Department of Urology, Korea University College of Medicine, Seoul, Korea.
Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea.
Investig Clin Urol. 2022 Nov;63(6):639-646. doi: 10.4111/icu.20220235.
Recently, the modified apical dissection (MAD) technique in robot-assisted laparoscopic radical prostatectomy (RARP) has shown excellent functional outcomes but has never been rigorously validated at various institutions. This study aimed to evaluate the effect of MAD on early continence and potency compared with the anterior suspension stitch (SS) technique.
A total of 100 patients who underwent RARP with SS and 100 who underwent RARP with MAD by a single surgeon were propensity score matched and retrospectively compared for continence and potency recovery at 1 week and 1, 3, 6, 9, and 12 months.
Continence was reached in 20.6%, 33.3%, 67.2%, 74.1%, 81.1%, and 83.0% of patients in the SS group, compared with 49.2%, 73.3%, 86.8%, 96.6%, 100.0%, and 100.0% in the MAD group at postoperative 1 week and 1, 3, 6, 9, and 12 months, respectively. In the SS group, potency rates were 0.0%, 20.0%, 50.0%, 66.7%, 75.0%, and 83.3%; in the MAD group, the rates were 50.0%, 90.0%, 88.9%, 100.0%, 100.0%, and 100.0%. Recovery of continence was higher in the MAD group within the first 6 months (p=0.005, <0.010, 0.041, 0.016 at 1 week, 1, 3, and 6 months). There were no significant differences in potency recovery rates between the two groups (all p≥0.05).
The MAD technique results in earlier recovery of continence compared with the SS technique.
最近，机器人辅助腹腔镜根治性前列腺切除术（RARP）中的改良顶部分离（MAD）技术显示出了优异的功能结果，但在不同机构从未经过严格验证。本研究旨在评估 MAD 与前悬缝合（SS）技术相比对早期控尿和勃起功能恢复的影响。
共对 100 例行 SS 的 RARP 患者和 100 例行 MAD 的 RARP 患者进行了倾向评分匹配，并对两组患者在术后 1 周和 1、3、6、9 和 12 个月时的控尿和勃起功能恢复情况进行了回顾性比较。
SS 组患者在术后 1 周和 1、3、6、9 和 12 个月时的控尿率分别为 20.6%、33.3%、67.2%、74.1%、81.1%和 83.0%，而 MAD 组患者分别为 49.2%、73.3%、86.8%、96.6%、100.0%和 100.0%。在 SS 组中，勃起功能恢复率为 0.0%、20.0%、50.0%、66.7%、75.0%和 83.3%；在 MAD 组中，这些比例分别为 50.0%、90.0%、88.9%、100.0%、100.0%和 100.0%。在术后前 6 个月，MAD 组的控尿恢复率更高（p=0.005、<0.010、0.041、0.016，在术后 1 周、1、3 和 6 个月）。两组之间的勃起功能恢复率无显著差异（均 p≥0.05）。
与 SS 技术相比，MAD 技术可更早恢复控尿功能。
