達文西機器手臂輔助腹腔鏡攝護腺根除手術術後應力性尿失禁之風險因子

邱亮維、黃志平

中國醫藥大學附設醫院 泌尿部

The Risk Factors of the Stress Urinary Incontinence after Robotic-Assisted Laparoscopic Radical Prostatectomy

Liang-Wei Chiu, Chi-Ping Huang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Purpose: The robotic-assisted laparoscopic radical prostatectomy (RALRP) is the risk of developing urinary incontinence (UI) in men. The stress urinary incontinence (SUI) following RALRP may be improved gradually in 6 to 12 months after operation. Using a no pad or safety pad definition, the overall incidence of SUI ranges from 8% to 11%, with a mean value of 9%, at 1 year after RALRP. Many factors were associated with the risk of incontinence after RP, including patient age and weight, prior transurethral resection of prostate and resection of neurovascular bundles. We aimed to report our experience about the risk factor associated with SUI after RALRP.

Materials and Methods: From January 2017 to December 2021, by a single urology team, with at least 12 months follow-up, we recruited 267 men who underwent RALRP due to prostate cancer. We excluded 13 patients that lost follow-up and 59 patients without complete data. In the end, a total of 195 men (73.0%) was included in the study. We examined several pre- and perioperative factors. The mild incontinence was defined as ≤2pads/day; the moderate incontinence was defined as 3-5pads/day; and the severe incontinence was defined as >5pads/day. All the statistical analysis was performed with SPSS 25.0.

Results: Among the patients, the mean age was 66.9 ± 6.71 years. Using no pad or safe pad definition, a total of 175 patients (89.7%) were continent 12 months after RALRP. 4.6%, 5.1%, and 0.5% of the patients had continence to mild, moderate, and severe incontinence, respectively. Several factors, including higher initial PSA level (p=0.081), aggressive clinical T stage (p=0.015), aggressive pathologic T stage (p=0.012), surgery without neurovascular bundle-sparing (p=0.027), and longer operation time (p=0.019), were increased risks of the degree of urinary incontinence after RP. However, no statistically significant correlation was found with other variables, such as age, BMI, prior TURP, or prior pelvic radiotherapy.