Catalona W J, Carvalhal G F, Mager D E, Smith D S
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Urol. 1999 Aug;162(2):433-8.
We update results in a series of consecutive patients treated with anatomic radical retropubic prostatectomy regarding recovery of erections, urinary continence and postoperative complications.
One surgeon performed anatomic radical retropubic prostatectomy on 1,870 men, using the nerve sparing modification when feasible. We evaluated recovery of erections and urinary continence in men followed for a minimum of 18 months. Patients who were not reliably potent before surgery, did not undergo a nerve sparing procedure, or received hormonal therapy or postoperative adjuvant radiotherapy were excluded from the analysis of potency rates but not of continence rates. Other postoperative complications were evaluated for the entire patient population.
Recovery of erections occurred in 68% of preoperatively potent men treated with bilateral (543 of 798) and 47% treated with unilateral (28 of 60) nerve sparing surgery. Recovery of erections was more likely with bilateral than with unilateral nerve sparing surgery in patients less than 70 years old (71 versus 48%, p<0.001) compared with patients with age 70 years old or older (48 versus 40%, p = 0.6). Recovery of urinary continence occurred in 92% (1,223 of 1,325 men) and was associated with younger age (p<0.0001) but not with tumor stage (p = 0.2) or nerve sparing surgery (p = 0.3). Postoperative complications occurred in 10% of patients overall and were associated with older age (p<0.002) but the incidence declined significantly with increasing experience of the surgeon (p<0.0001). There was no operative mortality.
Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with favorable results in preserving potency and urinary continence. Better results are achieved in young men with organ confined cancer. Other complications can be reduced with increasing surgeon experience.
我们更新了一系列接受耻骨后根治性前列腺切除术的连续患者在勃起功能恢复、尿失禁及术后并发症方面的结果。
一名外科医生对1870名男性实施了耻骨后根治性前列腺切除术，可行时采用保留神经改良术式。我们对随访至少18个月的男性患者的勃起功能和尿失禁恢复情况进行了评估。手术前无可靠勃起功能、未行保留神经手术、接受激素治疗或术后辅助放疗的患者被排除在勃起功能恢复率分析之外，但未被排除在尿失禁恢复率分析之外。对全体患者的其他术后并发症进行了评估。
术前有勃起功能的男性中，接受双侧保留神经手术的患者勃起功能恢复率为68%（798例中的543例），接受单侧保留神经手术的患者为47%（60例中的28例）。年龄小于70岁的患者中，双侧保留神经手术比单侧保留神经手术更易恢复勃起功能（71%对48%，p<0.001），而70岁及以上患者中两者差异无统计学意义（48%对40%，p = 0.6）。92%（1325例男性中的1223例）患者恢复了尿失禁，且与年轻患者相关（p<0.0001），但与肿瘤分期（p = 0.2）或保留神经手术（p = 0.3）无关。总体10%的患者出现术后并发症，且与年龄较大相关（p<0.002），但随着外科医生经验增加，并发症发生率显著下降（p<0.0001）。无手术死亡病例。
采用保留神经改良术式的耻骨后根治性前列腺切除术在保留勃起功能和尿失禁方面可取得良好效果。器官局限性癌的年轻男性患者效果更佳。随着外科医生经验增加，其他并发症可减少。
