盆筋膜腱弓重建对腹腔镜前列腺癌根治术后尿控的影响

目的:评估盆筋膜腱弓重建对腹腔镜前列腺癌根治术后尿控的影响。方法:回顾分析2012年1月至2014年12月42例局限性前列腺癌患者的临床资料,其中20例行盆筋膜腱弓重建腹腔镜前列腺癌根治术(重建组),22例行常规腹腔镜前列腺癌根治术(常规组),对比分析两组患者术后拔除尿管后第1天及术后1个月、3个月、6个月、12个月的尿控情况,以不使用尿垫作为完全尿控标准。结果:两组患者术前年龄、体重指数、前列腺体积、前列腺特异性抗原、Gleason评分差异均无统计学意义(P0.05)。常规组拔除尿管后第1天及术后1个月、3个月、6个月、12个月尿控率分别为4.55%(1/22)、18.18%(4/22)、36.36%(8/22)、68.18%(15/22)、81.82%(18/22);重建组分别为5.00%(1/20)、25.00%(5/20)、70.00%(14/20)、85.00%(17/20)、90.00%(18/20);重建组术后3个月尿控率高于常规组(P0.05),其余时间两组差异无统计学意义(P0.05)。结论:盆筋膜腱弓重建技术对于腹腔镜前列腺癌术后早期(3个月内)的尿控恢复可能有帮助,对远期尿控效果改善不明显。     

系统评价机器人辅助腹腔镜与单纯腹腔镜前列腺癌根治术后的控尿功能

目的:评价机器人辅助前列腺癌根治术(robot-assisted laparoscopic prostatectomy,RALP)与单纯腹腔镜前列腺癌根治术(pure laparoscopic radical prostatecomy,LRP)的术后控尿功能。方法:检索PubMed、Web of Science、Cochrane图书馆、CNKI、维普数据库及万方数据库关于RALP和LRP治疗局限性前列腺癌的比较性研究文献,按Cochrane操作员手册筛选文献、提取资料并评价质量后,采用RevMan5.2版本软件进行数据处理分析。结果:系统评价纳入2篇随机对照试验,7篇非随机对照试验,共1 950例患者,其中RALP治疗1 098例,LRP治疗852例。RALP相比LRP术后控尿率,1个月比值比(odds ratio,OR)=2.28,95%可信区间(confidence interval,CI)为(1.68,3.08),3个月OR=1.51,95%CI为(1.21,1.88),6个月OR=1.97,95%CI为(1.44,2.70),12个月OR=1.53,95%CI为(1.11,2.11),两者术后控尿功能差异有统计学意义(P0.05)。结论:在治疗局限性前列腺癌方面,RALP可能术后控尿功能更优。     

前列腺癌根治术中尿道后筋膜重建技术对尿控能力影响的荟萃分析

目的探讨前列腺癌根治术中尿道后筋膜重建技术对术后尿控的影响。方法检索Pubmed,Embase,Cochrane Library,Web of Science,CNKI和万方等数据库,查找比较前列腺癌根治术中尿道后筋膜重建和传统前列腺癌根治术后尿控能力的研究,检索时限均从建库至2018年1月31日。采用Review Manager 5.3软件进行Meta分析。结果共纳入22篇文献,其中随机对照研究有3篇,前瞻性观察研究有5篇,回顾性研究有14篇;共纳入的患者3594例,其中尿道后筋膜重建的患者2021例,标准前列腺癌根治术的患者1573例。拔出尿管后3~7 d、30 d、90 d、180 d尿控率,尿道后筋膜重建组优于标准手术组(OR=3.14,3.15,3.01,2.5;P<0.05);防止尿漏发生方面重建组优于标准手术组(OR=0.39,P<0.05);而拔出尿管后24 h尿控,切缘阳性率、急性尿潴留发生、吻合口狭窄发生率,勃起功能保护率两组间差异无统计学意义(OR=1.66,1.03,1.38,0.50,1.45;P>0.05)。结论前列腺癌根治术中尿道后筋膜重建可提高患者尿控早期恢复,还能减少尿漏发生,而在保证切缘阴性,急性尿潴留发生,吻合口狭窄等方面跟标准前列腺癌根治术一样具有安全性。     

腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建的早期尿控效果北大核心CSCD

目的探讨腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建的早期尿控效果。方法2020年2月~2021年4月我们在20例腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建。尿道后壁重建:将狄氏筋膜残端与尿道括约肌后壁中线结构缝合,再缝合至膀胱颈后壁筋膜;膀胱颈口荷包缝合及尿道吻合:将膀胱颈口肌层做连续荷包缝合,端端吻合膀胱颈及尿道;尿道前壁重建:将耻骨前列腺韧带与膀胱前壁连续缝合、悬吊尿道。结果20例手术均顺利完成,无中转开放或其他术式。手术时间(200.0±54.9)min,术中出血量(44.3±19.8)ml,术后住院时间(8.9±2.8)d,引流管留置时间(7.6±2.7)d,导尿管留置时间(12.9±2.6)d。术后病理:T2a期1例,T2b期4例,T2c期7例,T3a期5例,T3b期3例;术后标本病理Gleason评分:6分1例,7分9例,8分4例,9分5例,10分1例;切缘阳性率10%(2/20)。拔除导尿管后即刻和术后1、3、6个月尿控良好率分别为70%(14/20)、85%(17/20)、95%(19/20)、100%(20/20)。结论腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建安全、可行,操作容易,患者术后早期尿控恢复满意。     

前列腺癌根治术后早期尿控功能恢复相关影响因素分析

目的 探讨前列腺癌(PCa)根治术后尿控功能恢复的相关因素.方法 回顾性分析2016-10—2019-10在郑州大学第一附属医院行PCa根治术的390例PCa患者的临床资料.根据术后第1、3个月的尿控功能恢复情况分为尿控组和尿失禁组.比较2组患者的年龄、体质量指数(BMI)、吸烟、饮酒、手术方式;是否保留膀胱颈、神经血...     

保留尿道括约肌功能对腹腔镜前列腺癌根治术后尿控的影响

目的:探讨保留尿道括约肌功能对腹腔镜前列腺癌根治术后尿控的影响。方法:选取2013年5月至2015年8月收治的行腹腔镜前列腺癌根治术的80例前列腺癌患者作为研究对象,依据是否保留尿道括约肌功能分为对照组(未保留)及研究组(保留),每组40例,对比两组患者术后3个月的尿控情况。结果:两组患者尿控分级差异有统计学意义(P0.05);术后两组患者前列腺体积、前列腺特异性抗原、ICI-Q-SF评分、总并发症发生率差异有统计学意义(P0.05)。结论:保留尿道括约肌功能可显著提高腹腔镜前列腺癌根治术后的尿控效果,改善前列腺体积、前列腺特异性抗原、ICI-Q-SF评分等指标,降低术后并发症发生率,有助于尿控目标的实现,提高了患者的生活质量,具有重要的应用价值。     

提高前列腺癌根治术后尿控能力的临床研究

目的：探讨提高前列腺癌根治术后尿控能力的方法。方法：对15例前列腺癌采用保留尿道膜部括约肌及前列腺侧旁神经血管束的方法进行前列腺癌根治术。结果：经6—45个月随访，15例患者排尿通畅，无肿瘤复发，除1例有轻度尿失禁外，余14例6个月内均恢复尿控能力。结论：保留尿道膜部括约肌及前列腺侧旁神经血管束的方法能减低前列腺癌根治术后尿失禁。     

保留控尿功能的腹腔镜前列腺癌根治术

目的 探讨保护控尿功能的前列腺癌根治术的技术要点.方法 对收治的94例T1b～T2c前列腺癌患者行保留控尿功能的前列腺癌根治术,即腹腔镜下精细解剖前列腺尖部,保护EUS及其控尿神经,膀胱颈后唇成形后与尿道吻合;并同前期42例行常规前列腺癌根治术(LRP)的患者比较,术后30、60和90 d评估患者的控尿状况.控尿标准: 站立或行走时无尿液漏出,或全天使用尿垫不超过1块.结果 术后30、60 d控尿率LRP组为27.7%(13/47)、66.0%(31/47);CSLRP组为55.3%(26/47)、85.1%(40/47),均有统计学差异(χ2＝7.406,4.663,P<0.05).术后90 d两组控尿率为78.7%(37/47)和91.5%(43/47)(χ2＝3.02,P>0.05).结论 利用腹腔镜的优点,保护EUS和膀胱颈后唇成形加强尿道后壁,能明显加快前列腺癌根治术后控尿的恢复时间.     

