandwich" technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated.
There is no statistical difference in patients' basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49±4.72 minutes in Group A and 20.16±5.75 minutes in Group B (<0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (<0.001). Maximum flow rates before and after the "Sandwich" procedure for 12 months were 13.2±2.8 m/s and 15.4±3.6 m/s, respectively (=0.034). In addition, residual volumes before and after the "Sandwich" procedure for 12 months were 15 (0-20) mL and 0 (0-12.5) mL, respectively (=0.107).
Our prospective study confirms that the "Sandwich" technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.
早期尿失禁对生活质量有很大影响，是腹腔镜根治性前列腺切除术（LRP）后常见的一个缺点。这项前瞻性研究旨在进一步记录“三明治”尿道重建技术对LRP术后早期控尿的改善效果。
在2017年10月至2018年12月期间，本机构130例行LRP的患者被纳入这项前瞻性研究。A组66例患者接受采用“三明治”尿道重建技术的LRP，而B组其余64例患者未采用这种重建技术。对基本临床资料、围手术期相关资料、尿控情况及尿动力学检查进行分析和评估。
患者的基本临床资料、除尿道重建时间外的围手术期相关资料无统计学差异，A组尿道重建时间为23.49±4.72分钟，B组为20.16±5.75分钟（<0.001）。A组在术后2、4、8和12周的控尿率分别为54.55%、83.33%、93.94%和96.97%。B组的控尿率分别为10.94%、14.06%、37.50%和71.88%。与B组相比，A组术后控尿率显著更高（<0.001）。“三明治”手术前后12个月的最大尿流率分别为13.2±2.8m/s和15.4±3.6m/s（=0.034）。此外，“三明治”手术前后12个月的残余尿量分别为15（0 - 20）mL和0（0 - 12.5）mL（=0.107）。
我们的前瞻性研究证实，全尿道重建的“三明治”技术是安全可行的。它也很可能在LRP术后早期尿控恢复方面具有显著优势。然而，需要多中心、随机对照大样本随机对照试验来进一步证实这一最终结论。
