Hikita Katsuya, Honda Masashi, Shimizu Ryutaro, Teraoka Shogo, Kawamoto Bunya, Yumioka Tetsuya, Tsounapi Panagiota, Iwamoto Hideto, Morizane Shuichi, Takenaka Atsushi
Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
Low Urin Tract Symptoms. 2022 May;14(3):178-185. doi: 10.1111/luts.12421. Epub 2021 Dec 2.
The aim of this study was to investigate the longitudinal 5-year long-term outcomes for urinary continence and quality of life (QOL) after robot-assisted radical prostatectomy (RARP), particularly nerve-sparing.
Among patients who underwent RARP between October 2010 and October 2015, postoperative urinary symptoms were retrospectively examined using the International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), QOL index, and number of pads used. Patients were divided into nerve-sparing and non-nerve-sparing groups, and all data were evaluated before and at 1, 3, 6, 12, 24, 36, 48, and 60 months after surgery.
After propensity score matching, 47 patients each were included in the two groups. No significant difference in the IPSS or QOL index was seen between groups. The IPSS and QOL index showed an increase in the first month after RARP, but at 6 months, values were lower than preoperative levels and then slowly improved. Pad-free rates at 5 years after surgery were 93.6% and 80.1% in the nerve-sparing and non-nerve-sparing groups, respectively (P = .029). ICIQ-SF scores were significantly improved in the nerve-sparing compared with the non-nerve-sparing group at 1, 3, and 6 months after surgery. After 12 months, no significant changes were identified until 60 months.
In this study, nerve-sparing had a strong impact on urinary continence in the early postoperative period. After 12 months, urinary continence remained stable until 60 months.
本研究旨在探讨机器人辅助根治性前列腺切除术（RARP）后5年的尿失禁纵向长期结局及生活质量（QOL），尤其是保留神经的情况。
在2010年10月至2015年10月接受RARP的患者中，采用国际前列腺症状评分（IPSS）、国际尿失禁咨询问卷简表（ICIQ-SF）、生活质量指数和使用的尿垫数量对术后尿路症状进行回顾性检查。患者分为保留神经组和非保留神经组，所有数据在术前以及术后1、3、6、12、24、36、48和60个月进行评估。
倾向得分匹配后，两组各纳入47例患者。两组间IPSS或生活质量指数无显著差异。IPSS和生活质量指数在RARP术后第一个月有所升高，但在6个月时，数值低于术前水平，随后缓慢改善。保留神经组和非保留神经组术后5年的无尿垫率分别为93.6%和80.1%（P = 0.029）。术后1、3和6个月时，保留神经组的ICIQ-SF评分与非保留神经组相比有显著改善。12个月后，直到60个月均未发现显著变化。
在本研究中，保留神经在术后早期对尿失禁有显著影响。12个月后，尿失禁情况一直稳定至60个月。