腹腔镜前列腺癌根治术中膀胱颈完整保留对术后尿控及性功能的影响

目目的的::探讨腹腔镜前列腺癌根治术中膀胱颈完整保留对术后尿控功能及性功能的影响.方法:选取西安交通大学第二附属医院2015年3月-2019年3月期间收治的148例腹腔镜前列腺癌根治术患者作为研究对象,按照随机数字表法将其分为对照组(74例)与观察组(74例).对照组不保留膀胱颈,观察组完整保留膀胱颈.比较两组手术指标...     

提高腹腔镜前列腺癌根治术后控尿的临床研究

目的 分析总结腹腔镜前列腺癌根治术51例手术控尿技术的经验.方法 回顾性总结腹腔镜前列腺癌根治术患者51例.术前均病理证实前列腺癌诊断.T la～1b 4例(8%),T 1c 15例(29%),T2a 7例(14%),T2b 5例(10%),T2c 20例(39%).结果 腹腔镜下成功完成前列腺癌根治术49例.术后发生尿漏3例,均自愈.术后尿管留置14～45 d,平均16 d.术后随访3～53个月,平均17个月.术后3个月随访51例患者,13例尿失禁;术后6个月随访39例患者,7例尿失禁;术后12个月随访患者20例,5例尿失禁,其中完全性尿失禁1例.前20例和后31例在术后3个月时尿失禁发生率分别为6/20(30%)和7/31(22%),差异有统计学意义(P<0.05).直肠损伤2例,行结肠造口术.术后复发2例,一例行内分泌治疗后停药.另一例肺转移手术后死亡.其余病例前列腺特异抗原<0.2μL.结论 腹腔镜前列腺癌根治术治疗局限性前列腺癌是安全、有效的.术后控尿功能主要与术中前列腺尖部、耻骨前列腺韧带和神经血管束的处理及手术经验相关.     

Evaluation of early pelvic floor physiotherapy on the duration and degree of urinary incontinence after radical retropubic prostatectomy in a non-teaching hospital

The objective of this study was to study the effect of early pelvic floor re-education on the degree and duration of incontinence and to evaluate the results of radical retropubic prostatectomy (RRP) performed in a non-teaching hospital. This is a non-randomised study. From March 2000 to November 2003, 57 consecutive men, who underwent RRP for localized prostate cancer, participated in a pelvic floor re-educating program. Continence was defined as a loss of no more than 2-g urine on the 24-h pad test and no use of pads. The 24-h pad test was performed once in every 4 weeks until the patient indicated that he was continent. Diurnal and nocturnal continence was achieved after 1, 2, 3, 6 and 12 months post catheter removal in 40, 49, 70, 86 and 88% of all men, respectively. Comparison of our results with current literature suggest that the time period towards continence after a RRP can be shortened relevantly if pelvic floor re-education is started directly after catheter removal.     

The value of cystography in the prediction of early urinary continence after radical prostatectomy

