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Vol. 44. Issue 8.
Pages 535-541 (October 2020)
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Vol. 44. Issue 8.
Pages 535-541 (October 2020)
Original article
DOI: 10.1016/j.acuroe.2019.10.009
Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis
Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía
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E. Martínez-Holguín
Corresponding author
elenamarhol@gmail.com

Corresponding author.
, F. Herranz-Amo, E. Lledó-García, J. Ruíz-Bel, L. Esteban-Labrador, D. Subirá-Ríos, C. Hernández-Fernández
Servicio De Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tables (5)
Table 1. Comparison of clinical variables between the two cohorts.
Table 2. Comparison of pathological variables between both cohorts.
Table 3. Comparison of post-operative urinary continence status between the two study groups.
Table 4. Multivariate analysis of variables with possible influence on post-prostatectomy urinary incontinence.
Table 5. Summary of most relevant studies.
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Abstract
Introduction

There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results.

Objectives

to compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP.

Materials and Methods

Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007−2015. The UC was evaluated at 3, 6, 12, 18 and 24 months. Continence was defined and classified as follows: a) UC, no need of pads, and b) urinary incontinence (UI), use of pads.

To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when p < 0,05.

Results

Nerve-sparing was performed in 51,7% cases. At 24 months after surgery, 72,4% patients had UC, of which 87,7% were from the ORP group and 78,1% in the LRP group (p = 0,004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (p = 0,036). ORP patients showed a higher percentage of anastomosis stricture (p = 0,03).

Conclusions

LRP, non-nerve sparing, and SRT were directly related to postoperative IU.

Keywords:
Prostate cancer
Prostatectomy
Laparoscopic surgery
Urinary incontinence
Resumen
Introducción

Pocos son los estudios que comparan la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL) y sus resultados funcionales como la continencia urinaria (CU), siendo éste uno de los objetivos prioritarios tras el control oncológico.

Objetivos

comparar la CU postoperatoria en los pacientes con adenocarcinoma de próstata localizado, intervenidos mediante PRA frente a PRL.

Material y métodos

Comparación de dos cohortes (312 con PRA y 206 con PRL) entre los años 2007 y 2015. El estado de CU se recogió a los 3, 6, 12, 18 y 24 meses. Para el manejo estadístico hemos agrupado la continencia en: a) CU, pacientes que no precisaron absorbentes y, b) Incontinencia urinaria (IU), pacientes que precisaron absorbentes.

Para el contraste de variables cualitativas se ha utilizado el test de la Chi cuadrado para las variables cualitativas y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para la variable dependiente IU. La significación estadística se consideró cuando existió una p < 0,05.

Resultados

En el 51,7% se realizó conservación neurovascular. A los 24 meses de la cirugía, el 72,4% presentaban CU, de los cuales PRA 87,8% frente al 78,1% de PRL (p = 0,004). El 22,7% presentaron recidiva bioquímica (RB), siendo el 83% tratados con radioterapia de rescate (RTR). En los pacientes con RTR presentaron mayor porcentaje de IU frente a los que no la recibieron (p = 0,036). Se objetivó mayor porcentaje de estenosis de la anastomosis en PRA (p = 0,03).

Conclusiones

La PRL, la no CNV y la RTR se relacionaron directamente con la CU postoperatoria.

Palabras clave:
Cáncer de próstata
Prostatectomía
Cirugía laparoscópica
Incontinencia urinaria

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