中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

基于 mpMRI 评估机器人辅助腹腔镜根治性前列腺切除术后早期尿控的影响因素

Analysis of influencing factors of early urinary continence after robotassisted laparoscopic radical prostatectomy based on mpMRI

作者:张泽霖,朱依萍,张家昊,陈家浩,王小海,韩邦旻

Vol. 5 No. 4 Aug. 2024 DOI: 10.12180/j.issn.2096-7721.2024.04.001 发布日期:2024-10-22
关键词:机器人辅助手术;腹腔镜根治性前列腺切除术;尿失禁;影响因素

作者简介:

目的:探讨基于 mpMRI 评估机器人辅助腹腔镜根治性前列腺切除术后早期尿控的影响因素。方法: 选取 2019 年 12 月—2020 年 12 月上海交通大学医学院附属第一人民医院 35 例行机器人辅助腹腔镜根治性前列腺切 除术患者。以全天不需要使用尿垫和尿控评分≤ 7 分为尿控功能恢复的标准,对术后早期患者的尿控功能进行随访, 分析影响术后早期尿失禁的危险因素。结果:膜部尿道角与机器人辅助腹腔镜根治性前列腺切除术后 1 周 ~3 个月 的尿控功能存在明显相关性,尿道壁厚度与拔除尿管后的即时尿控及术后 2 周 ~3 个月的尿控功能相关,而前列腺 尖部形态则与术后 2 个月时的尿控情况有关,前列腺长度与术后 2 周的尿控功能恢复相关,前列腺尖部深度及前列 腺尖部深度比则与即刻尿控的恢复显著相关。结论:膜部尿道角、尿道壁厚度、前列腺长度、前列腺尖部形态、前 列腺尖部深度及前列腺尖部深度比是机器人辅助腹腔镜根治性前列腺切除术后尿失禁的独立预测因素。

Objective: To evaluate the influencing factors of early urinary continence after robot-assisted laparoscopic radical prostatectomy based on mpMRI. Methods: 35 patients underwent robot-assisted laparoscopic radical prostatectomy in the Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from December 2019 to December 2020 were selected. The urinary continence function of the patients in the early postoperative period was followed up, and risk factors affecting early postoperative urinary incontinence were analyzed. Results: The membranous urethral angle was significantly correlated with urinary continence at 1 to 3 months after surgery. The urethral wall thickness was correlated with immediate urinary continence after catheter removal and urinary continence at 2 to 3 months after surgery, while the prostate apex shapes were correlated with urinary continence function at 2 months after surgery, and prostate length was correlated with urinary continence function at 2 weeks after surgery. Prostate apical depth and the ratio of prostate apical depth were significantly correlated with the immediate urinary continence. Conclusion: Membranous urethral angle, urethral wall thickness, prostate length, prostate apex shape, prostate apical depth and prostate apical depth ratio are the influential factors of urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

稿件信息

收稿日期:2023-01-16  录用日期:2023-10-21 

Received Date: 2023-01-16  Accepted Date: 2023-10-21 

基金项目:国家自然科学基金(82072849) 

Foundation Item: National Natural Science Foundation of China(82072849) 

通讯作者:王小海,Email:wangxiaohai8@163.com;韩邦旻,Email:hanbm@163.com 

Corresponding Author: WANG Xiaohai, Email: wangxiaohai8@163.com; HAN Bangmin, Email: hanbm@163.com 

引用格式:张泽霖,朱依萍,张家昊,等 . 基于 mpMRI 评估机器人辅助腹腔镜根治性前列腺切除术后早期尿控的影响因素 [J]. 机 器人外科学杂志(中英文),2024,5(4):499-504. 

Citation: ZHANG Z L, ZHU Y P, ZHANG J H, et al. Analysis of influencing factors of early urinary continence after robot-assisted laparoscopic radical prostatectomy based on mpMRI[J]. Chinese Journal of Robotic Surgery, 2024, 5(4): 499-504. 

注:张泽霖,朱依萍为共同第一作者 Co-first Author: ZHANG Zelin, ZHU Yiping

参考文献

[1] Siegel R L , Miller K D , Fuchs H E , et al. Cancer Statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33. 

[2] Mohler J L, Antonarakis E S, Armstrong A J, et al. Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2019, 17(5): 479-505. 

