Ahlering Thomas E, Eichel Louis, Edwards Robert, Skarecky Douglas W
Department of Urology, University of California, Irvine, Medical Center, Orange, California 92868, USA.
Urology. 2005 Apr;65(4):740-4. doi: 10.1016/j.urology.2004.10.061.
To assess the preoperative parameters and clinical outcomes of patients undergoing robotic laparoscopic radical prostatectomy with specific attention to the body mass index (BMI). Little is known about the impact of obesity (BMI greater than 30) on the clinical outcomes of patients undergoing radical prostatectomy.
The data of 100 men undergoing robotic laparoscopic radical prostatectomy between June 2002 and October 2003 were prospectively entered into a database. The standard clinical characteristics (eg, prostate-specific antigen, Gleason score) and perioperative and postoperative parameters were evaluated. Additionally, all were assessed preoperatively and postoperatively for American Urological Association symptom and bother scores, uroflowmetry, postvoid residual urine volume, and sexual function.
Nineteen men were obese (BMI greater than 30) and 81 were not (BMI less than 30). The two groups had a similar need for transfusion, length of stay, and pathologic outcome. However, the obese men had poorer baseline urinary function (peak flow rate 13.9 versus 18.3 mL/s; voided volume 306 versus 454 mL; P < or =0.05) and sexual function (Sexual Health Inventory of Men score 14.1 versus 18.2; P < or =0.05). Obese men had significantly more complications (26.3% versus 4.9%; P = 0.01) and required more time to return to baseline activities (7 versus 4.3 weeks; P = 0.09) and urinary function. Finally, at 6 months, only 47% of obese patients versus 91.4% of nonobese patients had achieved pad-free urinary continence (P < or =0.001).
In this study, obese patients had significantly worse baseline urinary and sexual function, had complications, and did not recover urinary function as quickly or as well as nonobese patients. Obese patients also demonstrated a strong trend toward a delay in recovery time.
评估接受机器人腹腔镜根治性前列腺切除术患者的术前参数及临床结局，尤其关注体重指数（BMI）。关于肥胖（BMI大于30）对接受根治性前列腺切除术患者临床结局的影响，目前所知甚少。
前瞻性地将2002年6月至2003年10月期间接受机器人腹腔镜根治性前列腺切除术的100名男性患者的数据录入数据库。评估标准临床特征（如前列腺特异性抗原、Gleason评分）以及围手术期和术后参数。此外，术前和术后对所有患者进行美国泌尿外科协会症状及困扰评分、尿流率测定、排尿后残余尿量以及性功能评估。
19名男性患者肥胖（BMI大于30），81名不肥胖（BMI小于30）。两组患者在输血需求、住院时间和病理结果方面相似。然而，肥胖男性患者的基线排尿功能较差（峰值尿流率分别为13.9与18.3 mL/s；排尿量分别为306与454 mL；P≤0.05），性功能也较差（男性性功能健康量表评分分别为14.1与18.2；P≤0.05）。肥胖男性患者的并发症明显更多（26.3%对4.9%；P = 0.01），恢复至基线活动状态所需时间更长（7周对4.3周；P = 0.09），恢复排尿功能所需时间也更长。最后，在术后6个月时，只有47%的肥胖患者实现了无尿垫尿控，而非肥胖患者这一比例为91.4%（P≤0.001）。
在本研究中，肥胖患者的基线排尿和性功能明显更差，出现并发症，且排尿功能恢复速度不及非肥胖患者，恢复情况也不如非肥胖患者。肥胖患者在恢复时间方面也呈现出明显的延迟趋势。
