Corewell Health William Beaumont University Hospital, Royal Oak, USA.
University of Michigan, Ann Arbor, USA.
J Robot Surg. 2024 Nov 25;19(1):10. doi: 10.1007/s11701-024-02101-7.
Incontinence and sexual dysfunction remain common side effects from robotic-assisted radical prostatectomy (RARP) despite nerve sparing (NS) and bladder neck reconstruction techniques. Placing growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA-approved for surgery. The objective is to determine if vCUT use in NS-RARP accelerates return of continence and sexual function. A retrospective cohort of 176 patients undergoing NS-RARPs with and without vCUT from 2015 to 2020 was identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence at 3, 6, and 12 months, postoperatively was evaluated using MUSIC patient-reported outcomes (PRO), a validated questionnaire assessing urinary and sexual quality of life at baseline and post-treatment. A distinct cohort of 65 patients undergoing NS-RARP with and without vCUT was assessed for erections firm enough for intercourse at 12 and 24 months post-operatively using MUSIC-PRO. The association between vCUT use and social continence at 3 months was assessed via multivariable logistic regression. A descriptive analysis among patients with quality erections prior to surgery assessed the association between vCUT use and erection quality. Continence was achieved by 3 months post-op in 86% (99/115) of vCUT patients versus 74% (45/61) in non-vCUT patients (p = 0.044). In a multivariable analysis, although not reaching conventional statistical significance, vCUT patients were more likely to achieve continence than non-vCUT patients (OR = 2.21, p = 0.073). At 24 months post-op, 32% of vCUT patients reported good sexual function versus 33% in non-vCUT patients (p = 0.9). vCUT use during NS-RARP is associated with quicker return to social urinary continence. However, no differences were seen in return of potency. Further studies with longer follow-up and larger sample sizes may further evaluate effectiveness of vCUT in accelerating return of postoperative continence and potency.
尽管采用了神经保留（NS）和膀胱颈重建技术，机器人辅助根治性前列腺切除术（RARP）后仍会出现尿失禁和性功能障碍等常见副作用。在神经血管束上放置生长因子和抗炎物质是一种新兴技术，可增强尿控和勃起功能的恢复。可存活的冷冻脐带组织（vCUT）已获得 FDA 批准用于手术。其目的是确定 NS-RARP 中使用 vCUT 是否会加速尿控和性功能的恢复。通过密歇根州泌尿外科手术改进协作（MUSIC），确定了 2015 年至 2020 年期间接受 NS-RARP 并使用和未使用 vCUT 的 176 例患者的回顾性队列。使用 MUSIC 患者报告的结果（PRO）评估术后 3、6 和 12 个月时恢复社交尿控情况，该问卷是一种经过验证的评估基线和治疗后尿控和性功能生活质量的问卷。使用 MUSIC-PRO 评估 65 例接受 NS-RARP 并使用和未使用 vCUT 的患者在术后 12 和 24 个月时进行性交时勃起硬度足够的情况。通过多变量逻辑回归评估 vCUT 使用与术后 3 个月时社交尿控的关系。在手术前勃起质量良好的患者中进行描述性分析，评估 vCUT 使用与勃起质量之间的关系。在使用 vCUT 的患者中，有 86%（99/115）在术后 3 个月时达到尿控，而未使用 vCUT 的患者中为 74%（45/61）（p=0.044）。在多变量分析中，尽管未达到常规统计学意义，但与未使用 vCUT 的患者相比，使用 vCUT 的患者更有可能达到尿控（OR=2.21，p=0.073）。术后 24 个月时，使用 vCUT 的患者中有 32%报告良好的性功能，而未使用 vCUT 的患者中有 33%（p=0.9）。NS-RARP 中使用 vCUT 与更快恢复社交性尿控有关。但是，在恢复勃起功能方面没有差异。进一步的研究具有更长的随访时间和更大的样本量，可能会进一步评估 vCUT 在加速术后尿控和勃起功能恢复方面的有效性。
