- MeSH
- incidence MeSH
- lacerace etiologie chirurgie MeSH
- lidé MeSH
- perineum * zranění chirurgie MeSH
- pooperační komplikace * etiologie epidemiologie MeSH
- prospektivní studie MeSH
- retence moči * etiologie epidemiologie MeSH
- rizikové faktory MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- dopisy MeSH
- komentáře MeSH
- Geografické názvy
- Uganda MeSH
BACKGROUND: The advent of robotics has facilitated new surgical techniques for radical prostatectomy. These allow adjustment of pelvic anatomical and functional relationships after removal of the prostate to ameliorate postprostatectomy incontinence (PPI) and reduce the time to complete continence. OBJECTIVES: To describe the results of a new surgical technique for reconstruction of vesicourethral anastomosis using the levator ani muscle for support during robot-assisted radical prostatectomy (RARP). DESIGN, SETTING, AND PARTICIPANTS: A prospective, randomised, single-blind study among 66 consecutive patients with localised prostate cancer (cT1-2N0M0) undergoing RARP from June to September 2014, 32 using the new technique and 34 using the standard posterior reconstruction according to Rocco. SURGICAL PROCEDURE: In the advanced reconstruction of vesicourethral support (ARVUS) intervention group, the fibres of the levator ani muscle, Denonvilliers fascia, retrotrigonal layer, and median dorsal raphe were used to form the dorsal support for the urethrovesical anastomosis. Suture of the arcus tendineus to the bladder neck served as the anterior fixation. MEASUREMENTS: We compared demographic data and preoperative and postoperative functional and oncologic results for the two groups. The primary endpoint was continence evaluated at different time points (24h, 2, 4, and 8 wk, and 6 and 12 mo). The secondary endpoints were perioperative and postoperative complications and erectile function. RESULTS AND LIMITATIONS: Using a continence definition of 0 pads/d, the continence rates for the ARVUS versus the control group were 21.9% versus 5.9% at 24h (p=0.079), 43.8% versus 11.8% at 2 wk (p=0.005), 62.5% versus 14.7% at 4 wk (p<0.001), 68.8% versus 20.6% at 8 wk (p<0.001), 75.0% versus 44.1% at 6 mo (p=0.013), and 86.66% versus 61.29% at 12 mo (p=0.04). International Index of Erectile Function questionnaire results at 6 and 12 mo after surgery showed similar potency rates for the control group (40.0% and 73.33%) and the ARVUS group (38.8% and 72.22%). There were four postoperative complications (2 in each group): three haematomas requiring transfusion and one lymphocele that needed drainage. No urinary retention, anastomosis leak, or perineal pain was observed. Limitations include the small sample size and the single-institution design. CONCLUSIONS: The ARVUS technique yielded better urinary continence results than standard posterior reconstruction, with no negative impact on erectile function, complication rate, or oncologic outcome. External validation is warranted before clear recommendations can be made. PATIENT SUMMARY: We showed that postprostatectomy incontinence can be assuaged using a new technique for vesicourethral anastomosis reconstruction during robot-assisted radical prostatectomy (RARP). This could significantly improve the quality of life of patients after RARP. More studies are needed to support our results.
- MeSH
- anastomóza chirurgická metody MeSH
- inkontinence moči prevence a kontrola MeSH
- jednoduchá slepá metoda MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- močový měchýř chirurgie MeSH
- nádory prostaty chirurgie MeSH
- netěsnost anastomózy epidemiologie MeSH
- pánevní dno chirurgie MeSH
- pooperační komplikace epidemiologie prevence a kontrola MeSH
- prostatektomie metody MeSH
- retence moči epidemiologie MeSH
- roboticky asistované výkony metody MeSH
- senioři MeSH
- uretra chirurgie MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION AND HYPOTHESIS: Our purpose was to verify whether extensive dissection toward the sacrospinous ligament (SSL) needed for mesh fixation during anterior compartment repair increases the risk of postoperative voiding difficulties. METHODS: A total of 124 patients after anterior compartment mesh repair without simultaneous suburethral sling placement operated on in the period 2005-2012 were enrolled in this retrospective observational study. Patients with previous anti-incontinence surgery with normal urodynamics were not excluded; 30 patients with incomplete data, severe perioperative complications, and urinary retention before and after the surgery were excluded. Urinary retention was defined as post-void residual over 150 ml more than 48 h after permanent catheter removal. The rate of urinary retention after anterior compartment repair by mesh anchored to the SSL from an anterior approach (SSLS group) was compared to that following transobturator mesh repair often combined with SSL fixation from the posterior approach (TOT group). RESULTS: Of the 94 patients considered for statistical analysis, 62 were from the SLSS group and 32 from the TOT group. The groups were comparable in age (mean 65.5 vs 66.3), body mass index (24.8 vs 25.9), and parity (2.4 vs 2.9). Patients from the SSLS group had higher rates of prior vaginal reconstructive (27 vs 19 %) and anti-incontinence surgery (26 vs 19 %). Postoperative urinary retention was statistically significantly more frequent in the SSLS group compared to the TOT group [(17 (27 %) vs 2 (6.25 %), odds ratio 5.7, 95 % confidence interval 1.2-26.3, p = 0.027]. Hospital discharge with self-catheterization was statistically insignificantly more frequent in the SSLS group [8 % (5) vs 3 % (1)]. CONCLUSIONS: Extensive dissection needed for SSL suspension from an anterior approach may lead to more frequent postoperative voiding difficulties. This phenomenon could be explained by more considerable injury to pelvic splanchnic nerves during the dissection. A large prospective study is needed for validation of our results.
- MeSH
- chirurgické síťky škodlivé účinky MeSH
- cystokéla chirurgie MeSH
- gynekologické chirurgické výkony škodlivé účinky MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamenta chirurgie MeSH
- poruchy močení epidemiologie MeSH
- retence moči epidemiologie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
