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Retzius Sparing Robot-Assisted Radical Prostatectomy Conveys Early Regain of Continence over Conventional Robot-Assisted Radical Prostatectomy: A Propensity Score Matched Analysis of 1,863 Patients.

Retzius保留机器人辅助的根治性前列腺切除术传达了比传统机器人辅助的根治性前列腺切除术的早期控尿恢复: 1,863 例患者的倾向评分匹配分析。

  • 影响因子:1.46
  • DOI:10.1097/JU.0000000000000461
  • 作者列表:"Lee J","Kim HY","Goh HJ","Heo JE","Almujalhem A","Alqahtani AA","Chung DY","Chang K","Choi YD","Rha KH
  • 发表时间:2020-01-01
Abstract

PURPOSE:We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy. MATERIALS AND METHODS:Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome. RESULTS:After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001). CONCLUSIONS:Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.

摘要

目的: 我们比较Retzius保留机器人辅助根治性前列腺切除术和传统机器人辅助根治性前列腺切除术治疗前列腺癌术后早期控尿恢复。 材料和方法: 2005 年 10 月至 2018 年 5 月,由一名外科医生采用常规和Retzius保留技术完成 1,863 例机器人辅助前列腺癌根治术,分别占 1,150 和 713。为了比较两组之间的控尿结果,使用 9 个术前变量进行倾向评分匹配,包括年龄、体重指数、前列腺特异性抗原、活检Gleason分级组、临床T分期、经直肠超声检查前列腺体积,和I-PSS (国际前列腺症状评分),I-PSS生活质量评分和国际勃起功能指数-5 评分。术后每月通过pad计数评估控尿,直至第 6 个月,并转化为二元结果。 结果: 倾向评分匹配后,每组 609 例匹配,所有 9 个变量无显著差异。Kaplan-Meier曲线分析显示,在 6 个月的研究期间,保留Retzius的机器人辅助根治性前列腺切除术与显著优于传统机器人辅助根治性前列腺切除术的控尿治愈率相关 (p <0.001)。 结论: 基于多变量和大病例系列的倾向评分匹配,Retzius保留机器人辅助前列腺癌根治术可能是未来机器人辅助前列腺癌根治术的候选方案。与传统机器人辅助根治性前列腺切除术相比,它实现了更好的早期控尿恢复、较短的手术时间和早期恢复。

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翻译标题与摘要 下载文献
影响因子:1.46
发表时间:2020-01-01
来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000461
作者列表:["Lee J","Kim HY","Goh HJ","Heo JE","Almujalhem A","Alqahtani AA","Chung DY","Chang K","Choi YD","Rha KH"]

METHODS:PURPOSE:We compared early continence recovery after surgical treatment of prostate cancer with Retzius sparing robot-assisted radical prostatectomy and conventional robot-assisted radical prostatectomy. MATERIALS AND METHODS:Robot-assisted radical prostatectomy was done by a single surgeon in 1,863 cases between October 2005 and May 2018 using the conventional and the Retzius sparing technique in 1,150 and 713, respectively. To compare continence outcomes between the groups propensity score matching was performed using 9 preoperative variables, including age, body mass index, prostate specific antigen, biopsy Gleason Grade Group, clinical T stage, prostate volume on transrectal ultrasound, and the I-PSS (International Prostate Symptom Score), I-PSS quality of life score and International Index of Erectile Function-5 scores. Continence was assessed by the pad count every month postoperatively until month 6 and was converted to a binary outcome. RESULTS:After propensity score matching 609 cases per group were matched with no significant difference in all 9 variables. The Kaplan-Meier curve analysis revealed that Retzius sparing robot-assisted radical prostatectomy was associated with a significantly better continence recovery rate than conventional robot-assisted radical prostatectomy during the 6-month study period (p <0.001). CONCLUSIONS:Based on propensity score matching with multiple variables and a large case series, Retzius sparing robot-assisted radical prostatectomy can be a candidate for future robot-assisted radical prostatectomy. It achieves better early continence recovery, a short operative time and early recovery compared to conventional robot-assisted radical prostatectomy.

翻译标题与摘要 下载文献
影响因子:1.46
发表时间:2020-01-01
来源期刊:The Journal of urology
DOI:10.1097/JU.0000000000000458
作者列表:["McCrery R","Lane F","Benson K","Taylor C","Padron O","Blok B","De Wachter S","Pezzella A","Gruenenfelder J","Pakzad M","Perrouin-Verbe MA","Le Normand L","Van Kerrebroeck P","Mangel J","Peters K","Kennelly M","Shapiro A","Lee U","Comiter C","Mueller M","Goldman HB"]

METHODS:PURPOSE:Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. MATERIALS AND METHODS:A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. RESULTS:At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. CONCLUSIONS:The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.

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