Coughlin Geoff, Palmer Kenneth J, Shah Ketul, Patel Vipul R
Center for Robotic and Computer-Assisted Surgery, Columbus, Ohio 43210-1228, USA.
Arch Esp Urol. 2007 May;60(4):408-18. doi: 10.4321/s0004-06142007000400011.
To present a contemporary review of the functional outcomes following robotic-assisted radical prostatectomy based on published postoperative erectile function and urinary continence data.
A review of the available literature on Medline and PubMed databases was performed.
Factors affecting erectile function include age, preoperative SHIM scores, co-morbidities and nerve sparing techniques. Large robotic-assisted laparoscopic radical prostatectomy (RALP) series like the Vattikuti Institute's and Ohio State University's demonstrate early potency outcomes: 70% and 80% of patients, respectively, who underwent bilateral nerve sparing and had a pre-operative SHIM score > 17, regained potency after a follow-up of 12 months. This has also been reproduced by smaller series, where 43% of patients achieved potency within 3 months postop and 68%, 79% of patients who underwent unilateral or bilateral nerve sparing, respectively, were able to have intercourse with or without PDE5 inhibitors after 12 months follow-up. Postoperative continence rates after RALP for larger series are 76%-92% and 95. 2%-98% while that for smaller series range from 76% and 89% at 3 and 12 months, respectively.
RALP is a safe, minimally invasive procedure that produces functional outcomes comparable to contemporary results of both open and laparoscopic prostatectomy.
基于已发表的术后勃起功能和尿失禁数据,对机器人辅助根治性前列腺切除术后的功能结局进行当代综述。
对Medline和PubMed数据库中的现有文献进行综述。
影响勃起功能的因素包括年龄、术前国际勃起功能指数(SHIM)评分、合并症和神经保留技术。大型机器人辅助腹腔镜根治性前列腺切除术(RALP)系列,如Vattikuti研究所和俄亥俄州立大学的系列,展示了早期的勃起功能恢复结果:分别有70%和80%接受双侧神经保留且术前SHIM评分>17的患者,在随访12个月后恢复了勃起功能。较小的系列研究也得出了类似结果,其中43%的患者在术后3个月内恢复了勃起功能,分别有68%和79%接受单侧或双侧神经保留的患者,在随访12个月后,无论是否使用5型磷酸二酯酶(PDE5)抑制剂都能够进行性交。大型系列研究中RALP术后的尿失禁率为76%-92%和95.2%-98%,而较小系列研究在3个月和12个月时的尿失禁率分别为76%和89%。
RALP是一种安全的微创手术,其功能结局与当代开放性和腹腔镜前列腺切除术的结果相当。