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The following is a summary of “Is there any difference in urinary continence between bilateral and unilateral nerve sparing during radical prostatectomy? A systematic review and meta-analysis,” published in the February 2024 issue of Surgery by Xiang et al.
Urinary incontinence represents one of the foremost long-term complications following radical prostatectomy (RP) in men with prostate cancer. Preserving the neurovascular bundles (NVBs) is vital in facilitating postoperative urinary continence recovery. However, the comparative efficacy of bilateral nerve-sparing (BNS) versus unilateral nerve-sparing (UNS) in optimizing urinary continence outcomes post-RP remains uncertain. The primary objective of this study is to compare urinary continence outcomes between BNS and UNS systematic approaches in post-RP patients.
A comprehensive search of PubMed and Web of Science databases, up to May 31, 2023, was conducted to identify relevant English-language articles comparing urinary continence outcomes in patients undergoing BNS versus UNS radical prostatectomy. Meta-analyses were performed using a random-effects model to compute pooled relative risk (RR) estimates with 95% confidence intervals for urinary continence across selected follow-up intervals. Sensitivity analyses were conducted on prospective studies and robotic-assisted RP studies.
Pooling data from 26,961 participants across fifty-seven studies, their meta-analysis revealed that BNS conferred superior urinary continence rates compared to UNS at all selected follow-up time points. Specifically, RRs were 1.36 (1.14–1.63; p = 0.0007) at ≤ 1.5 months, 1.28 (1.08–1.51; p = 0.005) at 3–4 months, 1.12 (1.03–1.22; p = 0.01) at 6 months, 1.08 (1.05–1.12; p < 0.00001) at 12 months, and 1.07 (1.00–1.13; p = 0.03) at ≥ 24 months, respectively. Notably, the observed advantages of BNS in urinary continence were sustained over a minimum follow-up duration of 24 months, albeit with a gradual decline in RRs over time. However, pooled estimates exhibited substantial heterogeneity across studies. Sensitivity analyses corroborated the robustness of the findings, with consistent results observed in prospective and robotic-assisted RP studies.
In conclusion, the meta-analysis underscores the superiority of BNS over UNS in optimizing urinary continence outcomes post-RP, with these advantages persisting for a minimum duration of 24 months. These findings underscore the potential clinical benefits of preserving the neurovascular bundles and call for further high-quality studies to validate and consolidate these observations.
Source: wjso.biomedcentral.com/articles/10.1186/s12957-024-03340-6