The narrow vesicourethral angle measured on postoperative cystography can predict urinary incontinence after robot-assisted laparoscopic radical prostatectomy
The narrow vesicourethral angle measured on postoperative cystography can predict urinary incontinence after robot-assisted laparoscopic radical prostatectomy
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DOI：
10.1080/21681805.2018.1428683
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发表时间：
2018-01-01
影响因子：
1.5
通讯作者：
Matsuda, Tadashi
中科院分区：
文献类型：
--
作者：
Sugi, Motohiko;Kinoshita, Hidefumi;Matsuda, Tadashi
目的：直肠癌根治术与尿失禁等并发症有关。膀胱尿道吻合术的特殊特征与根治性尿道切除术后尿失禁之间的显著相关性已被证实。本研究的目的是确定最有用的预测术后尿失禁后，机器人辅助腹腔镜根治性膀胱切除术（RALP）根据膀胱尿道吻合术的功能，确定由术后cystography.Materials和方法：最终的研究队列由150例患者。RALP术后1周内行膀胱造影。测量膀胱纵、横径比（L/H）、膀胱尿道连接处（UVJ）位置及膀胱颈角。通过导管取出后1天的1小时垫试验和使用安全垫评价术后痉挛状态，从患者记录中回顾性检索。然后分析这些变量与尿失禁之间的关联。结果：RALP术后1个月、1年、1 h尿垫试验阳性率分别为31.3%、56%、93.3%。在多变量分析中，尿失禁是显着相关的神经保留，L/H和膀胱角上确定的1小时垫测试，但只有膀胱角在1个月和1年postoperatives.Conclusion：膀胱造影测量狭窄的膀胱角是一个有用的预测RALP术后尿失禁。
Objective: Radical prostatectomy is associated with complications including urinary incontinence. A significant association between specific features of the vesicourethral anastomosis and urinary incontinence after radical prostatectomy has been demonstrated. The aim of this study was to identify the most useful predictor of postoperative urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP) according to the features of the vesicourethral anastomosis as determined by postoperative cystography.Materials and methods: The final study cohort consisted of 150 patients. Postoperative cystography was performed within 1 week after RALP. The ratio between the longitudinal and horizontal lengths (L/H) of the bladder, the position of the urethrovesical junction (UVJ) and the bladder neck angle as seen on the cystogram were evaluated. Postoperative continence status was evaluated by a 1 h pad test 1 day after catheter removal and by the use of safety pads, retrieved retrospectively from patient records. The association between these variables and urinary incontinence was then analyzed. All patients were followed for at least 1 year postoperatively.Results: The continence rates on the 1 h pad test and 1 month and 1 year after RALP were 31.3%, 56% and 93.3%, respectively. In multivariate analyses, urinary incontinence was significantly associated with nerve sparing, L/H and the vesical angle as determined on the 1 h pad test, but only with the vesical angle at 1 month and 1 year postoperatively.Conclusion: A narrow vesical angle measured on cystography is a useful predictor of postoperative urinary incontinence after RALP.