The Effect of the Vesical Adaptation Response to Diuresis on Lower Urinary Tract Symptoms after Robot-Assisted Laparoscopic Radical Prostatectomy: A Pilot Proof of Concept Study.
The Effect of the Vesical Adaptation Response to Diuresis on Lower Urinary Tract Symptoms after Robot-Assisted Laparoscopic Radical Prostatectomy: A Pilot Proof of Concept Study.
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DOI：
10.1371/journal.pone.0159514
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Kojima Y
中科院分区：
文献类型：
--
作者：
Haga N;Aikawa K;Hoshi S;Yabe M;Akaihata H;Hata J;Sato Y;Ogawa S;Ishibashi K;Kojima Y
当尿量增加时，正常受试者每次排尿时的排尿量也增加。这通常被理解为膀胱对利尿的适应性反应（VARD）。由于机器人辅助腹腔镜根治性膀胱切除术（RARP）后膀胱功能的变化应该改善下尿路症状（LUTS），本研究的目的是探讨VARD是否参与RARP后LUTS的改善。在RARP前后对100例接受RARP并具有国际前列腺症状评分（IPSS）、生活质量（QOL）指数、频率-容量图（FVC）、尿流率和排尿后残余尿（PVR）的连续患者进行了评价。根据术前IPSS总评分，将该队列分为术前LUTS患者和术前无LUTS患者。VARD定义为每次排尿时尿量与排尿量之间存在显著相关性（R2> 0.2）。在术前LUTS的患者中，RARP后IPSS总评分、储尿和排尿症状评分均显著改善（均P <0.001）。RARP治疗后生活质量指数明显改善（P <0.05）。尽管RARP前未观察到VARD（R2 = 0.05），但RARP后观察到了VARD（3个月R2 = 0.22，12个月R2 = 0.23）。RARP后PVR显著降低（P = 0.004）。在RARP后获得VARD时观察到LUTS改善。因此，术前LUTS患者的尿QOL也得到改善。RARP可能是通过获得VARD改善LUTS的有效方法。
When urine output increases, voided volume at each voiding also increases in normal subjects. This is generally understood as a vesical adaptation response to diuresis (VARD). Because lower urinary tract symptoms (LUTS) are supposed to be improved by the change in bladder function after robot-assisted laparoscopic radical prostatectomy (RARP), the aim of the present study was to investigate whether VARD is involved in the improvement of LUTS after RARP. 100 consecutive patients who underwent RARP and had the International Prostate Symptom Score (IPSS), quality of life (QOL) index, a frequency-volume chart (FVC), uroflowmetry, and post-voided residual urine (PVR) available were evaluated before and after RARP. This cohort was divided into patients with and without preoperative LUTS according to the preoperative IPSS total score. VARD was defined as the presence of a significant correlation between the urine output rate and voided volume at each voiding (R2>0.2). In patients with preoperative LUTS, the IPSS total, storage, and voiding symptom scores were significantly improved after RARP (all P<0.001). The QOL index was also significantly improved after RARP (P<0.05). Although VARD was not seen before RARP (R2 = 0.05), it was seen after RARP (3 months R2 = 0.22, 12 months R2 = 0.23). PVR was significantly reduced after RARP (P = 0.004). Improvement of LUTS was seen with acquisition of VARD after RARP. As a result, urinary QOL was also improved in patients with preoperative LUTS. RARP might be an effective procedure for amelioration of LUTS by the acquisition of VARD.