前列腺於膀胱頸內突對於經機械手臂輔助腹腔鏡前列腺根除手術之病患其手術後禁尿之影響
洪晟鈞、歐宴泉、楊晨洸
台中榮民總醫院 外科部 泌尿科
The influence of intravesical prostatic protrution and post operative continence after patients received robotic assisted laparoscopic radical prostatectomy
Sheng-Chun Hung, Yen-Chuan Ou, PhD, Cheng-Kuang Yang
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Purpose: We try to evaluate the influence of intravesical prostatic protrusion (IPP) in the postoperative continence of patient who received robotic assisted laparoscopic radical prostatectomy..
Materials and Methods: A total 600 patients who underwent robotic assisted laparoscopic radical prostatectomy were included in the study. Preoperative MRI was performed in all patients and the vertical distance from the tip of the protruding prostate to the base of the urinary bladder was measured in all sagittal plane. The degree of intravesical prostatic protrusion were divided into three groups ( IPP<5mm, 5mm<IPP<10mm, 10mm<IPP). All patients underwent surgical intervention with anterior approach of prostatectomy and the continence component such as puboprostatic ligament and arcus tendinus were preserved. Posterior reconstruction of the rhabdomyosphincter was also performed. Continence was defined as no pad use or only one safety pad per day and assessed at at 1, 3 and 12 months postoperatively. The correlation between the intravesical prostatic protruding and postoperative continence was examed.
Results: The overall continence rate at 1, 3 and 12 month was 69.2%, 91.33% and 95.5%. Among the three groups, there is significant difference in 1 month, 3 month and 12 monoth continence rate ( IPP < 5mm: 82.5%, 96.3%, 97.7%; 5mm < IPP < 10mm: 61.9%, 89.4%, 94.4%; 10mm < IPP: 30%, 75.6%, 88.9%, p < 0.001). At one month, 415 patients achieved continence but 195 patinets still incontinence and the length of IPP among the two groups were 4.43±3.74 mm and 8.69±6.63mm, p < 0.001. Respectively, at the 3 month and 12 month, 548 and 573 patients achieved continence and the IPP length among continence and incontinence group were 5.29±4.56mm vs. 10.50±8.32mm and 5.55±4.93 vs. 9.88±8.37, there is also statistical significance.
Conclusions: To our result, the intravesical prostatic protrusion have negative influence in continence of patients received robotic assisted radical prostatectomy. The patient with less protruding prostate may achieve early continence after operation and the postoperative incontinence rate was markedly higher in patient with more protruding prostat