ObjectiveTo determine the association between vesicourethral anastomosis level (VUAL) and the condition of the bladder neck with early recovery of urinary continence on cystography after radical prostatectomy.Materials and methodsThis was a retrospective analysis of 116 patients who underwent radical prostatectomy at our hospital from 2008 to 2013. On cystography, the VUAL in the pelvic cavity was defined according to the upper margin of the pubic symphysis; above the upper margin was considered a higher VUAL and below it was considered a lower VUAL. The condition of the bladder neck was determined by whether or not there was contrast flow into the proximal urethra. Early recovery of urinary continence was defined as not requiring pads within 3 months. We determined the predictive factors for the early recovery of continence.ResultsAmong all patients, 68.1% achieved an early recovery of urinary continence. The patients with a higher VUAL were younger and had a shorter time to continence than those with a lower VUAL. The early recovery rates were 88.9% and 58.8% with a higher and lower VUAL, respectively (p < 0.001). The patients with a closed bladder neck also had better results of early continence than those with an open bladder neck (82.9% vs. 45.7%, respectively). VUAL level and bladder neck condition were independent predictors of an early recovery of urinary continence [odds ratio 5.821 (95% confidence interval: 1.632–20.75) higher vs. lower VUAL, p = 0.007; and odds ratio 5.828 (95% confidence interval: 2.259–15.036) closed vs. open bladder neck, p < 0.0001] after adjusting for age, risk of recurrence, operative method, prostate volume, and nerve sparing procedure.ConclusionPostoperative cystography can provide information on VUAL and bladder neck condition which can predict recovery of urinary continence after radical prostatectomy. A higher VUAL and bladder neck closure were associated with a higher rate of early recovery of urinary continence.     

根治性前列腺切除术中保护尿控功能的理论与实践

根治性前列腺切除术是目前治疗局限性前列腺癌的首选方法,尿失禁仍是该手术术后最常见的并发症之一。随着手术技术的进步,近些年来不断有研究者提出关于术中如何保护尿控功能的观点和看法。本文现将根治性前列腺切除术中保护尿控功能的理论与实践做一介绍。     

Delayed recovery of urinary continence after laparoscopic radical prostatectomy

AIM: To study the rate at which patients regained urinary continence during our institution's early experience with laparoscopic radical prostatectomy. METHODS: The urinary continence of 34 patients was recorded at various intervals following laparoscopic radical prostatectomy. These data were compared with those from 49 patients who had undergone radical retropubic prostatectomy. RESULTS: For laparoscopic prostatectomy patients, 2.9% had regained urinary continence at 1 month, 29.4% at 3 months, 46.9% at 6 months, 56.0% at 9 months and 60.0% at 12 months. For retropubic prostatectomy patients, the corresponding rates were 22.4% at 1 month, 63.3% at 3 months, 84.1% at 6 months, 92.9% at 9 months and 92.9% at 12 months. Backward stepwise logistic regression analysis indicated that laparoscopic surgery itself significantly predicted urinary incontinence at every interval from 1 to 9 months following surgery (P < 0.05). CONCLUSION: Patients' postoperative recovery of urinary continence was not satisfactory in our early experience with laparoscopic radical prostatectomy. Further efforts to elucidate the reason for this poor functional outcome are mandatory before the procedure is accepted as part of standard practice.     

Open radical retropubic prostatectomy using high anterior release of the levator fascia and constant haptic feedback in bilateral neurovascular bundle preservation plus early postoperative phosphodiesterase type 5 inhibition: a contemporary series

Background

Patients with newly diagnosed localized prostate cancer who choose surgery want cure and decent quality of life, namely, pad-free urinary control and, often, erectile function satisfactory for sexual intercourse.

Objective

Determine in a prospective study the positive surgical margin rate and functional outcomes for a consecutive series of patients undergoing open radical retropubic prostatectomy (ORRP) with bilateral neurovascular bundle preservation (BNVBP) performed by one experienced surgeon.

Design, setting, and participants

Of 197 consecutive patients undergoing BNVBP during 2008, 123 were evaluable, allowing both immediate postoperative phosphodiesterase type 5 inhibition (PDE5i) and a third-party questionnaire with validated urinary and erectile function domains provided preoperatively and at 3, 6, and 12 mo postoperatively.

Intervention

Two interventions were used: (1) ORRP with ×4.3 optical loupes and constant digital tactile monitoring during BNVBP preceded by high anterior release (HAR) of levator fascia and neurovascular bundles and (2) early postoperative PDE5i.

Measurements

Age; biopsy Gleason score; clinical stage; preoperative prostate-specific antigen level; pathologic grade; stage; margin status; University of California, Los Angeles Prostate Cancer Index domain for urinary pad use and bother; and International Index of Erectile Function-5 (IIEF-5) were used.

