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腹腔镜根治性前列腺切除术术后早期控尿效果的改善:尿道吊带技术。

Improved early continence following laparoscopic radical prostatectomy: the urethral hammock technique.

机构信息

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.

出版信息

World J Urol. 2024 Mar 16;42(1):168. doi: 10.1007/s00345-024-04857-x.


DOI:10.1007/s00345-024-04857-x
PMID:38492077
Abstract

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.

摘要

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。

相似文献

[1]
Improved early continence following laparoscopic radical prostatectomy: the urethral hammock technique.

World J Urol. 2024-3-16

[2]
A simple reconstruction of the posterior aspect of rhabdosphincter and sparing of puboprostatic collar reduces the time to early continence after laparoscopic radical prostatectomy.

J Endourol. 2014-1-23

[3]
Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra for the early recovery of urinary continence after retropubic radical prostatectomy: a prospective case-control study.

Int J Urol. 2013-6-26

[4]
"Total reconstruction" of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy.

Int Braz J Urol. 2016

[5]
Urethral-fixation technique improves early urinary continence recovery in patients who undergo retropubic radical prostatectomy.

BJU Int. 2017-2

[6]
[Relationship between recovery of urinary continence after laparoscopic radical prostatectomy and preoperative/postoperative membranous urethral length].

Beijing Da Xue Xue Bao Yi Xue Ban. 2022-4-18

[7]
Modified apical dissection of the prostate improves early continence in laparoscopic radical prostatectomy: technique and initial results.

J Cancer Res Clin Oncol. 2009-9-23

[8]
Simple suturing of the bladder neck muscle layer at the vesicourethral anastomosis site to the dorsal vein complex during anterior reconstruction led to a better postoperative urinary continence after robot-assisted laparoscopic prostatectomy.

Scand J Urol. 2020-12

[9]
[Bladder wall neourethra technique improves early urinary continence after laparoscopic radical prostatectomy].

Zhonghua Nan Ke Xue. 2022-10

[10]
[Urinary continence in laparoscopic radical prostatectomy with bladder neck preservation].

Zhejiang Da Xue Xue Bao Yi Xue Ban. 2013-11

本文引用的文献

[1]
Sustainable functional urethral reconstruction improves early urinary continence after robot-assisted radical prostatectomy: a randomised controlled trial.

BJU Int. 2023-6

[2]
A new method of intraoperative pelvic neuromonitoring: a preclinical feasibility study in a porcine model.

Sci Rep. 2022-3-7

[3]
Denonvilliers' fascia acts as the fulcrum and hammock for continence after radical prostatectomy.

BMC Urol. 2021-12-17

[4]
Reconstruction of the Denonvillier's fascia and posterior ligament of the external urethral sphincter: Assessment of its effect on urinary continence after laparoscopic radical prostatectomy.

Arch Ital Urol Androl. 2021-9-30

[5]
A Randomised Controlled Trial to Assess the Benefit of Posterior Rhabdosphincter Reconstruction in Early Urinary Continence Recovery after Robot-assisted Radical Prostatectomy.

Eur Urol Oncol. 2022-8

[6]
Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy.

Int Urol Nephrol. 2021-7

[7]
Intravesical prostatic protrusion may affect early postoperative continence undergoing robot-assisted radical prostatectomy.

BMC Urol. 2020-10-21

[8]
Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide.

Eur Urol. 2021-6

[9]
Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.

BJU Int. 2019-3-15

[10]
Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques.

Eur Urol. 2018-12-2

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