機械手臂輔助攝護腺切除手術後膀胱尿道吻合處滲漏之探討
江長和 1、黃子豪 1,2、陳昱光 1、張延驊 1,2、盧星華 1,2、鍾孝仁 1,2、黃逸修 1,2、林子平 1,2、林志杰 1,2、黃奕燊 1,2、陳威任 1,2、林冠榮 1,2、黃志賢 1,2
1 台北榮民總醫院泌尿部
2 國立陽明大學醫學院泌尿學科及書田泌尿科學研究中心
Vesicourethral anastomosis leakage after robotic assisted laparoscopic prostatectomy
Chang-Ho Chiang1, Tzu-Hao Huang1,2, Yu- Kuang Chen1, Yen-Hwa Chang1,2, Shing-Hwa Lu1,2, Hsiao-Jen Chung1,2,
Yi-Hsiu Huang1,2, Tzu-Ping Lin1,2,Shing-Hwa Lu1,2, Chih-Chieh Lin 1,2, I-Shen Huang1,2, Wei-Jen Chen1,2,Kuan-Jung Lin1,2, William J. Huang1,2
1Department of Urology, Taipei Veterans General Hospital, Taiwan
2Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan
Purpose:
Robotic assisted laparoscopic prostatectomy (RALP) has been widely adopted in Taiwan for more than 10 years. Vesicourethral anastomosis leakage is an important complication after RALP. Currently it was thought that prostate volume and loss of hemoglobin could predict the prevalence of leakag in some studies. This study aimed to evaluate the incidence of anastomosis leakage after RALP and its associated risk factors by using a prospectively-collected cohort in a single medical center.
Materials and Methods:
From January 2017 to December 2019, total 450 patients underwent RALP at Taipei Veterans General Hospital. Anastomosis leakage is determined by postoperative cystography and 45 patients were excluded due to lack of cystography. We compared the difference between patients who had anastomosis leakage after RALP and those who did not. Demographic data and various perioperative factors were included in our analyses. A sensitivity analysis was conducted by looking at the risk factors for clinically significant leakage, which is defined as delayed urethral catheter removal due to anastomosis leakage.
Results
Of 405 enrolled patients, 97 (24.0%) had a leakage on postoperative cystographyand 308 (76%) did not. Clinically significant leakage was present in 52 patients (12.9%). In our cohort, older age, higher preoperative PSA, larger prostate, preoperative anemia, prior history of transurethral resection of prostate, more advanced tumor pathological stage, requirement for bladder neck reconstruction, use of suspension stitch during operation, and less experienced surgeons were associated with anastomosis leakage after RALP. However, on multivariant analysis, only larger prostate (>50mL) (OR=2.657, 95% CI: 1.324-5.332, p=0.006) and bladder neck reconstruction (OR=2.591, 95%CI: 1.387-4.480, p=0.003) were significantly associated with anastomosis leakage. Sensitivity analysis looking at clinically significant leakage showed that bladder neck reconstruction (OR=3.481, 95%CI: 1.477-8.204, p=0.004) and preoperative anemia (hemoglobin < 12 mg/dL) (OR=5.399, 95%CI: 1.547-18.836, p=0.008) were significant risk factors.
Conclusions