利用尿道周圍重建改善達文西機器人攝護腺根除手術病人的早期禁尿
何肇晏1、林宜佳1,2、蔡德甫1,2、葉忠信1,2、莊光達1,2、鄭以弘1、仇光宇1,2、陳宏恩1、黃一勝1,2
1新光吳火獅紀念醫院外科部泌尿科
2輔仁大學醫學系
CONCOMMITENT Anterior AND posterior PERIURETHRAL reconstruction improveS early continence followingRobot-assisted laparoscopic radical prostatectomy
Chao-Yen Ho1, Yi-Chia Lin1,2, Te-Fu Tsai1,2, Chung-Hsin Yeh1,2, Guang-Dar Juang1,2, Yi-Hong Cheng1, Kuang-Yu Chou1,2, Hung-En Chen1, Thomas I.S. Hwang1,2
1Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital, Taipei
2School of Medicine, Fu-Jen Catholic university, New Taipei City
Purpose:
Continence is one of the major outcomes following robot-assisted laparoscopic radical prostatectomy (RARP). Post-operative incontinence influenced mental status and quality of life in patients underwent RARP. In this study, we investigate whether the peri-urethral reconstruction (PUR) influence continence outcome after RARP.
Materials and Methods:
From June 2014 to March 2016, 34 patients underwent RARP in our institution. PUR was performed randomly. The anterior reconstruction consisted a suspension of the dorsal venous plexus and anterior urethra to the pubic symphysis. The posterior reconstruction consisted of a repair of the Denonvillier’s fascia and an approximation of the posterior bladder neck to the posterior urethra. Demographics, perioperative parameters and continence outcome were collected prospectively. The achievement of continence was defined as less than 1 pad a day.
Results:
Twenty-three patients under went RARP with PUR while other eleven patients were not. The median age of the 2 groups were 68 (42-75) and 73 (52-79) years old. The median operative time of two groups were 280 and 365 minutes, and the hospital stay of the two groups were 10 days and 11.5days.The overall complication rate was 20.6%. The immediate continence rates between patients with and without PUR were 43.5%and38.2%. The early continence rates (< 3 months) between patients with and without PUR were 78.3% and64.7%. Significant quicker recovery of the patients underwent RARP plus PUR was found. (p<0.05) The post-operative stage and PSA level were not associated with continence outcome.
Conclusions:
RARP plus PUR offered a better continence recovery. No significant increase of operative time and hospital stay can be noted.