Tongco W P, Wehner M S, Basler J W
Division of Urology and Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA
Urology. 2001 Mar;57(3):495-8. doi: 10.1016/s0090-4295(00)01011-6.
Urethral length after radical prostatectomy has correlated positively with postoperative urinary continence. Because sparing the prostatic urethra may improve continence after prostatectomy, we evaluated anatomic and pathologic consequences of urethral-sparing surgery.
From February to October 1999, 12 patients with clinically localized prostate cancer received a bladder neck-sparing radical retropubic prostatectomy by one surgeon. At the time of operation, the prostatic urethra was anatomically dissected from the prostatectomy specimen and sent separately to pathology to evaluate for the presence of adenoma or prostate cancer.
All patients had clinically localized prostate cancer with routine preoperative evaluations, including negative bone scans for prostate-specific antigen (PSA) greater than 10 or Gleason score higher than 7. Pathologic specimens confirmed localized prostate cancer in 7 of 12 specimens. Positive margins were identified in 5, including 2 patients with locally advanced disease. All 12 urethral specimens showed residual prostate adenoma but no prostate cancer. Follow-up ranged from 8 to 16 months with a zero PSA for all evaluated.
Residual prostate adenoma is found on dissected urethral specimens during radical retropubic prostatectomy. Although urethral-sparing prostatectomy may improve continence after radical prostatectomy, residual adenoma may confound follow-up PSA results. Furthermore, the malignant potential of the benign periurethral adenoma is unknown. The patient and clinician must understand the implications of residual prostatic tissue when performing urethral-sparing radical retropubic prostatectomy.
根治性前列腺切除术后尿道长度与术后尿失禁呈正相关。由于保留前列腺尿道可能改善前列腺切除术后的尿失禁情况，我们评估了保留尿道手术的解剖学和病理学后果。
1999年2月至10月，12例临床局限性前列腺癌患者由一名外科医生实施了保留膀胱颈的耻骨后根治性前列腺切除术。手术时，从前列腺切除标本中解剖出前列腺尿道，并单独送病理检查，以评估是否存在腺瘤或前列腺癌。
所有患者经常规术前评估均为临床局限性前列腺癌，包括前列腺特异性抗原（PSA）大于10或Gleason评分高于7时骨扫描阴性。病理标本证实12例标本中有7例为局限性前列腺癌。5例切缘阳性，其中2例为局部进展性疾病。所有12例尿道标本均显示有残留前列腺腺瘤，但无前列腺癌。随访时间为8至16个月，所有评估患者的PSA均为零。
耻骨后根治性前列腺切除术中，解剖的尿道标本上发现有残留前列腺腺瘤。尽管保留尿道的前列腺切除术可能改善根治性前列腺切除术后的尿失禁情况，但残留腺瘤可能会混淆随访PSA结果。此外，良性尿道周围腺瘤的恶性潜能尚不清楚。患者和临床医生在实施保留尿道的耻骨后根治性前列腺切除术时，必须了解残留前列腺组织的影响。
