Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence (EC) recovery; however, evidence regarding the best approach remains controversial. The objectives are to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomized control trials (RCTs); to summarize the immediate continence and the EC reported; and to propose a new standardization for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery was included. The heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised, and quality assessed. Results: In total, 39 RCTs were included: 19 of 39 studies were low-quality RCTs, presenting small cohort, monocentric, or single-surgeon data. The best RCT-supported evidence is in favor of robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) and of the Retzius-sparing (RS) technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament (PPL) preservation, posterior reconstruction with or without combination of anterior suspension technique, and nerve-sparing (NS) approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings, and the selective ligature of dorsal venous complex (DVC) were not significantly associated with EC improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, and DVC suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and RS have high-quality evidence supporting their ability to enhance postoperative EC recovery. NS, bladder neck, and PPL preservation may contribute to better EC recovery, although the evidence level is low. Further multicenter RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardization was proposed.

中文翻译：

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根治性前列腺切除术中的节制控制技术：随机对照试验的系统评价。

背景：已经开发了许多保留失禁的根治性前列腺切除术技术来增强术后早期失禁（EC）恢复；然而，关于最佳方法的证据仍然存在争议。目标是根据质量评估随机对照试验（RCT）的证据，对各种前列腺切除术技术进行严格评估；总结立即节制和 EC 报告；并提出新的失禁结果报告标准化。方法：从五个医疗登记处获取的数据按照系统评价和荟萃分析的首选报告项目 (PRISMA) 标准进行报告。其中包括已发表的英文全文随机对照试验的证据，报告手术后 6 个月内的术后尿失禁结果。手术技术和失禁定义的异质性不允许进行荟萃分析。所有随机对照试验均经过严格评价和质量评估。结果：总共纳入了 39 项随机对照试验：39 项研究中有 19 项是低质量随机对照试验，提供小队列、单中心或单外科医生数据。最好的 RCT 支持证据支持机器人辅助根治性前列腺切除术 (RARP) 与腹腔镜根治性前列腺切除术 (LRP) 相比，以及保留 Retzius 技术 (RS) 与传统前列腺切除术相比。其他技术，例如保留膀胱颈和耻骨前列腺韧带 (PPL)、结合或不结合前路悬吊技术的后路重建以及神经保留 (NS) 方法似乎可以增强 EC。相反，保留盆腔筋膜、膀胱颈粘膜外翻/折叠/吊带以及选择性结扎背静脉复合体（DVC）与 EC 改善没有显着相关性。缺乏关于保留耻骨膀胱复合体、保留精囊、耻骨前列腺环前部重建、肌筋膜重建和耻骨骨膜 DVC 悬吊技术的随机对照试验。结论：RARP 和 RS 有高质量的证据支持其增强术后 EC 恢复的能力。尽管证据水平较低，但 NS、膀胱颈和 PPL 保留可能有助于 EC 更好的恢复。需要进一步的多中心随机对照试验来建立标准手术技术的最佳组合。提出了新的失禁结果报告标准化。