Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
University of Verona, Verona, Italy.
World J Urol. 2024 Nov 29;43(1):3. doi: 10.1007/s00345-024-05381-8.
To investigate the relationship between a set of prostate-urethral complex (PUC) measurements and incontinence after robot-assisted radical prostatectomy (RARP).
The study included data from patients undergoing RARP performed by 2 expert surgeons between 2019 and 2022, with data about preoperative magnetic resonance imaging (MRI) and functional follow-up. Continence status was assessed according to a stringent definition (no PADS used). MRIs were evaluated to calculate prostatic urethral length, membranous urethral length, membranous urethral width, levator ani thickness, and prostate shape. The association of PUC measurements with continence after RARP was studied. Secondarily, we evaluated whether pre-determined cut-off values of PUC measurements could be associated with time to continence. Cumulative hazard incidence analysis was performed by the Nelson-Aalen hazard function. Cumulative incidence hazard curves were built; the Peto-Peto test was used to evaluate the difference among the curves.
366 patients were included. At the 12-month follow-up, 333 patients (90.1%) were continent. Classification of PUC measurements overlapped between continent and noncontinent patients. However, a statistically significant difference was observed for levator ani thickness, greater in continent patients (12.8 mm vs. 11.7; p = 0.02). Multivariable models found BMI as independent predictor of incontinence (HR 1.04, 95% C.I 1.00-1.07, p = 0.04). None of PUC measurements associated with incontinence. Also, cumulative hazard incidence analysis at 3 / 6 / 12-months found no statistically significant difference in PUC measurements.
No association was found between anatomical characteristics of PUC and continence or time to continence after RARP performed by proficient surgeons. Our data would suggest that once the surgeon has surpassed the learning curve, anatomical variations do not significantly affect the appropriate and proficient execution of the prostate apex dissection during RARP.
研究前列腺尿道复合体（PUC）测量值与机器人辅助根治性前列腺切除术（RARP）后尿失禁之间的关系。
本研究纳入了 2019 年至 2022 年间由 2 位专家外科医生进行的 RARP 患者的数据，包括术前磁共振成像（MRI）和功能随访的数据。采用严格的定义（不使用 PADS）评估控尿状态。评估 MRI 以计算前列腺尿道长度、膜部尿道长度、膜部尿道宽度、肛提肌厚度和前列腺形状。研究了 PUC 测量值与 RARP 后控尿之间的关系。其次，我们评估了 PUC 测量值的预定截止值是否与达到控尿的时间相关。采用 Nelson-Aalen 风险函数进行累积危险发生率分析。构建累积发生率危险曲线；采用 Peto-Peto 检验评估曲线之间的差异。
共纳入 366 例患者。在 12 个月的随访中，333 例（90.1%）患者控尿。控尿和非控尿患者的 PUC 测量分类重叠。然而，肛提肌厚度在控尿患者中较大（12.8 毫米比 11.7 毫米；p=0.02），存在统计学差异。多变量模型发现 BMI 是尿失禁的独立预测因子（HR 1.04，95%CI 1.00-1.07，p=0.04）。没有任何 PUC 测量值与尿失禁相关。此外，在 3/6/12 个月的累积危险发生率分析中，在 RARP 后 3/6/12 个月时，PUC 测量值之间未发现统计学上的显著差异。
在由熟练外科医生进行的 RARP 后，PUC 的解剖特征与控尿或达到控尿时间之间没有发现关联。我们的数据表明，一旦外科医生超过了学习曲线，解剖学变异就不会显著影响 RARP 中前列腺尖部解剖的正确和熟练执行。
