Department of Urology, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China.
Breast Disease Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Ann Surg Oncol. 2024 Dec;31(13):8978-8985. doi: 10.1245/s10434-024-16225-5. Epub 2024 Sep 17.
This study was designed to evaluate the efficacy of different periurethral structural reconstruction approaches to improve postoperative continence post robot-assisted radical prostatectomy (RARP), which remains a critical concern.
This study included patients with prostate cancer who received single, combined, and nonreconstruction following RARP from April 2017 to May 2021. Medical details were recorded, and patients were followed up via phone or the outpatient clinic. Continence, potency recovery, and quality of life were evaluated. Continence rate was assessed by daily urinary pads use and was compared between groups with the Kaplan-Meier method. Potency recovery was assessed by the questionnaire score. All variables were further analyzed via univariable and multivariable regression analysis.
Sixty patients were included in nonreconstruction group. Fifty-two and 156 patients were included in the single and combined group, respectively. Across early postoperative follow-up period, both single and combined reconstruction group showed higher continence rate (p < 0.05). The combined approach showed an advantage over the single one in improving continence rate (p < 0.05). Univariable and multivariable regression analysis point to the reconstruction approach as an independent factor that affects postoperative continence recovery post RARP.
Periurethral reconstruction approaches were found to be beneficial in promoting early continence recovery after RARP, without compromising preserved neurovascular bundle. Combination of anterior and posterior reconstruction could be more beneficial on continence recovery and should be considered in clinical practice.
本研究旨在评估不同的尿道周围结构重建方法对改善机器人辅助前列腺根治术后（RARP）术后控尿的疗效，这仍然是一个关键问题。
本研究纳入了 2017 年 4 月至 2021 年 5 月接受 RARP 后接受单一、联合和非重建的前列腺癌患者。记录了医疗细节，并通过电话或门诊对患者进行随访。评估了控尿、勃起功能恢复和生活质量。通过每日使用尿垫来评估控尿率，并通过 Kaplan-Meier 方法比较组间差异。通过问卷评分评估勃起功能恢复情况。所有变量均通过单变量和多变量回归分析进一步分析。
非重建组纳入 60 例患者。单重建组和联合重建组分别纳入 52 例和 156 例患者。在早期术后随访期间，单重建组和联合重建组的控尿率均较高（p < 0.05）。联合重建组在改善控尿率方面优于单重建组（p < 0.05）。单变量和多变量回归分析表明，重建方法是影响 RARP 后术后控尿恢复的独立因素。
尿道周围重建方法有助于促进 RARP 后早期控尿恢复，而不会影响保留的神经血管束。前、后重建联合可能更有利于控尿恢复，在临床实践中应考虑采用。
