urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2022-10-4-54-69urovest-625Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВлияние техник реконструкции везикоуретрального сегмента при радикальной простатэктомии на функцию удержания мочи: оценка ближайших и отдалённых результатовInfluence of vesicourethral segment reconstruction techniques in radical prostatectomy on urinary continence: evaluation of immediate and long-term outcomeshttps://orcid.org/0000-0002-1710-0169КоганМ. И.KoganM. I.

Коган Михаил Иосифович — доктор медицинских наук, профессор, заслуженный деятель науки РФ, заведующий кафедрой урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России.

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Mikhail I. Kogan — M.D., Dr.Sc.(Med), Full Prof., Honored Scientist of the Russian Federation, Head, Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

dept_kogan@mail.ruhttps://orcid.org/0000-0003-0674-9429БелоусовИ. И.BelousovI. I.

Белоусов Игорь Иванович — доктор медицинских наук, доцент, профессор кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России.

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lgor I. Belousov — M.D., Dr.Sc.(Med), Assoc.Prof.(Docent), Prof., Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

belrost_dept@mail.ruhttps://orcid.org/0000-0001-7706-8925МитусовВ. В.MitusovV. V.

Митусов Валерий Викторович — доктор медицинских наук, доцент, профессор кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России.

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Valery V. Mitusov — M.D., Dr.Sc.(Med), Assoc.Prof.(Docent), Prof., Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

mvv@list.ruhttps://orcid.org/0000-0002-0674-3601ТохтамишянС. К.TokhtamishyanS. K.

Тохтамишян Сурен Капрелович — аспирант кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России; врач-уролог, урологическое отделение, МАУ «ЦГБ г. Азова».

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Suren K. Tokhtamishyan — M.D., Postgrad. Student, Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University; Urologist, Urology Division, Azov City Central Hospital.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

kaprelovich@yandex.ruhttps://orcid.org/0000-0003-1958-9858ИсмаиловР. С.IsmailovR. S.

Исмаилов Руслан Самедович - кандидат медицинских наук, ассистент кафедры урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) РостГМУ Минздрава России.

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Ruslan S. Ismailov - M.D., Cand.Sc.(Med), Assist.Prof., Dept. of Urology and Human Reproductive Health (with Pediatric Urology and Andrology Course), Rostov State Medical University.

29 Nakhichevanskiy Ln., Rostov-on-Don, 344022

dr.ruslan.ismailov@gmail.comРостовский государственный медицинский университет Минздрава РоссииРоссияRostov State Medical UniversityRussian Federation2022261220221045469Copyright © Коган М.И., Белоусов И.И., Митусов В.В., Тохтамишян С.К., Исмаилов Р.С., 20232023Коган М.И., Белоусов И.И., Митусов В.В., Тохтамишян С.К., Исмаилов Р.С.Kogan M.I., Belousov I.I., Mitusov V.V., Tokhtamishyan S.K., Ismailov R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/625Введение

Введение. В настоящее время разработаны и апробированы различные методики и модификации выполнения радикальной простатэктомии (РПЭ), направленные на предотвращение и минимизацию формирования недержания мочи (НМ). Тем не менее, НМ остаётся актуальной проблемой у пациентов, перенесших РПЭ, в частности, на ранних сроках наблюдения.

Цeль исследования

Цeль исследования. Оценить и сопоставить эффективность модифицированных реконструктивных техник формирования везикоуретрального анастомоза при радикальной простатэктомии в отношении профилактики недержания мочи в сравнении со стандартной методикой на различных сроках наблюдения.

Материалы и методы

Материалы и методы. Дизайн: одноцентровое клиническое простое сравнительное исследование в параллельных группах с ретроспективной и проспективной оценкой материала, выполненное в период с 2017 по 2022 г. Пациенты — мужчины с верифицированным раком простаты сТ1а – 2сN0 – хM0 стадий без декомпенсированных коморбидностей. Возраст — 45 – 78 лет. Ретроспективная часть — группа (Г) 1: 90 пациентов, перенёсших ненервсбергающую открытую позадилонную РПЭ с наложением «классического» везикоуретрального анастомоза (ВУА). Проспективная часть — Г2: 46 пациентов, подвергнутых аналогичной хирургии с выполнением модифицированного ВУА в двух вариациях: без и с сохранением простатической уретры — Г2а (n = 25) и Г2b (n = 21) соответственно. Инициальное обследование: стандартное предоперационное лабораторно-инструментальное обследование, оценка симптомов нижних мочевых путей (СНМП) с помощью опросника IPSS-QoL. Наблюдательное обследование: объективная оценка НМ по установленным критериям и cубъективная — с помощью опросника ICIQ-SF, отслеживание динамики СНМП с помощью IPSS-QoL. Контрольные периоды наблюдения: 0-точка (после удаления катетера), 1, 3, 6, и 12 месяцев (точка выхода); динамика восстановления функции удержания мочи определялась ежемесячно. Статистический анализ: Statistica ver.10.0 (StatSoft Inc., Tulsa, OK, USA) с использованием непараметрических методов (УД p < 0,05 при а = 0,05)

