Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
J Robot Surg. 2022 Oct;16(5):1175-1181. doi: 10.1007/s11701-021-01357-7. Epub 2022 Jan 29.
We assessed whether the severity of anastomotic urinary leakage detected during routine cystourethrography after robot-assisted laparoscopic prostatectomy (RALP) affects urinary continence recovery. Around 302 patients who underwent RALP between August 2013 and May 2019 were included retrospectively. According to routine cystourethrographic findings obtained on the sixth or eighth postoperative day, which indicated leakage severity, patients were divided into three groups: no-leakage, grade 1 (linear shaped leakage, but not spreading), and grade 2 (spreading strip-shaped leakage). The preoperative factors and intraoperative factors were compared between no-leakage and leakage group (grade 1 and grade 2). Continence recovery was compared between the three groups. Continence recovery was defined as no pad used or one security pad used in a day. Cystourethrography revealed anastomotic urinary leakage in 44 patients (14.5%), of which 20 patients (6.6%) had grade 1 leakage and 24 patients (7.9%) had grade 2 leakage. On multivariate logistic regression analysis, the only significant predictor for urethrovesical anastomotic urinary leakage on cystourethrography following RALP was intraoperative anastomotic leakage (OR 5.306; 95% CI 1.530-18.398, p = 0.009). Continence recovery rates for no-leakage, grade 1 leakage, and grade 2 leakage groups were 11%, 20%, and 25% after 1 month (P = 0.131); 25%, 25%, and 45.8% after 3 months (P = 0.474); 44.6%, 55%, and 60.8% after 6 months (P = 0.184); and 63.1%, 87.5%, and 78.2% after 12 months (P = 0.095), respectively. In conclusion, urinary leakage in urethrovesical anastomosis, even at its severity, had no negative effects on continence recovery after RALP.
我们评估了机器人辅助腹腔镜前列腺切除术（RALP）后常规膀胱尿道造影术（cystourethrography）期间检测到的吻合口尿漏的严重程度是否影响尿控恢复。回顾性纳入了 2013 年 8 月至 2019 年 5 月期间接受 RALP 的约 302 例患者。根据术后第 6 或第 8 天常规膀胱尿道造影的结果，将患者分为无漏尿、1 级（线性漏尿，但不扩散）和 2 级（扩散条状漏尿）。比较无漏尿和漏尿组（1 级和 2 级）之间的术前和术中因素。比较三组的控尿恢复情况。控尿恢复定义为每天不使用尿垫或仅使用一片安全垫。膀胱尿道造影显示 44 例（14.5%）患者存在吻合口尿漏，其中 20 例（6.6%）为 1 级漏尿，24 例（7.9%）为 2 级漏尿。多变量逻辑回归分析显示，RALP 后膀胱尿道造影显示尿道膀胱吻合口尿漏的唯一显著预测因素是术中吻合口漏尿（OR 5.306；95%CI 1.530-18.398，p=0.009）。无漏尿、1 级漏尿和 2 级漏尿组在 1 个月时的控尿恢复率分别为 11%、20%和 25%（P=0.131）；3 个月时分别为 25%、25%和 45.8%（P=0.474）；6 个月时分别为 44.6%、55%和 60.8%（P=0.184）；12 个月时分别为 63.1%、87.5%和 78.2%（P=0.095）。结论：尿道膀胱吻合口漏尿，即使严重，对 RALP 后控尿恢复也无负面影响。