Results and limitations

Surgical margins were positive in 1 of the 123 evaluable patients (1%). At 1 yr, 95% of patients were pad-free. Satisfactory erectile function was achieved by 109 patients (89%): 82 (67%) scored an IIEF-5 of 22–25, and 27 (22%) scored <22–25 with ≥4 on either satisfaction or confidence questions or achieved “full” erection within the first year. Mean hospital stay was 1.3 d. Limitations were (1) observational, noncomparative, single-surgeon series and (2) in third-party methodology, failure to capture patient answers for all questionnaire intervals with resultant inability to address durability of functional results for all patients.

Conclusions

ORRP using ×4.3 optical loupe magnification, constant haptic feedback in BNVBP with HAR, and immediate postoperative PDE5i yielded satisfactory outcomes.     

Sustainable functional urethral reconstruction improves early urinary continence after robot-assisted radical prostatectomy: a randomised controlled trial

Objective

To evaluate the impact of sustainable functional urethral reconstruction (SFUR) on early recovery of urinary continence (UC) after robot-assisted radical prostatectomy.

Patients and Methods

Overall, 96 patients with primary prostate cancer were randomised into the SFUR or standard group (n = 48 each). The primary outcome was the 1-month UC recovery. Secondary outcomes included short-term (≤3 months) UC recovery, urinary function, micturition-related bother, perioperative complications, and oncological outcomes. Kaplan–Meier curves and Cox proportional hazard models were used to assess the 3-month UC recovery. Generalised estimating equations were used to compare postoperative urinary function and micturition-related bother.

Results

The 1-month UC recovery rates, median 24-h pad weights, and median operative time in the SFUR and standard groups were 73% and 49% (P = 0.017), 0 and 47 g (P = 0.001), and 125 and 103 min (P = 0.025), respectively. The UC recovery rates in the SFUR vs standard groups were 53% vs 23% at 1 week (P = 0.003), 53% vs 32% at 2 weeks (P = 0.038), and 93% vs 77% at 3 months (P = 0.025). The median time to UC recovery in the SFUR and standard groups was 5 and 34 days, respectively (log-rank P = 0.006); multivariable Cox regression supported this result (hazard ratio 1.73, 95% confidence interval 1.08–2.79, P = 0.024). Similar results were observed when UC was defined as 0 pads/day. Urinary function (P = 0.2) and micturition-related bother (P = 0.8) were similar at all follow-up intervals. The perioperative complication rates, positive surgical margin rates, and 1-year biochemical recurrence-free survival were comparable between both groups (all P > 0.05).

Conclusion

SFUR resulted in earlier UC recovery without compromising postoperative urinary function. Long-term validation and multicentre studies are required to confirm the results of this novel technique.     

经腹膜外腹腔镜下前列腺癌根治术及其控尿技术

目的 探讨腹膜外途径腹腔镜前列腺癌根治术及其控尿技术的应用价值。方法 前列腺癌患者28例，年龄60～75岁，平均68岁。PSA0．7～23．6ng／ml。TNM分期：T1N0M011例，T2N0M015例，T3aN0M2例。均行腹膜外途径腹腔镜前列腺癌根治术。，术中充分剪开盆筋膜，分离至前列腺尖部，缝扎背血管复合体。分离膀胱颈部（前列腺交界处），横断并尽可能保护颈部括约肌。仔细观察盆底肌肉并于近端剪开前列腺尖部，尽可能保护盆底括约肌，最后缩小并重建膀胱颈口，间断吻合膀胱和尿道。结果 28例手术均顺利完成，手术时间180～380min，平均240min；出血量400～1200ml，平均800ml，15例出血量〉500ml者输血200～800ml。术后病理示切缘阴性25例，3例前列腺尖部切缘阳性者术后加用全雄激素阻断治疗3个月。患者均于术后2周拔除导尿管，3例术后出现轻度尿失禁，经提肛训练等辅助治疗3个月后好转，能自主排尿。术后3个月时PSA0．02～0．10ng／ml。随访1个月～2年，未见肿瘤复发转移。结论 腹腔镜下经腹膜外途径前列腺癌根治术安全、有效，值得临床推广。