Abstract

Objective

The objective was to investigate the current evidence and discern urinary continence rates post robot-assisted laparoscopic radical prostatectomy (RALP).

Methods

A systematic review of the literature was carried out, searching the Embase, Scopus and PubMed databases between 1 January 2000 and 1 May 2020. The search terms “Robotic prostatectomy AND continence” were employed. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical analysis was performed using the programme R; cumulative analysis of percentage of men continent was calculated.

Results

A total of 3101 abstracts and 50 full text articles were assessed, with 22 publications included (n = 2813 patients). There were 21 randomised controlled trials and one partly randomised controlled trial with four publications comparing RALP to other prostate cancer treatments. Thirteen studies explored different RALP techniques, and five studies examined vesicourethral anastomosis (VUA). There were statistically significant improvements in early urinary continence rates in three studies analysing reconstructive techniques (83% vs 60%, p = 0.04; 26.5% vs 15.4%, p = 0.016; 77% vs 44.1%, p ≤ 0.001). Long-term continence rates were not significantly improved across all studies assessing reconstruction. One study comparing RALP vs laparoscopic radical prostatectomy (LRP) demonstrated a statistically significant improvement in continence at 3 months (80% vs 73.3%, p < 0.001); 6 months (83.3% vs 81.4%, p < 0.001); 12 months (95% vs 83.3%, p < 0.001) and 24 months (96.7% vs 85%, p < 0.001). Early continence was less favourable for RALP when compared to brachytherapy (BT) patients at 3 months (86% vs 98.7%, p < 0.05) and 6 months (90.5% vs 98.7%, p < 0.05).

Conclusion

Early continence rates were improved across numerous techniques in RALP. These results were not translated into significantly improved long-term outcomes. Continence rates following RALP were favourable compared to LRP, similar to ORP and less favourable compared to BT. Our findings suggest that post-RALP continence can be further improved with alterations in robotic technique.

中文翻译：

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机器人辅助腹腔镜前列腺癌根治术后尿失禁率的系统评价

摘要

客观的

目的是调查当前证据并辨别机器人辅助腹腔镜根治性前列腺切除术（RALP）后的尿失禁率。

方法

对2000年1月1日至2020年5月1日期间的Embase、Scopus和PubMed数据库进行了系统的文献综述。采用了检索词“机器人前列腺切除术和失禁”。文章是根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南选择的。使用R程序进行统计分析；累积分析计算了男性大陆的百分比。

结果

总共评估了 3101 篇摘要和 50 篇全文文章，其中包括 22 篇出版物（n  = 2813 名患者）。有 21 项随机对照试验和一项部分随机对照试验，其中有四篇出版物将 RALP 与其他前列腺癌治疗进行了比较。十三项研究探索了不同的 RALP 技术，五项研究检查了膀胱尿道吻合术 (VUA)。在分析重建技术的三项研究中，早期尿失禁率有统计学上的显着改善（83% vs 60%，p  = 0.04；26.5% vs 15.4%，p  = 0.016；77% vs 44.1%，p ≤ 0.001）。在所有评估重建的研究中，长期失禁率并未显着改善。一项比较 RALP 与腹腔镜根治性前列腺切除术 (LRP) 的研究表明，3 个月时节制能力有统计学显着改善（80% vs 73.3%，p  < 0.001）；6 个月（83.3% vs 81.4%，p  < 0.001）；12 个月（95% vs 83.3%，p  < 0.001）和 24 个月（96.7% vs 85%，p  < 0.001）。与近距离放射治疗 (BT) 患者相比，在 3 个月（86% vs 98.7%，p  < 0.05）和 6 个月（90.5% vs 98.7%，p  < 0.05）时，早期节制对 RALP 不利。

结论

RALP 中的多种技术均提高了早期失禁率。这些结果并未转化为显着改善的长期结果。与 LRP 相比，RALP 后的失禁率较高，与 ORP 相似，但与 BT 相比较差。我们的研究结果表明，RALP 后的失禁可以通过机器人技术的改变得到进一步改善。