Kokura Kazuki, Kanematsu Akihiro, Yamamoto Shingo, Watanabe Jun
Department of Urology, Hyogo Medical University Hospital, Nishinomiya, Japan.
Department of Urology, Toyooka Hospital, Toyooka, Hyogo, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70147. doi: 10.1111/ases.70147.
We analyze determinants of postoperative recovery from urinary incontinence following robot-assisted laparoscopic radical prostatectomy, with a focus on membranous urethral length and inclusion of nerve sparing.
This retrospective study included patients who underwent robot-assisted laparoscopic radical prostatectomy from 2017 to 2022 performed at a single institution. Cox proportional hazards analysis was conducted for postoperative recovery from urinary incontinence, defined as use of zero or one pad/day. Examined patient factors were age, body mass index, prostate volume, and membranous urethral length, while surgical factors were nerve-sparing status, operative time, and console time.
A total of 197 patients were included in the analysis. Median membranous urethral length was 11.6 mm. Nerve sparing was performed in 92 (46.7%), with unilateral preservation in 68 and bilateral preservation in 24. In total, patients both univariate and multivariate Cox hazard analyses showed that the only significant factor for recovery from urinary incontinence was membranous urethral length (hazard ratio 1.059, p = 0.01), while nerve sparing was not significant (hazard ratio 1.132, p = 0.43). However, when patients were subdivided into two groups based on the median value for membranous urethral length (11.6 mm), nerve sparing was not a significant factor for recovery in the longer group (≥ 11.6 mm, n = 99, hazard ratio 0.898, p = 0.64), while that was significant in the shorter group (< 11.6 mm, n = 98, hazard ratio 1.55, p = 0.049).
The present results may indicate that nerve sparing is more recommended for patients with a shorter membranous urethral length.
我们分析机器人辅助腹腔镜根治性前列腺切除术后尿失禁恢复的决定因素，重点关注膜性尿道长度和保留神经情况。
这项回顾性研究纳入了2017年至2022年在单一机构接受机器人辅助腹腔镜根治性前列腺切除术的患者。对术后尿失禁恢复情况进行Cox比例风险分析，尿失禁定义为每天使用零片或一片尿垫。检查的患者因素包括年龄、体重指数、前列腺体积和膜性尿道长度，而手术因素包括保留神经情况、手术时间和控制台操作时间。
共有197例患者纳入分析。膜性尿道长度中位数为11.6毫米。92例（46.7%）进行了保留神经手术，其中68例为单侧保留，24例为双侧保留。总体而言，单因素和多因素Cox风险分析均显示，尿失禁恢复的唯一显著因素是膜性尿道长度（风险比1.059，p = 0.01），而保留神经不显著（风险比1.132，p = 0.43）。然而，根据膜性尿道长度中位数（11.6毫米）将患者分为两组时，在较长组（≥11.6毫米，n = 99，风险比0.898，p = 0.64）中，保留神经不是恢复的显著因素，而在较短组（<11.6毫米，n = 98，风险比1.55，p = 0.049）中则显著。
目前的结果可能表明，对于膜性尿道长度较短的患者，更建议保留神经。
