Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía / Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis

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), que es 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 24meses. 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 24meses de la cirugía, el 72,4% presentaban CU, de los cuales el 87,8% con PRA frente al 78,1% con PRL (p = 0,004). El 22,7% presentaron recidiva bioquímica (RB), siendo el 83% tratados con radioterapia de rescate (RTR). 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 preservación de los fascículos neurovasculares y la RTR se relacionaron directamente con la CU postoperatoria

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. MATERIAL 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 24months. 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<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI

Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis. / Comparación entre prostatectomía laparoscópica y abierta: análisis de la continencia urinaria poscirugía.

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. MATERIAL 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 24months. 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<.05. RESULTS: Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS: LRP, non-nerve sparing, and SRT were directly related to postoperative UI.