Factors Contributing to Early Recovery of Urinary Continence Analyzed by Pre- and Postoperative Pelvic Anatomical Features at Robot-Assisted Laparoscopic Radical Prostatectomy

摘要

OBJECTIVE: The aim of the present study is to elucidate factors contributing to early recovery of urinary continence after robot-assisted laparoscopic radical prostatectomy (RARP) from the perspective of urethral and vesical anatomical features after RARP. PATIENTS AND METHODS: Sixty consecutive patients undergoing RARP also underwent pre- and postoperative urethrovesicography (UVG). Both pre- and postoperative UVG evaluated the posterior-urethral vesical angle and position of the urethrovesical junction. Postoperative UVG was performed 7 days after RARP and also evaluated postoperative membranous urethral length (MUL) and the postoperative degree of atony of the external urethral sphincter. Associations were analyzed between pre- or postoperative UVG variables and urinary incontinence as well as between UVG variables significantly correlating with urinary incontinence and neurovascular bundle-preservation procedures. RESULTS: Postoperative MUL was the only factor significantly associated with the state of continence in the early postoperative period according to multivariate logistic regression analysis (odds ratio, 1.94; 95% confidence interval, 1.22-3.12; p<0.005). A cutoff value of 17 mm offered the best accuracy in receiver operating characteristics analysis. Postoperative MUL was significantly increased in the group with preservation of the neurovascular bundle (p=0.01). CONCLUSIONS: Postoperative MUL is the most important factor for recovery of urinary continence in the early postoperative period after RARP. Postoperative MUL >17 mm as measured on UVG can be expected to predict early recovery of urinary continence. Postoperative MUL was greater with preservation of the neurovascular bundle, thus allowing early recovery of urinary continence.