ABSTRACT
OBJECTIVES: We investigated the correlation between surgical outcomes and postoperative urinary continence recovery in robot-assisted radical prostatectomy (RARP). METHODS: Patients who underwent RARP in our institution (n = 195) were included in this study. Preserved urethral length (PUL) was assessed during the procedure. Other outcomes of the surgical procedure were collected from operative records. Kaplan-Meier analysis with log-rank test was used to compare urinary continence recovery rate with the PUL, sparing of the neurovascular bundle (NVB), and other surgical procedures. Univariate and multivariate analyses were performed using Cox proportional hazards model, and p-values of <0.05 were considered significant. RESULTS: Patients with a PUL ≥26 mm had 10.0%, 24.7%, 36.6%, and 89.0% continence recovery rates at 30, 60, 90, and 365 days after surgery, respectively, while patients with a PUL <26 mm had 0%, 17.8%, 26.1%, and 80.9% recovery rates, respectively. Kaplan-Meier curves showed significantly better postoperative urinary continence recovery at 30 days after RARP in patients with a PUL ≥26 mm than those with a PUL <26 mm (p = 0.0028) and in patients with NVB preservation than those with no NVB preservation (p = 0.014). Urinary continence recovery within 30, 60, and 90 days after surgery was 90.6% for patients with a PUL of ≥26 mm and NVB preservation, while only 82.3% for patients with a PUL of <26 mm or no NVB preservation. CONCLUSION: Our results suggest that a PUL ≥26 mm and NVB preservation after RARP correlate with a significantly higher postoperative rate of recovery of urinary continence.
Subject(s)
Prostatectomy , Prostatic Neoplasms , Recovery of Function , Robotic Surgical Procedures , Urethra , Urinary Incontinence , Humans , Male , Prostatectomy/adverse effects , Prostatectomy/methods , Middle Aged , Robotic Surgical Procedures/adverse effects , Robotic Surgical Procedures/methods , Aged , Urethra/surgery , Urethra/innervation , Prostatic Neoplasms/surgery , Urinary Incontinence/prevention & control , Urinary Incontinence/etiology , Retrospective Studies , Organ Sparing Treatments/methods , Organ Sparing Treatments/adverse effects , Prostate/surgery , Prostate/innervation , Kaplan-Meier Estimate , Treatment Outcome , Postoperative Complications/prevention & control , Postoperative Complications/etiologyABSTRACT
Personal mobility vehicles (PMVs) are compact and lightweight compared to automobiles; hence, human dynamic behavior affects a vehicle's postural stability. In this study, the dynamic behaviors of drivers of inverted pendulum vehicles (IPV) under manual and automatic driving were investigated. One particular feature of applying automatic driving to IPV is constant posture stabilization control. In this study, the drivers' center of gravity (COG)/center of foot pressure position (COP) and joint moments during turning were investigated experimentally. It was found that the drivers' COG shifted backward during turning and deceleration. For COP, it was found that drivers maintained balance by moving their inner foot more inward and their outer foot more outward during turning. These results are significant for understanding the steps taken to withstand centrifugal forces during turning. The joint moments of the foot were more significant in automatic turning than in manual turning to prevent falling owing to centrifugal force. These findings can facilitate the development of an automatic control method that shifts the COG of a driver, as in manual turning.
