Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
J Robot Surg. 2023 Oct;17(5):2279-2285. doi: 10.1007/s11701-023-01640-9. Epub 2023 Jun 19.
The incontinence after RARP significantly decreases the quality of life in prostate cancer patients. A number of techniques have been introduced for the recovery of continence after RARP. Although, the mechanism of the continence recovery is still unclear. We aimed to evaluate the early recovery of continence after RARP by inducing early anterior adhesion and reducing the hypermobility of the urethra through the modified bladder neck suspension (BNS) procedure. From March 2018 to February 2020, a total of 227 consecutive patients who underwent RARP (by single surgeon) were included. Patients were divided into two groups based on operation procedure (Standard procedure vs BNS procedure). Demographics, perioperative variables, and pathologic outcome were analyzed. We assessed recovery of continence at 1, 3, 6 and 9 months after surgery. Postoperative recovery of continence defined as the use of no pad during 24 h. Multivariable logistic regression analyses were performed to evaluate independent predictors of the early recovery of continence at 1 month. We performed RARP with standard procedure (n = 106) or BNS procedure (n = 121). There was no statistical difference in perioperative variables between the two groups except anastomosis time (21.6 ± 12.9 vs 17.0 ± 7.6, p = 0.003). The pad free continence rate were 80.2% (standard group) and 91.3% (BNS group) at 9 month after RARP (p = 0.037). However, early continence rate (1mo) were significantly higher in the BNS group (12.3% vs 29.1%, p = 0.004). On multivariate logistic analyses, BNS procedure (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.03-7.45, p = 0.0426), age (OR 0.92, CI 0.86-0.98, p = 0.0154) were independent factor for early recovery of continence after RARP. The modified bladder neck suspension procedure showed significantly better outcomes than the standard procedure in terms of the early recovery of urinary continence.
根治性前列腺切除术(RARP)后尿失禁显著降低了前列腺癌患者的生活质量。目前已经引入了许多技术来恢复 RARP 后的尿失禁。尽管如此，尿失禁恢复的机制仍不清楚。我们旨在通过改良膀胱颈悬吊术（BNS）来诱导早期前粘连和减少尿道的过度活动，从而评估 RARP 后早期尿失禁的恢复情况。
从 2018 年 3 月至 2020 年 2 月，共纳入了 227 例由同一位外科医生进行 RARP 的连续患者。根据手术操作（标准操作与 BNS 操作）将患者分为两组。分析了患者的人口统计学、围手术期变量和病理结果。我们评估了术后 1、3、6 和 9 个月的尿失禁恢复情况。术后尿失禁恢复定义为 24 小时内不使用尿垫。采用多变量逻辑回归分析评估术后 1 个月尿失禁早期恢复的独立预测因素。我们采用标准手术（n=106）或 BNS 手术（n=121）进行 RARP。两组患者的围手术期变量无统计学差异，除吻合时间外（21.6±12.9 与 17.0±7.6，p=0.003）。RARP 术后 9 个月，无垫尿失禁率分别为 80.2%（标准组）和 91.3%（BNS 组）（p=0.037）。然而，BNS 组的早期尿失禁率（1mo）显著更高（12.3%与 29.1%，p=0.004）。多变量逻辑回归分析显示，BNS 操作（比值比[OR]2.78，95%置信区间[CI]1.03-7.45，p=0.0426）、年龄（OR0.92，CI0.86-0.98，p=0.0154）是 RARP 后早期尿失禁恢复的独立因素。
改良膀胱颈悬吊术在早期恢复尿控方面的效果明显优于标准术式。
