Dall Christopher P, Mason J Bradley, Choudhury Eshrar, Mora-Garijo Belen, Egan Jillian, Hu Jim C, Kowalczyk Keith J
Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA.
Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA.
Urol Oncol. 2024 Mar;42(3):67.e17-67.e24. doi: 10.1016/j.urolonc.2023.11.020. Epub 2024 Jan 10.
Prostatic fascia-sparing robotic-assisted radical prostatectomy (PFS-RARP) has improved short-term postoperative continence compared to standard prostatectomy (S-RARP) but long-term differences remain unclear.
One hundred two S-RARP followed by 239 PFS-RARPs were performed by a single surgeon. Univariate analyses were performed with t-test, χ, Wilcoxon rank sum, Fisher exact, and analysis of variance (ANOVA). Regression models analyzed associates of EPIC-CP scores and oncologic outcomes. Cox proportional hazards modeling assessed postoperative continence. Primary outcomes included patient-reported urinary incontinence (UI) via EPIC-CP and continence rates. Secondary outcomes included EPIC-CP scores, positive surgical margins (PSM), and biochemical recurrence (BCR). Perioperative outcomes and time to continence were measured.
Median follow-up for PFS-RARP vs. S-RARP was 26 vs. 65 months. PFS-RARP demonstrated improved EPIC-CP UI and total scores at 24 months. On multivariate analysis, PFS-RARP was associated with improved EPIC-CP UI and total scores through 18 months, but not with PSM or BCR. PFS-RARP had a 39% and 66% reduced risk of incontinence using 0 and 0 to 1 pad-use definitions (HR 0.61, 95% CI 0.39 - 0.95; HR:0.34, 95% CI 0.16 - 0.76). Continence returned faster with PFS-RARP (0 PPD: 91.0 days vs. 261 days, P < 0.001; 0-1 PPD: 32.7 days vs. 171 days, P < 0.001). There were no differences in PSM (35% vs. 25%, P = 0.064). There were more anterior PSM in PFS-RARP vs. S-RARP (47% vs. 26% P = 0.035), but no differences in BCR (16% vs. 22% P = 0.241).
PFS-RARP improves continence and patient-reported QOL up to 24 months postoperatively without compromising oncologic outcomes.
与标准前列腺切除术（S-RARP）相比，保留前列腺筋膜的机器人辅助根治性前列腺切除术（PFS-RARP）改善了术后短期尿失禁情况，但长期差异仍不明确。
由同一位外科医生实施了102例S-RARP和239例PFS-RARP手术。采用t检验、χ²检验、Wilcoxon秩和检验、Fisher精确检验和方差分析（ANOVA）进行单因素分析。回归模型分析了EPIC-CP评分和肿瘤学结局的相关因素。Cox比例风险模型评估术后尿失禁情况。主要结局包括患者通过EPIC-CP报告的尿失禁（UI）和尿失禁率。次要结局包括EPIC-CP评分、手术切缘阳性（PSM）和生化复发（BCR）。测量围手术期结局和尿失禁恢复时间。
PFS-RARP与S-RARP的中位随访时间分别为26个月和65个月。PFS-RARP在24个月时的EPIC-CP UI和总分有所改善。多因素分析显示，PFS-RARP在18个月内与改善的EPIC-CP UI和总分相关，但与PSM或BCR无关。使用0片和0至1片尿垫使用定义时，PFS-RARP的尿失禁风险分别降低了39%和66%（风险比[HR] 0.61，95%置信区间[CI] 0.39 - 0.95；HR：0.34，95% CI 0.16 - 0.76）。PFS-RARP的尿失禁恢复更快（0片尿垫：91.0天对261天，P < 0.001；0至1片尿垫：32.7天对171天，P < 0.001）。PSM无差异（35%对25%，P = 0.064）。PFS-RARP的前位PSM比S-RARP更多（47%对26%，P = 0.035），但BCR无差异（16%对22%，P = 0.241）。
PFS-RARP可改善术后24个月内的尿失禁情况和患者报告的生活质量，且不影响肿瘤学结局。
