Mladen Stankovic, Bastian Schumacher
Department of Urology, Salem Hospital, Academic Hospital - University of Heidelberg, Heidelberg, Germany.
Urologia. 2025 Feb;92(1):148-153. doi: 10.1177/03915603241293839. Epub 2024 Nov 14.
To assess the utility and reliability of cost-effective cystography-measured bladder capacity as a prognostic tool for predicting very early continence recovery following radical prostatectomy. Additionally, the study aims to discuss the clinical implications of the findings, including their potential impact on patient management, postoperative rehabilitation strategies, and the development of personalized care pathways for prostate cancer patients.
In this prospective monocentric study, we analyzed 223 patients who underwent either robot assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between January 2022 and January 2024. Postoperative cystography was routinely performed 5 days after robot-assisted radical prostatectomy and 7 days after open radical prostatectomy. Very early continence rates were determined using a standardized pad-test conducted on the first day following catheter removal. The bladder capacity during cystography was measured and documented for every patient. The correlation between the rate of continence recovery and the bladder capacity was then assessed. To determine other predictive factors for recovery of continence, several parameters were analyzed using multivariate logistic regression analysis, including age, prostate volume, nerve-sparing technique and surgical procedure.
Urinary continence rates at day 1 after catheter removal were 73.5% for patients who underwent RARP and 72.6% for patients who underwent ORP. A strong prognostic value of cystography-measured bladder capacity on very early continence rates was reported ( < 0.001), with a cut-off value calculated to be 140 ml of bladder capacity. After adjusting for additional variables such as age, surgical procedure, prostate volume and nerve-sparing technique, multivariate linear model analysis still found a strong correlation between cystography-measured bladder capacity and very early continence rates ( < 0.001).
The cystography-measured bladder capacity may be a good predictor of the recovery of post-prostatectomy urinary continence.
评估具有成本效益的膀胱造影测量膀胱容量作为预测前列腺癌根治术后极早期控尿恢复的预后工具的实用性和可靠性。此外，本研究旨在讨论研究结果的临床意义，包括其对患者管理、术后康复策略以及前列腺癌患者个性化护理路径发展的潜在影响。
在这项前瞻性单中心研究中，我们分析了2022年1月至2024年1月期间接受机器人辅助根治性前列腺切除术（RARP）或开放性根治性前列腺切除术（ORP）的223例患者。机器人辅助根治性前列腺切除术后5天和开放性根治性前列腺切除术后7天常规进行术后膀胱造影。使用在拔除导尿管后的第一天进行的标准化尿垫试验确定极早期控尿率。测量并记录每位患者膀胱造影期间的膀胱容量。然后评估控尿恢复率与膀胱容量之间的相关性。为了确定控尿恢复的其他预测因素，使用多因素逻辑回归分析分析了几个参数，包括年龄、前列腺体积、保留神经技术和手术方式。
接受RARP的患者在拔除导尿管后第1天的尿控率为73.5%，接受ORP的患者为72.6%。报告了膀胱造影测量的膀胱容量对极早期控尿率具有很强的预后价值（<0.001），计算得出的膀胱容量临界值为140 ml。在调整年龄、手术方式、前列腺体积和保留神经技术等其他变量后，多因素线性模型分析仍发现膀胱造影测量的膀胱容量与极早期控尿率之间存在很强的相关性（<0.001）。
膀胱造影测量的膀胱容量可能是前列腺切除术后尿控恢复的良好预测指标。
