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Inicio Actas Urológicas Españolas (English Edition) Early continence after radical prostatectomy: A systematic review
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Vol. 43. Issue 10.
Pages 526-535 (December 2019)
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Vol. 43. Issue 10.
Pages 526-535 (December 2019)
Review article
Early continence after radical prostatectomy: A systematic review
Variaciones de la prostatectomía radical para una recuperación de la continencia urinaria precoz: una revisión sistemática
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8
A. Salazar
Corresponding author
aina.salazar@gmail.com

Corresponding author.
, L. Regis, J. Planas, A. Celma, F. Díaz, I. Gallardo, E. Trilla, J. Morote
Servicio de Urología, Hospital Universitari Vall d’Hebron; Universistat Autònoma de Barcelona, Barcelona, Spain
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Table 1. Studies and results analyzing bladder neck preservation.
Table 2. Studies and results analyzing posterior and anteroposterior reconstruction.
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Abstract
Background and objective

Urinary incontinence is the adverse effect with more impact on patients’ quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy.

Evidence acquisition

We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis.

Evidence synthesis

The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence.

Conclusions

The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique.

Keywords:
Radical prostatectomy
Urinary incontinence
Prostate cancer
Resumen
Contexto y objetivo

La incontinencia urinaria es el efecto secundario con mayor impacto en la calidad de vida después de la prostatectomía radical. El objetivo de nuestro artículo es revisar la evidencia científica actual sobre las variaciones quirúrgicas descritas para preservar la continencia urinaria después de la prostatectomía radical.

Adquisición de la evidencia

Se realizó una revisión sistemática de la literatura en PubMed, Cochrane y ScienceDirect según los criterios PRISMA (Preferred reporting items for systematic reviews and meta-analyses), utilizando los términos: urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot assisted laparoscopic prostatectomy, robotic prostatectomy y los criterios de selección PICO. Se identificaron 1.603 referencias de las que se seleccionaron 27 publicaciones que cumplieron los criterios de inclusión, 6 fueron ensayos clínicos aleatorizados y 4 metaanálisis.

Síntesis de la evidencia

Las técnicas más empleadas para alcanzar una continencia urinaria precoz son la preservación del cuello vesical, de las bandeletas neurovasculares y la reconstrucción del rabdoesfínter, siendo esta la técnica con mayor evidencia, ya que existen 3 ensayos clínicos aleatorizados. Pese que algunas variaciones técnicas han conseguido mejorías en los resultados funcionales, la ausencia de consenso en la definición de incontinencia urinaria y la manera de evaluarla no permiten elaborar recomendaciones técnicas basadas en evidencia científica de calidad.

Conclusiones

La reconstrucción del rabdoesfínter es la única técnica que ha demostrado mejoría en la recuperación precoz de la continencia urinaria tras la prostatectomía radical. La evidencia científica actual es heterogénea y limitada, por lo que son necesarios estudios aleatorizados bien diseñados para evaluar las modificaciones técnicas.

Palabras clave:
Prostatectomía radical
Incontinencia urinaria
Cáncer de próstata

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