Результаты

Результаты. Предоперационные демографические, анкетные и инструментальные показатели не имели различий (р > 0,05) между группами, тем самым подтверждая однородность выборок. После выполнения РПЭ уретральный катетер удаляли в периоде от 7 до 21 суток. Различий (р > 0,05) в продолжительности дренирования между группами не определено. Полное удержание мочи непосредственно после удаления катетера выявлено в Г1, Г2а и Г2b в 20,0%, 44,0% и 57,1% случаев, соответственно. Последующий объективный мониторинг восстановления континенции с 1 месяца показал наличие различий (р < 0,001) между группами в динамике реабилитации в течение года. Улучшение континентности мочи за годовой период наблюдения было достигнуто совокупно Г1, Г2а и Г2b в 48,9%, 44,0% и 33,3% случаев соответственно. Тотальное НМ сохранялось в Г1 и Г2а к 12 месяцу соответственно у 22,2% и 8,0% пациентов, а в Г2b — не выявлено. Тяжесть НМ к концу наблюдения, по данным ICIQ-SF, была наиболее выраженной (р < 0,001) у пациентов в Г1. У континентных пациентов во всех группах с 1 месяца отмечено выраженное снижение тяжести обструктивных и ирритативных СНМП и улучшение качества жизни без различий (0,157 < р < 0,390) в показателях IPSS-QoL между группами.

Заключение

Заключение. Применение модифицированных методик реконструкции ВУА позволило по сравнению со стандартной добиться высоких показателей континенции у пациентов как непосредственно после удаления уретрального катетера, так и на последующих сроках наблюдения, без формирования выраженной ятрогенной обструкции. Модификация с сохранением простатической уретры является наиболее эффективной методикой, позволившей добиться реабилитации НМ до полной и социальной континенции у всех пациентов в течение года после хирургии.

Introduction

Introduction. Currently, various methods and modifications of radical prostatectomy (RP) have been developed and tested, aimed at preventing and minimizing the development of urinary incontinence (UI). However, UI remains an urgent problem in patients who undergo RP, especially at the early follow-up stages.

Objective

Objective. To evaluate and compare the effectiveness of modified reconstructive techniques for vesicourethral anastomosis in radical prostatectomy for the prevention of urinary incontinence with respect to the standard technique at different follow-up periods.

Materials and methods

Materials and methods. Design: single-centre, clinical, simple, comparative, parallel-group study with retrospective and prospective material evaluation, conducted in 2017 – 2022. Patients: men with verified prostate cancer cT1a – 2cN0 – xM0 without decompensated comorbidities. Age: 45 – 78 years. Retrospective part — group (G) 1: 90 patients who underwent non-nerve-sparing open retropubic RP with a "classic" vesicourethral anastomosis (VUA). Prospective part — G2: 46 patients who underwent similar surgery with modified VUA in two variations: without and with prostatic urethra-sparing — G2a (n = 25) and G2b (n = 21), respectively. Initial examination: standard preoperative laboratory and instrumental examination, assessment of lower urinary tract symptoms (LUTS) using the IPSS-QoL questionnaire. Follow-up examination: objective evaluation of UI according to established criteria and subjective assessment using the ICIQ-SF questionnaire, tracking the dynamics of LUTS using IPSS-QoL. Follow-up periods: 0-point (after catheter removal), 1, 3, 6, and 12 months (exit-point); the dynamics of recovery of urinary continence (UC) was determined monthly. Statistical analysis: Statistica ver.10.0 (StatSoft Inc., Tulsa, OK, USA) using non-parametric methods (CL p < 0.05 at a = 0.05)

Results

Results. Preoperative demographic, questionnaire and instrumental statistics did not differ (p > 0.05) between the groups, confirming the homogeneity of the samples. After RP, the urethral catheter was removed in a period of 7 to 21 days. There was no difference (p > 0.05) in the duration of drainage between the groups. Total urinary continence (TUC) immediately after catheter removal was detected in G1, G2a and G2b in 20.0%, 44.0% and 57.1% of cases, respectively. Subsequent objective monitoring of UC recovery from 1 month showed differences (p < 0.001) between the groups in the dynamics of rehabilitation during the year. The improvement in UC over the one-year follow-up period was cumulatively achieved in G1, G2a and G2b in 48.9%, 44.0% and 33.3% of cases, respectively. Total UI persisted in G1 and G2a by month 12 in 22.2% and 8.0% of patients, respectively, and was not detected in G2b. The severity of UI by the end of the follow-up according to the ICIQ-SF data was the most pronounced (p < 0.001) in patients from G1. TUC-patients in all groups from 1 month showed a marked decrease in the severity of obstructive and irritative LUTS and improved quality of life, with no differences (0.157 < p < 0.390) in IPSS-QoL values between groups.

Conclusions

Conclusions. The use of modified VUA reconstruction techniques made it possible, compared with the standard one, to achieve high continence rates in patients both immediately after the removal of the urethral catheter and at subsequent follow-up periods, without the formation of severe iatrogenic obstruction. Prostatic urethra-sparing modification is the most effective technique that provided the rehabilitation of UI to a complete and/or social level in all patients within a year after surgery.

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The authors declare that there are no conflicts of interest present.