Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy

被引:0
作者
Benedikt Hoeh
Jan L. Hohenhorst
Mike Wenzel
Clara Humke
Felix Preisser
Clarissa Wittler
Marie Brand
Jens Köllermann
Thomas Steuber
Markus Graefen
Derya Tilki
Pierre I. Karakiewicz
Andreas Becker
Luis A. Kluth
Felix K. H. Chun
Philipp Mandel
机构
[1] University Hospital Frankfurt,Department of Urology
[2] Goethe University Frankfurt am Main,Cancer Prognostics and Health Outcomes Unit, Division of Urology
[3] University of Montréal Health Center,Martini
[4] University Hospital Hamburg-Eppendorf,Klinik Prostate Cancer Center
[5] University Hospital Frankfurt,Dr. Senckenberg Institute of Pathology
[6] University Hospital Hamburg-Eppendorf,Department of Urology
[7] Koc University Hospital,Department of Urology
来源
Journal of Robotic Surgery | 2023年 / 17卷
关键词
Urinary continence; Urinary incontinence; Radical prostatectomy; FFLU; NVBP; Functional outcomes;
D O I
暂无
中图分类号
学科分类号
摘要
The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1–2, 4% 3–5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51–27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.
引用
收藏
页码:177 / 184
页数:7
相关论文
共 176 条
[1]  
Haese A(2019)A comparative study of robot-assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures BJU Int 123 1031-1040
[2]  
Knipper S(2017)Short- and long-term functional outcomes and quality of life after radical prostatectomy: patient-reported outcomes from a tertiary high-volume center Eur Urol Focus 3 615-620
[3]  
Isbarn H(2016)10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer N Engl J Med 375 1415-1424
[4]  
Heinzer H(2012)Radical prostatectomy versus observation for localized prostate cancer N Engl J Med 367 203-213
[5]  
Tilki D(2021)Feasibility and outcome of radical prostatectomy following inductive neoadjuvant therapy in patients with suspicion of rectal infiltration Urol Oncol: Semin Orig Investig 118 193-204
[6]  
Salomon G(2016)Symptomatic and quality-of-life outcomes after treatment for clinically localised prostate cancer: a systematic review BJU Int 19 32-104
[7]  
Pompe RS(2019)Post-radical prostatectomy urinary incontinence: is there any discrepancy between medical reports and patients’ perceptions? BMC Urol 14 155798832095753-329
[8]  
Tian Z(2020)Current mental distress among men with a history of radical prostatectomy and related adverse correlates Am J Mens Health 107 100-534
[9]  
Preisser F(2011)Trifecta outcomes after robot-assisted laparoscopic radical prostatectomy: trifecta outcomes after RALP BJU Int 60 320-207
[10]  
Tennstedt P(2011)Full functional-length urethral sphincter preservation during radical prostatectomy Eur Urol 44 530-236