Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
BMC Urol. 2022 Sep 7;22(1):145. doi: 10.1186/s12894-022-01097-2.
We assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA).
Clinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation.
Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (< 25 kg/m) (p = 0.040), longer preoperative MUL (≥ 9.5 mm) (p = 0.013), longer postoperative MUL (≥ 9 mm) (p < 0.001), higher PVUA (< 14.5 mm) (p = 0.019) and shorter operating time (< 170 min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90-7.40, p < 0.001) and higher PVUA (OR 2.02, 95% CI 1.07-3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into 3 groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% versus 68.2% versus 85.0% (p < 0.001) at 3 months.
PVUA and postoperative MUL were significant factors for short-term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.
我们评估机器人辅助腹腔镜根治性前列腺切除术（RARP）后短期尿失禁恢复是否与术后膜状尿道长度（MUL）和膀胱尿道吻合术位置（PVUA）有关。
评估了 2019 年 8 月至 2021 年 2 月期间接受 RARP 的 251 例患者的 PVUA 和术前及术后 MUL 等临床变量。通过患者在至少 6 个月的随访中每天进行一次访谈，评估有无垫或一个安全衬垫来确定是否恢复尿控。使用单变量和多变量逻辑回归分析来评估与术后 3 个月时恢复尿控相关的变量。
术后 3 个月和 6 个月的尿控恢复率分别为 75%和 84%。较低的 BMI（<25kg/m）（p=0.040）、较长的术前 MUL（≥9.5mm）（p=0.013）、较长的术后 MUL（≥9mm）（p<0.001）、较高的 PVUA（<14.5mm）（p=0.019）和较短的手术时间（<170min）（p=0.013）在单变量分析中与术后 3 个月时的尿控恢复显著相关。多变量分析显示，术后 MUL（OR 3.75，95%CI 1.90-7.40，p<0.001）和较高的 PVUA（OR 2.02，95%CI 1.07-3.82，p=0.032）是尿控恢复的独立因素。根据多变量分析将患者分为 3 组，发现尿控恢复率依次增加，3 个月时分别为 43.7%、68.2%和 85.0%（p<0.001）。
PVUA 和术后 MUL 是短期尿控恢复的重要因素。保留尿道长度可能有助于 RARP 后恢复尿控。
