Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
World J Urol. 2024 Mar 16;42(1):168. doi: 10.1007/s00345-024-04857-x.
PURPOSE: To introduce and illustrate a novel urethral reconstruction technique-the 'urethral hammock-technique'-and to assess its impact on early postoperative continence following laparoscopic radical prostatectomy (LRP). METHODS: 119 patients who underwent LRP between January 2020 and May 2022 (hammock group: n = 43, control group: n = 76) were included in the study. The primary outcome was continence (zero pads or max. one security pad) at 1, 3, and 6 months following surgery. Secondary outcomes were operative time, complications, and histological findings. Univariate and multivariate regression analyses were performed to reveal predictors for continence. p values < 0.05 with a two-sided 95%-confidence interval were considered statistically significant. RESULTS: Baseline characteristics were comparable among both groups. The number of patients achieving complete continence in both the hammock and control groups at various time intervals was: 4 weeks 37.2% (16/43) vs. 19.2% (14/73) (p = 0.047); 3 months 60.5% (26/43) vs. 37.3% (28/75) (p = 0.021) and 6 months 72.1% (31/43) vs. 60.3% (44/73) (p = 0.23), respectively. Adjusting for bladder neck preservation status and age, the hammock technique was a significant predictor for continence for the 4-week (OR 0.33, 95% CI 0.13-0.83, p = 0.019) and 3-month (OR 0.28, 95% CI 0.12-0.66, p = 0.004) interval but not for the 6-month interval (OR 0.64, 95% CI 0.27-1.5, p = 0.31). Operative time, complication rates, time till catheter extraction and histological findings were comparable between both groups (all p > 0.05). CONCLUSIONS: The hammock technique is a simple and reproducible technique to improve early postoperative continence for at least 3 months following surgery. However, these promising results warrant confirmation through a randomized controlled trial.
目的:介绍并阐述一种新的尿道重建技术——“尿道吊床技术”,并评估其对腹腔镜根治性前列腺切除术(LRP)后早期术后控尿的影响。
方法:研究纳入了 2020 年 1 月至 2022 年 5 月期间接受 LRP 的 119 名患者(吊床组:n=43,对照组:n=76)。主要结局是术后 1、3 和 6 个月的控尿(零垫或最大一个安全垫)。次要结局是手术时间、并发症和组织学发现。采用单变量和多变量回归分析来揭示控尿的预测因素。p 值<0.05,双侧 95%置信区间被认为具有统计学意义。
结果:两组患者的基线特征无差异。在不同时间点,吊床组和对照组达到完全控尿的患者数量分别为:4 周 37.2%(16/43)比 19.2%(14/73)(p=0.047);3 个月 60.5%(26/43)比 37.3%(28/75)(p=0.021)和 6 个月 72.1%(31/43)比 60.3%(44/73)(p=0.23)。调整膀胱颈保留状态和年龄后,吊床技术是 4 周(OR 0.33,95%CI 0.13-0.83,p=0.019)和 3 个月(OR 0.28,95%CI 0.12-0.66,p=0.004)间隔的控尿显著预测因素,但不是 6 个月间隔的控尿(OR 0.64,95%CI 0.27-1.5,p=0.31)。两组的手术时间、并发症发生率、导尿管拔除时间和组织学发现无差异(均 p>0.05)。
结论:吊床技术是一种简单且可重复的技术,可提高术后至少 3 个月的早期术后控尿能力。然而,这些有希望的结果需要通过随机对照试验来证实。
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