[3]   Ficarra V, Novara G, Rosen R C, et al. Systematic review and Metaanalysis of studies reporting urinary continence recovery after robotassisted radical prostatectomy[J]. Eur Urol, 2012, 62(3): 405-417. 

[4] Basiri A, de la Rosette J J, Tabatabaei S, et al. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?[J]. World J Urol, 2018, 36(4): 609-621. 

[5] Jeong S J, Yi J, Chung M S, et al. Early recovery of urinary continence after radical prostatectomy: correlation with vesicourethral anastomosis location in the pelvic cavity measured by postoperative cystography[J]. Int J Urol, 2011, 18(6): 444-451. 

[6] Macura K J, Genadry R R. Female urinary incontinence: pathophysiology, methods of evaluation and role of MR imaging[J]. Abdom Imaging, 2008, 33(3): 371-380. 

[7] HUANG H C, JIANG Y H, LIN V C, et al. Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy-bladder neck level and urodynamic parameters[J]. J Formos Med Assoc, 2019, 118(1 Pt 2): 237-243. 

[8] Kageyama S, Yoshida T, Nagasawa M, et al. The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy[J]. BMC Urol, 2018, 18(1): 52. 

[9] Yu Y D, Lee M, Hong S K, et al. Impact of variations in prostatic apex shape on apical margin positive rate after radical prostatectomy: robot-assisted laparoscopic radical prostatectomy vs open radical prostatectomy[J]. J Endourol, 2018, 32(1): 46-53. 

[10] Matsuzaki H, Yanagi Y, Hara M, et al. Diagnostic value of dynamic contrast-enhanced MRI for submucosal palatal tumors[J]. Eur J Radiol, 2012, 81(11): 3306-3312. 

[11] 张帆 , 黄晓娟 , 杨斌 , 等 . 前列腺尖部深度与腹腔镜前列腺癌根 治术后早期控尿功能恢复的相关性 [J]. 北京大学学报 ( 医学版 ), 2021, 53(4): 692-696. 

[12] Tienza A, Hevia M, Benito A, et al. MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy[J]. Int Urol Nephrol, 2015, 47(8): 1343-1349. 

[13] Machioka K, Kadono Y, Naito R, et al. Evaluating urinary incontinence before and after radical prostatectomy using the international consultation on incontinence questionnaire-short form[J]. Neurourol Urodyn,2019,38(2):726-733. 

[14] Pavlovich C P, Rocco B, Druskin S C, et al.Urinary continence recovery after radical prostatectomy-anatomical/reconstructive and nerve-sparing techniques to improve outcomes[J]. BJU Int, 2017, 120(2): 185-196. 

[15] Walz J, Burnett A L, Costello A J, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy[J]. European Urology, 2010, 57(2): 179-192. 

[16] Covas Moschovas M, Bhat S, Onol F F, et al. Modified apical dissection and lateral prostatic fascia preservation improves early postoperative functional recovery in robotic-assisted laparoscopic radical prostatectomy: results from a propensity score-matched analysis[J]. European Urology, 2020, 78(6): 875-884. 

[17] Sadahira T, Mitsui Y, Araki M, et al. Pelvic magnetic resonance imaging parameters predict urinary incontinence after robot-assisted radical prostatectomy[J]. Low Urin Tract Symptoms, 2019, 11(3): 122-126. 

[18] Soljanik I, Bauer R M, Becker A J, et al. Is a wider angle of the membranous urethra associated with incontinence after radical prostatectomy?[J]. World Journal of Urology, 2014, 32(6): 1375- 1383. 

[19] Sauer M, Tennstedt P, Berliner C , et al. Predictors of short and long term urinary incontinence after radical prostatectomy in prostate MRI: significance and reliability of standardized measurements[J]. European Journal of Radiology, 2019. DOI: 10.1016/ j.ejrad.2019.108668. 

[20] Wenzel M, Preisser F, Mueller M, et al. Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy[J]. Int Urol Nephrol, 2021, 53(7): 1297-1303. 

[21] Fukui S, Kagebayashi Y, Iemura Y, et al. Preoperative MRI parameters predict urinary continence after robot-assisted laparoscopic prostatectomy in prostatic cancer patients[J]. Diagnostics, 2019, 9(3): 102.

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