神经保留有利于机器人辅助腹腔镜根治性前列腺切除术后膜性尿道长度较短患者尿失禁的恢复。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery Pub Date : 2025-09-10 DOI:10.1111/ases.70147

Kazuki Kokura, Akihiro Kanematsu, Shingo Yamamoto, Jun Watanabe

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引用次数: 0

摘要

目的：我们分析机器人辅助腹腔镜根治性前列腺切除术后尿失禁术后恢复的决定因素，重点关注膜性尿道长度和包括神经保留。材料和方法：本回顾性研究包括2017年至2022年在单一机构接受机器人辅助腹腔镜根治性前列腺切除术的患者。对尿失禁术后恢复情况进行Cox比例风险分析，尿失禁定义为0或1个尿垫/天。检查患者的因素包括年龄、体重指数、前列腺体积和尿道膜长度，而手术因素包括神经保留情况、手术时间和手术时间。结果：共纳入197例患者。尿道中膜长度为11.6 mm。神经保留92例（46.7%），单侧保留68例，双侧保留24例。总的来说，单因素和多因素Cox风险分析显示，尿失禁恢复的唯一显著因素是尿道膜长度（风险比1.059,p = 0.01），而神经保留不显著（风险比1.132,p = 0.43）。然而，当以膜性尿道长度中位数（11.6 mm）将患者细分为两组时，神经保留在较长组（≥11.6 mm, n = 99，风险比0.898,p = 0.64）中并不是恢复的显著因素，而在较短组则是显著因素(结论：本研究结果可能表明，对于膜性尿道长度较短的患者，更推荐神经保留。

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Nerve Sparing Is Beneficial for Recovery From Urinary Incontinence in Patients With Shorter Membranous Urethral Length After Robot-Assisted Laparoscopic Radical Prostatectomy

Purpose

We analyze determinants of postoperative recovery from urinary incontinence following robot-assisted laparoscopic radical prostatectomy, with a focus on membranous urethral length and inclusion of nerve sparing.

Materials and Methods

This retrospective study included patients who underwent robot-assisted laparoscopic radical prostatectomy from 2017 to 2022 performed at a single institution. Cox proportional hazards analysis was conducted for postoperative recovery from urinary incontinence, defined as use of zero or one pad/day. Examined patient factors were age, body mass index, prostate volume, and membranous urethral length, while surgical factors were nerve-sparing status, operative time, and console time.

Results

A total of 197 patients were included in the analysis. Median membranous urethral length was 11.6 mm. Nerve sparing was performed in 92 (46.7%), with unilateral preservation in 68 and bilateral preservation in 24. In total, patients both univariate and multivariate Cox hazard analyses showed that the only significant factor for recovery from urinary incontinence was membranous urethral length (hazard ratio 1.059, p = 0.01), while nerve sparing was not significant (hazard ratio 1.132, p = 0.43). However, when patients were subdivided into two groups based on the median value for membranous urethral length (11.6 mm), nerve sparing was not a significant factor for recovery in the longer group (≥ 11.6 mm, n = 99, hazard ratio 0.898, p = 0.64), while that was significant in the shorter group (< 11.6 mm, n = 98, hazard ratio 1.55, p = 0.049).