Impact of posterior musculofascial reconstruction on early continence after robot-assisted laparoscopic radical prostatectomy: results of a prospective parallel group trial.
Impact of posterior musculofascial reconstruction on early continence after robot-assisted laparoscopic radical prostatectomy: results of a prospective parallel group trial.
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DOI：
10.1016/j.eururo.2010.03.028
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发表时间：
2010-07-01
期刊：
影响因子：
23.4
通讯作者：
van der Poel, Henk
中科院分区：
文献类型：
--
作者：
Joshi, Neil;de Blok, Willem;van der Poel, Henk
背景：根治性尿道切除术后早期有相当比例的患者发生尿失禁。支持组织的后方重建已被发现，以减少失禁在开放和传统的腹腔镜直肠切除series.Objective：探讨是否我们的版本的后方肌筋膜重建将减少早期失禁，并对患者的生活质量（QoL）的有益影响。设计，设置，和参与者：在一个三级转诊的肿瘤机构中，107名连续患者接受由一名外科医生进行的初次机器人辅助腹腔镜根治性直肠癌切除术（RALP），（未随机分配）干预组（n=53）或对照组（n=54）。外科手术：RALP伴正中纤维缝重建（MFRR），随后形成尿道膀胱吻合口（干预组）与不进行后路重建的标准吻合术测量：测量包括基线和3个月间隔的尿失禁;术前和术后6个月通过简单问卷、欧洲癌症研究与治疗组织（EORTC）生活质量-核心30（QLQ-C30）和前列腺癌模块（PR 25）问卷测量的QoL;肿瘤特征;手术时间;结果和局限性：干预组和对照组的平均置管时间分别为11.74 d和12.74 d（p=0.451）; 6例和8例病例的膀胱造影显示渗漏（p=0.28）; 3个月时失禁（任何不自主尿量）为75%和69%（p=0.391），6个月时为51%和43%（p=0.686）。仅1例（对照组）发生尿潴留。两组在6个月时所有QoL领域（失眠除外）恢复至基线的病例百分比相似。短期随访，缺乏盲法，并可能在我们的方法MFRR进行与其他研究相比，小的差异被确定为显着limitations.CONCLUSIONS：没有显着差异，在任何分析的结果措施进行了观察。肌筋膜复合体的后部重建似乎不能改善RALP术后早期尿失禁。
BACKGROUND: A significant proportion of patients develop urinary incontinence early after radical prostatectomy. Posterior reconstruction of supporting tissues has been found to reduce incontinence in open and conventional laparoscopic prostatectomy series.OBJECTIVE: To investigate whether our version of a posterior musculofascial reconstruction will reduce early incontinence and have a beneficial effect on patients' quality of life (QoL).DESIGN, SETTING, AND PARTICIPANTS: One hundred seven consecutive patients undergoing primary robot-assisted radical laparoscopic prostatectomy (RALP) performed by a single surgeon at one tertiary referral oncology institution were alternately assigned (not randomised) to intervention (n=53) or control groups (n=54).SURGICAL PROCEDURE: RALP with median fibrous raphe reconstruction (MFRR) followed by formation of the urethrovesical anastomosis (intervention group) versus standard anastomosis without posterior reconstruction (control group).MEASUREMENTS: Measurements included incontinence at baseline and 3-mo intervals; QoL as measured by a simple questionnaire, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life-Core 30 (QLQ-C30), and Prostate Cancer Module (PR25) questionnaires preoperatively and at 6 mo postprocedure; tumour characteristics; operative time; fascial preservation score; duration of catheterisation; and anastomotic leakage on cystogram.RESULTS AND LIMITATIONS: For intervention and control groups respectively, mean catheter duration was 11.74 d and 12.74 d (p=0.451); leakage on cystogram was present in six and eight cases (p=0.28); and incontinence (any involuntary urine loss) at 3 mo was 75% and 69% (p=0.391) and at 6 mo was 51% and 43% (p=0.686). Urinary retention occurred only in one case (control group). The percentage of cases returning to baseline in all QoL domains (except insomnia) was similar at 6 mo between the two groups. Short follow-up, lack of blinding, and probable small differences in our method of MFRR performed compared with other studies were identified as significant limitations.CONCLUSIONS: No significant difference in any of the analysed outcome measures was observed. Posterior reconstruction of the musculofascial complex does not appear to improve early urinary incontinence after RALP.