| Part 1 The recovery of urinary continence under the influence of total pelvic floor reconstruction after Laparoscopic Radical ProstatectomyObjective To evaluate the influence of total pelvic floor reconstruction( TR)technique on the recovery of urinary continence after laparoscopic radical prostatectomy.Methods From January 2013 to January 2015 laparoscopic radical prostatectomy was performed by surgeons on 133 cases. Of them, 73 underwent total pelvic floor reconstruction(TR group)and 60 underwent no total pelvic floor reconstruction(non-TR). No significant differences in age, prostate volume, preoperative PSA,clinical stage and Gleason score were found between the two groups. Urinary incontinence was evaluated using a patient self-assessment questionnaire based on the International Consultation on Incontinence Questionnaire. The operative time,estimated blood loss, preoperative PSA, complications, positive surgical margins and urinary continence at the time of catheter removal, 1, 3 and 12 months after operation were compared between the two groups, retrospectively.Results The operation was successful in all cases. The follow-up was 12 to 36 months. No significant differences in operative time, bladder neck preservation,neurovascular bundle sparing, positive surgical margins and perioperative complications were found between the two groups(P>0.05 for all). TR group has a better urinary continencethan non-TR group at the time of catheter removal, 1 and 3month after operation(30.1% vs15.0%, 42.5% vs 25.0%, 67.1% vs 43.3%, P<0.05 for all). There were no statistical differences between two groups in urinary continence at 12 months after operation(P>0.05).Conclusion Total pelvic floor reconstruction technique can improve the early recovery of urinary continence after laparoscopic radical prostatectomy without increasing the operative time and the risk of positive surgical margins.Part 2 Development of Nomograms to Predict Early Recovery of Continence After Laparoscopic Radical ProstatectomyObjective Urinary incontinence after radical prostatectomy remains a significant complication and a major impact on quality of life. We developed and validated nomograms to predict urinary continence recovery after radical prostatectomy based on logistic regression analysis.Methods We conducted a retrospective review of data from 244 patients who underwent Laparoscopic Radical Prostatectomy from January 2011 to January 2015.Urinary continence rates at the time of catheter removal, 1, 3 and 12 months after operation were evaluated. We used logistic regression to evaluate the association between each variable and continence and then used multivariable logistic regression to create our model. Nomograms were constructed using the multivariable logistic regression models by R software. Internal validation was conducted by C-index and calibration curve.Results In all, urinary continence rates at the time of catheter removal, 1, 3 and 12 months after operation were 18.85%, 28.69%, 55.33%, 94.26%, respectively.Predictors of continence at the time of catheter removal were International Prostate Symptom Score(IPSS)(OR:0.276, 95%CI:0.114-0.668), membranous urethra length(MUL)(OR:1.224, 95%CI:1.077-1.392), bladder neck preservation(BNP)(OR:12.457, 95%CI:4.540-34.180) and total pelvic floor reconstruction(TR)(OR:7.654, 95%CI:2.968-19.741)( P < 0.05 for all). Predictors of continence at 1month postoperatively were age(OR:0.926, 95%CI: 0.879-0.976), MUL(OR:1.119,95%CI:1.009-1.241), BNP(OR: 9.768, 95%CI: 4.684-20.369) and TR(OR:3.577,95%CI:1.695-7.550) while age(OR:0.904, 95%CI:0.854-0.957), body mass index(BMI)(OR:0. 851, 95%CI:0.753-0.961), MUL(OR:1.242, 95%CI:1.116-1.383),BNP(OR:6.384, 95%CI:3.116-13.082) and TR(OR:7.354, 95%CI: 3.233-16.730) for 3months after operation(P<0.05 for all). Age(OR:0.743, 95%CI:0.617-0.894) and BMI(OR:0.588, 95%CI:0.440-0.787) were predictors of continence at 12 months(P< 0.05 for all). C-index of nomograms were 0.898, 0.851 and 0.860 after internal validation, respectively. Each developed nomogram was reasonably well fitted to the ideal line of the calibration plot.Conclusion Nomograms that predicting early recovery of continence after laparoscopic radical prostatectomy include preoperative and intraoperative factors and validated adequately. Clinicians can predict continence outcomes of patients by using our models. |
