ロボット支援前立腺全摘術導入初期症例の術後尿禁制の検討: 恥骨後式根治的前立腺全摘術との比較

Abstract

To compare the results of urinary incontinence in patients with clinically localized prostate cancer, T1a- 3aN0M0, treated by robot-assisted laparoscopic prostatectomy (RALP) or open radical retropubic prostatectomy (RRP), we studied 44 patients treated with RALP and 60 who received RRP by one surgeon between March 2004 and January 2011. The pad-free and safety-pad (1 pad a day) rates after surgery were calculated with Kaplan-Meyer method. All preoperative and postoperative factors were not significantly different between the two groups. Overall, 88% of the patients in the RRP group were pad-free with a mean follow-up of 54 months and 93% of the patients in the RALP group were pad-free with a mean follow-up of 22.1 months. However, the pad-free rates at 3, 6 and 12 months after surgery were 33, 58.6 and 75.8%, respectively, in the RRP group compared to 44, 72 and 89.5% in the RALP group, respectively (p＝0.0393). Similarly, 97% of the patients in the RRP group and 98% of the patients in the RALP group used a safety-pad during the observation period. The rates of safety-pad at 3, 6 and 12 months after surgery were 52.7, 71.6 and 81%, respectively, in the RRP group compared to 78.9，92 and 94.7% in the RALP group, respectively (p＝0.002). In conclusion, while the follow-period is short and the number of patients is small, RALP may provide a better functional outcome after surgery in terms of early recovery of urinary incontinence than RRP. This may be one of the reasons to justify the use of robotic surgery as an alternative to the traditional RRP.