口服抗血栓药物对机器人辅助根治性前列腺切除术后尿控恢复的影响：一项回顾性队列研究。
Impact of oral antithrombotic agents on urinary continence recovery following robot-assisted radical prostatectomy: a retrospective cohort study.
机构信息
Department of Urology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
出版信息
BMC Urol. 2024 Sep 28;24(1):211. doi: 10.1186/s12894-024-01594-6.
BACKGROUND
Robot-assisted radical prostatectomy (RARP) is a preferred minimally invasive surgical treatment for prostate cancer. The number of elderly patients and those with cardiovascular and/or cerebrovascular issues undergoing surgery is increasing, and many of them are taking antithrombotic (AT) agents. However, the effect of AT agents on postoperative urinary recovery has not been adequately studied. In this study, we analyzed the differences in the postoperative recovery of urinary continence and oncological outcomes in patients undergoing RARP for localized prostate cancer between AT agent adherents and non-adherents.
METHODS
A total of 394 patients who underwent conventional anterior RARP between February 2015 and February 2021 were categorized into two groups: those taking oral AT agents (AT group) and the control group. Urinary continence recovery, complications, and oncological outcomes were compared between the groups. A Cox proportional hazards analysis was performed to identify clinical factors that affect urinary continence recovery.
RESULTS
The background data and bleeding complications did not differ significantly between the groups. The recovery of continence was significantly poorer in the AT group in terms of complete pad free (HR: 0.53 [95% CI: 0.39-0.71]) and use of ≤ 1 safety pad (HR: 0.74 [95% CI: 0.59-0.94]). The rate of anastomotic leakage on cystography was significantly higher in the AT group (20.9% vs. 6.7%). A univariate analysis revealed that taking antithrombotic agents, higher prostate-specific antigen levels, and a more advanced clinical stage were associated with a poor urinary continence recovery; a multivariate analysis showed that taking AT agents was an independent factor negatively associated with urinary continence recovery. There was no significant difference between the groups in the positive surgical margin rate (19.0% vs. 23.8%) or the biochemical-recurrence-free rate.
CONCLUSION
Taking oral AT agents may be associated with poor urinary continence recovery after RARP.
背景
机器人辅助根治性前列腺切除术（RARP）是前列腺癌的首选微创治疗方法。接受手术的老年患者和心血管和/或脑血管疾病患者数量不断增加，其中许多人正在服用抗血栓（AT）药物。然而，AT 药物对术后尿控恢复的影响尚未得到充分研究。在这项研究中，我们分析了接受局部前列腺癌 RARP 的患者中，服用 AT 药物的患者与未服用 AT 药物的患者在术后尿控恢复和肿瘤学结局方面的差异。
方法
共有 394 例患者于 2015 年 2 月至 2021 年 2 月期间接受传统的前侧 RARP，将其分为两组：服用口服 AT 药物（AT 组）和对照组。比较两组患者的尿控恢复情况、并发症和肿瘤学结局。采用 Cox 比例风险分析确定影响尿控恢复的临床因素。
结果
两组患者的背景数据和出血并发症无显著差异。在完全无尿垫（HR：0.53[95%CI：0.39-0.71]）和使用≤1 个安全垫（HR：0.74[95%CI：0.59-0.94]）方面，AT 组的控尿恢复明显较差。膀胱造影术上吻合口漏的发生率在 AT 组明显更高（20.9%vs.6.7%）。单因素分析显示，服用抗血栓药物、较高的前列腺特异性抗原水平和较晚期的临床分期与尿控恢复不良相关；多因素分析显示，服用 AT 药物是与尿控恢复不良相关的独立负相关因素。两组的阳性切缘率（19.0%vs.23.8%）或生化无复发生存率无显著差异。
结论
服用口服 AT 药物可能与 RARP 后尿控恢复不良有关。
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