雷氏空間保留攝護腺根除手術吻合滲漏危險因子分析

林奇柏、王百孚、石宏仁、林介山、張進寶、嚴孟意、黃勝賢、陳俊吉、江恆杰、張建祥、
陳柏華、陳一中、潘岳

彰化基督教醫院泌尿外科

Anastomotic urinary leakage after Retzius-sparing robot-assisted radical prostatectomy.

Chi-Bo Lin, Pai-Fu Wang, Hung-Jen Shih, Jesun Lin, Chang-Pao Chang, Meng-Yi Yan, Sheng-Hsien Huang, Chun-Chi Chen, Herng-Jye Jiang, Jian-Xiang Zhang, Pao-Hwa Chen, Yi-Zhong Chen, Pan Yueh

Division of Urology, Department of Surgery, Changhua Christian Hospital

Purpose:
We aimed to analyze the clinical significance of anastomotic urinary leakage (AUL) following Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and evaluate its risk factors.

Materials and Methods:
We conducted a retrospective study to review patients with prostate cancer undergoing Rs-RARP by a single surgeon. “Positive AUL” was defined as water leakage tested by bladder insufflation (water-tight test) after vesico-urethral anastomosis. Those with positive AUL received cystography about 2-4 weeks after operation. Univariate and multivariate analyses were performed to identify the risk factors of AUL. Postoperative urinary continence rates and time to achieve continence were also analyzed.

Results:
A total of 193 patients underwent Rs-RARP for prostate cancer. Of these patients, AUL was observed in 29 patients (15%) by water-tight test and 4 patients (2%) revealed minor AUL on post-op cystography. There was no major AUL cases on the post-op cystography. Patients with AUL exhibited a significantly longer time to achieve continence than those without AUL. The univariate analysis  demonstrate that prostate volume, console time and positive nerve sparing were significantly associated with overall AUL. In the multivariate analysis, longer console time remained a significant predicator of AUL. The time to recovery of continence (≤ 1 pad/day) was significantly longer in patients with AUL by water-tight test.

Conclusions:
The presence of AUL during water-tight test was associated with delayed urinary continence. Longer console time, nerve sparing and bigger prostate volume were the risk factors of AUL. A selective cystography has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.