Namiki Shunichi, Saito Seiichi, Nakagawa Haruo, Sanada Takehiko, Yamada Atsushi, Arai Yoichi
Department of Urology, Tohoku University Graduate School of Medicine, Tohoku, Japan.
J Urol. 2007 Jul;178(1):212-6; discussion 216. doi: 10.1016/j.juro.2007.03.043. Epub 2007 May 17.
We conducted a 3-year longitudinal study assessing the impact of unilateral sural nerve graft on recovery of potency and continence following radical prostatectomy.
A total of 113 patients undergoing radical retropubic prostatectomy were classified into 3 groups according to the degree of nerve sparing, that is unilateral nerve preservation with contralateral sural nerve graft interposition, bilateral nerve sparing and unilateral nerve sparing. Urinary continence and potency were estimated by the UCLA Prostate Cancer Index questionnaire.
Patients in the nerve sparing plus sural nerve graft group were younger than those in the bilateral nerve sparing or unilateral nerve sparing groups. At baseline the unilateral nerve sparing plus sural nerve graft group and the bilateral nerve sparing group reported better sexual function than the unilateral nerve sparing group (62.1 and 61.5 vs 49.9, p<0.05). The bilateral nerve sparing group showed more rapid recovery than the unilateral nerve sparing plus sural nerve graft group after radical retropubic prostatectomy (p<0.01). After 24 months there were no significant differences observed between the bilateral nerve sparing and the unilateral nerve sparing plus sural nerve graft group (28.7 vs 32.9). The bilateral nerve sparing group reported a better sexual function score than the unilateral nerve sparing group throughout the postoperative period (p<0.05). The bilateral nerve sparing group maintained significantly better urinary function at 1 month after radical retropubic prostatectomy than the unilateral nerve sparing plus sural nerve graft group (p <0.05). After 3 months these groups were almost continent. The unilateral nerve sparing group reported lower urinary function scores during the first year compared to the other groups.
The nerve graft procedure may contribute to the recovery of urinary function as well as sexual function after radical retropubic prostatectomy. This finding needs to be validated in a randomized trial.
我们进行了一项为期3年的纵向研究，评估单侧腓肠神经移植对根治性前列腺切除术后性功能和控尿恢复的影响。
113例行耻骨后根治性前列腺切除术的患者根据神经保留程度分为3组，即单侧神经保留并植入对侧腓肠神经、双侧神经保留和单侧神经保留。通过加州大学洛杉矶分校前列腺癌指数问卷评估尿控和性功能。
神经保留加腓肠神经移植组患者比双侧神经保留组或单侧神经保留组患者年轻。基线时，单侧神经保留加腓肠神经移植组和双侧神经保留组的性功能报告优于单侧神经保留组（62.1和61.5对49.9，p<0.05）。耻骨后根治性前列腺切除术后，双侧神经保留组比单侧神经保留加腓肠神经移植组恢复更快（p<0.01）。24个月后，双侧神经保留组与单侧神经保留加腓肠神经移植组之间未观察到显著差异（28.7对32.9）。在整个术后期间，双侧神经保留组的性功能评分优于单侧神经保留组（p<0.05）。耻骨后根治性前列腺切除术后1个月，双侧神经保留组的尿功能明显优于单侧神经保留加腓肠神经移植组（p<0.05）。3个月后，这些组几乎都能控尿。与其他组相比，单侧神经保留组在第一年的尿功能评分较低。
神经移植手术可能有助于耻骨后根治性前列腺切除术后尿功能和性功能的恢复。这一发现需要在随机试验中得到验证。
