Parsons J Kellogg, Marschke Penny, Maples Patricia, Walsh Patrick C
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Urology. 2004 Nov;64(5):987-90. doi: 10.1016/j.urology.2004.06.048.
To determine whether postoperative methylprednisolone improves the recovery of sexual function after nerve-sparing radical retropubic prostatectomy.
We randomized men undergoing bilateral nerve-sparing radical retropubic prostatectomy by a single surgeon to receive 6 days of placebo or methylprednisolone beginning on postoperative day 1. At 3, 6, and 12 months postoperatively, we assessed potency with the abbreviated International Index of Erectile Function questionnaire and urinary continence with participant-reported pad use. We used the chi-square test, Fisher's exact test, and the two-sample t test with equal variances for comparisons between study groups.
No operative complications occurred and 70 (100%) of 70 participants experienced normal wound healing. The odds of being potent for participants who received methylprednisolone (n = 34) compared with those who received placebo (n = 36) did not significantly differ at 3 (odds ratio 0.29, 95% confidence interval 0.08 to 1.05), 6 (odds ratio 0.63, 95% confidence interval 0.17 to 2.4), or 12 (odds ratio 1.18, 95% confidence interval 0.29 to 4.8) months. The mean International Index of Erectile Function scores did not significantly differ at 3 (P = 0.08), 6 (P = 0.50), or 12 (P = 0.71) months. At 12 months, 74% of the methylprednisolone and 71% of the placebo participants were potent (P = 0.8). The proportions of participants who were continent did not differ significantly at 3 (P = 0.89), 6 (P = 0.25), or 12 (P = 0.49) months. At 12 months, 96% of the methylprednisolone and 100% of the placebo participants were continent.
At doses sufficient to produce a systemic anti-inflammatory effect, postoperative methylprednisolone was not associated with improved potency at up to 12 months after bilateral nerve-sparing radical retropubic prostatectomy in men 40 to 60 years old.
确定术后甲基强的松龙是否能改善保留神经的耻骨后根治性前列腺切除术后性功能的恢复情况。
我们将由单一外科医生实施双侧保留神经的耻骨后根治性前列腺切除术的男性患者随机分组，从术后第1天开始，一组接受6天的安慰剂治疗，另一组接受甲基强的松龙治疗。在术后3、6和12个月时，我们使用简化版国际勃起功能指数问卷评估勃起功能，并通过患者报告的护垫使用情况评估尿失禁情况。我们使用卡方检验、Fisher精确检验以及等方差双样本t检验对研究组之间进行比较。
未发生手术并发症，70名参与者中有70名（100%）伤口愈合正常。在术后3个月（比值比0.29，95%置信区间0.08至1.05）、6个月（比值比0.63，95%置信区间0.17至2.4）或12个月（比值比1.18，95%置信区间0.29至4.8）时，接受甲基强的松龙治疗的参与者（n = 34）与接受安慰剂治疗的参与者（n = 36）相比，勃起功能正常的几率无显著差异。在术后3个月（P = 0.08）、6个月（P = 0.50）或12个月（P = 0.71）时，平均国际勃起功能指数评分无显著差异。在12个月时，接受甲基强的松龙治疗的参与者中有74%勃起功能正常，接受安慰剂治疗的参与者中有71%勃起功能正常（P = 0.8）。在术后3个月（P = 0.89）、6个月（P = 0.25）或12个月（P = 0.49）时，尿失禁患者的比例无显著差异。在12个月时，接受甲基强的松龙治疗的参与者中有96%尿控正常，接受安慰剂治疗的参与者中有100%尿控正常。
在40至60岁男性双侧保留神经的耻骨后根治性前列腺切除术后长达12个月的时间里，在足以产生全身抗炎作用的剂量下，术后甲基强的松龙与勃起功能改善无关。
