Menon Mani, Shrivastava Alok, Kaul Sanjeev, Badani Ketan K, Fumo Michael, Bhandari Mahendra, Peabody James O
Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, United States.
Eur Urol. 2007 Mar;51(3):648-57; discussion 657-8. doi: 10.1016/j.eururo.2006.10.055. Epub 2006 Nov 3.
Contemporary techniques of radical prostatectomy achieve excellent oncologic outcomes; erectile dysfunction is the most common adverse effect. We have modified our technique of robotic radical prostatectomy (Vattikuti Institute prostatectomy [VIP]) in an attempt to minimize decrease of erectile function while maintaining the excellent oncologic outcomes achieved by the radical retropubic prostatectomy. We present our current technique of VIP with preservation of the lateral prostatic fascia ("veil of Aphrodite").
A total of 2652 patients with localized carcinoma prostate underwent VIP. The salient features of our current technique are early transection of the bladder neck, preservation of the prostatic fascia, and control of the dorsal vein complex after dissection of the prostatic apex. Oncologic and functional outcomes were obtained through a questionnaire collected by a third party not involved in patient care.
Complete follow-up information was obtained in 1142 patients with a minimum follow-up of 12 mo (range: 12-66 mo; median: 36 mo). The actuarial 5-yr biochemical recurrence rate was 8.4% and the actual biochemical recurrence rate was 2.3%. Median duration of incontinence was 4 wk; 0.8% patients had total incontinence at 12 mo. The intercourse rate was 93% in men with no preoperative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function.
VIP with veil nerve sparing offers oncologic and continence results that are comparable to the results of conventional nerve-sparing radical prostatectomy. Early potency results are encouraging.
当代根治性前列腺切除术技术可实现出色的肿瘤学治疗效果；勃起功能障碍是最常见的不良反应。我们改进了机器人根治性前列腺切除术技术（瓦蒂库蒂研究所前列腺切除术[VIP]），旨在尽量减少勃起功能的下降，同时保持耻骨后根治性前列腺切除术所取得的出色肿瘤学治疗效果。我们介绍目前保留前列腺外侧筋膜（“阿佛洛狄忒之幕”）的VIP技术。
共有2652例局限性前列腺癌患者接受了VIP手术。我们当前技术的显著特点是早期横断膀胱颈、保留前列腺筋膜以及在前列腺尖部分离后控制背静脉复合体。通过由未参与患者护理的第三方收集的问卷获得肿瘤学和功能学结果。
1142例患者获得了完整的随访信息，最短随访时间为12个月（范围：12 - 66个月；中位数：36个月）。5年精算生化复发率为8.4%，实际生化复发率为2.3%。尿失禁的中位持续时间为4周；0.8%的患者在12个月时出现完全尿失禁。在未发生术前勃起功能障碍且接受保留神经手术的男性中，性交率为93%，尽管只有51%恢复到基线功能。
保留阿佛洛狄忒之幕神经的VIP手术在肿瘤学和控尿方面的结果与传统保留神经的根治性前列腺切除术相当。早期的勃起功能恢复结果令人鼓舞。
