Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Urology, The Second Affiliated Hospital of Soochow University, Jiangsu, China.
BJU Int. 2023 Jun;131(6):720-728. doi: 10.1111/bju.15956. Epub 2023 Jan 9.
To evaluate the impact of sustainable functional urethral reconstruction (SFUR) on early recovery of urinary continence (UC) after robot-assisted radical prostatectomy.
Overall, 96 patients with primary prostate cancer were randomised into the SFUR or standard group (n = 48 each). The primary outcome was the 1-month UC recovery. Secondary outcomes included short-term (≤3 months) UC recovery, urinary function, micturition-related bother, perioperative complications, and oncological outcomes. Kaplan-Meier curves and Cox proportional hazard models were used to assess the 3-month UC recovery. Generalised estimating equations were used to compare postoperative urinary function and micturition-related bother.
The 1-month UC recovery rates, median 24-h pad weights, and median operative time in the SFUR and standard groups were 73% and 49% (P = 0.017), 0 and 47 g (P = 0.001), and 125 and 103 min (P = 0.025), respectively. The UC recovery rates in the SFUR vs standard groups were 53% vs 23% at 1 week (P = 0.003), 53% vs 32% at 2 weeks (P = 0.038), and 93% vs 77% at 3 months (P = 0.025). The median time to UC recovery in the SFUR and standard groups was 5 and 34 days, respectively (log-rank P = 0.006); multivariable Cox regression supported this result (hazard ratio 1.73, 95% confidence interval 1.08-2.79, P = 0.024). Similar results were observed when UC was defined as 0 pads/day. Urinary function (P = 0.2) and micturition-related bother (P = 0.8) were similar at all follow-up intervals. The perioperative complication rates, positive surgical margin rates, and 1-year biochemical recurrence-free survival were comparable between both groups (all P > 0.05).
SFUR resulted in earlier UC recovery without compromising postoperative urinary function. Long-term validation and multicentre studies are required to confirm the results of this novel technique.
评估可持续性功能尿道重建（SFUR）对机器人辅助根治性前列腺切除术后早期尿控（UC）恢复的影响。
共有 96 例原发性前列腺癌患者被随机分为 SFUR 组或标准组（每组 48 例）。主要结局是 1 个月 UC 恢复情况。次要结局包括短期（≤3 个月）UC 恢复情况、尿功能、排尿相关困扰、围手术期并发症和肿瘤学结局。采用 Kaplan-Meier 曲线和 Cox 比例风险模型评估 3 个月 UC 恢复情况。采用广义估计方程比较术后尿功能和排尿相关困扰。
SFUR 组和标准组的 1 个月 UC 恢复率、中位 24 小时垫重和中位手术时间分别为 73%和 49%（P=0.017）、0 和 47g（P=0.001）和 125 和 103min（P=0.025）。SFUR 组与标准组在 1 周时的 UC 恢复率分别为 53%和 23%（P=0.003）、2 周时分别为 53%和 32%（P=0.038）和 3 个月时分别为 93%和 77%（P=0.025）。SFUR 组和标准组的 UC 恢复中位时间分别为 5 天和 34 天（对数秩 P=0.006）；多变量 Cox 回归支持这一结果（风险比 1.73，95%置信区间 1.08-2.79，P=0.024）。当 UC 定义为 0 片/天时也观察到类似的结果。在所有随访间隔，尿功能（P=0.2）和排尿相关困扰（P=0.8）相似。两组的围手术期并发症发生率、切缘阳性率和 1 年生化无复发生存率相当（均 P>0.05）。
SFUR 可实现早期 UC 恢复，而不影响术后尿功能。需要进行长期验证和多中心研究来确认这项新技术的结果。
