膀胱尿道三層吻合術有助於機器人手臂輔助攝護腺根除術後尿失禁之恢復
陳鴻毅、林承家、黃賢祥、林政鋒、陳文祥、吳俊德
基隆長庚醫院 外科部 泌尿科
Robot- Assisted Radical Prostatectomy With Three-Layer Vesicourethral Reconstruction Improves Early Urinary Continence Recovery
Hung-Yi Chen, Cheng-chia Lin, Shian-Shiang Huang, Cheng-Feng Lin, Wen-Hsiang Chen, Chun-Te Wu
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung
Purpose:
Three-layer vesicourethral anastomosis regains the anatomical structure during robot-assisted radical prostatectomy (RARP). We present our preliminary data of three-layer veiscourethral reconstruction to improve early continence recovery and the relationship between postoperative cystography pattern.
Materials and Methods
We retrospectively reviewed patients underwent robot-assisted radical prostatectomy (RARP) by a single experienced surgeon after case 200 to minimize technique and surgeon variation. Between May 2015 and September 2017, total 125 consecutive patients were divided into 2 groups of one-layer (1-layer group, n=85) and three-layer (3-layer group, n=40) vesicourethral reconstruction. Urethra suspension, bladder neck sparing and reconstruction were applied in all patient for better continence recovery. Preoperative, intraoperative, postoperative, and pathological variables were analyzed. Postprostatectomy follow up for at least 6 months and all patient received cystography within 2 weeks after RARP before Foley catheter removal.
Result
Immediately and early continence recovery rate within 4 weeks after RARP were significantly higher in 3-layer group (65%) than in the 1-layer group (32.9%, p=0.0092). Incontinence-free survival is also with significant difference between 2 groups (p= 0.043). Cystography parameters in 3-layer group has lower anastomosis leakage (p=0.017), less sharp bladder neck angle (p= 0.033) and higher bladder neck level category (I+II vs. III+IV, p= 0.031). During subgroup (early continence vs. >1 month) analysis between 1-layer and 3-layer group was compatible with above findings and resulted in more statistical difference, which suggests cystography as a more reliable predictor for postprostatectomy incontinence (PPI).
Conclusion
Three-layer reconstruction improves the early continence rate after RARP and postoperative cystography pattern can be a predictor of PPI effectively.