雷氏空間保留法於機器人輔助腹腔鏡前列腺切除術的應用可增加早期排尿控制- 彰基的初始經驗
郭謹瑋、王百孚
彰化基督教醫院 外科部 泌尿科
Improved early continence rate by Retzius-sparing method during robot-assisted laparoscopic radical prostatectomy : Preliminary experience in a single institute ChinWei Kuo, BaiFu Wang
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Purpose
To report the technique, as well as functional and oncologic results of our preliminary experience of Retzius-sparing method for robot-assisted laparoscopic prostatectomy.
Materials and methods
Between February 2014 and September 2016, 35 RALP with Retzius-sparing method were performed at our institute. Demographic, perioperative, and postoperative data were recorded. Continence status was assessed immediately after urethral catheter removal; at the first and every three months after RALP. Peri-prostatic structures, including endopelvic fascia and dorsal venous complex, as well as bladder neck were all preserved. The whole procedure of dissection and vesicourethral anastomosis was accomplished by totally posterior approach. Complications were classified according to the Clavien-Dindo classification.
Results
Median follow-up was 11.06 ± 7.1 months; median age was 66.5 ± 5.9 years old. Retzius-sparing method was performed in 35 patients, and 15 of them (43%) were continent immediately within one week and 19 of them (59%) were continent one month after operation. In nerve-sparing group, the one month continence rate is upto 92.3%. On the other hand, 85% of total patients were continent after 3 months. The mean duration of the catheterization was 7.09 ± 3.3 days. Furthermore, there were no complications were noted such as intra-peritoneal urine leakage, bladder neck contracture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications.
Conclusion:
Our preliminary experience of using Retzius-sparing method for RALP provided satisfied continence rate at the time of catheter removal and within short-term period of follow-up. The one month continence rate is upto 92.3% in nerve-sparing group especially. This technique can help early recovery of urinary incontinence and better quality of life after RALP