Davila Hugo H, Weber Timothy, Burday David, Thurman Scott, Carrion Rafael, Salup Raoul, Lockhart Jorge L
Division of Urology, Department of Interdisciplinary Oncology, Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Health Sciences Center, Tampa, FL, USA.
BJU Int. 2007 Nov;100(5):1026-9. doi: 10.1111/j.1464-410X.2007.07169.x. Epub 2007 Sep 14.
To review the long-term results in patients treated with either total or partial prostate-sparing cystectomy, focusing on erectile function (EF), as en-bloc radical cystectomy (RC) with or without urethrectomy has been the method of choice for managing invasive bladder carcinoma, but has inherent risks of subsequent urinary incontinence and erectile dysfunction, with a marked effect on quality of life, especially in younger patients.
Between 2003 and 2005 we assessed 21 men (mean age 56 years) who had either a prostate apex-sparing cystectomy (PASC, 15) or total prostate-sparing cystectomy (TPSC, six). The mean follow-up was 30 months for PASC and 24 months for TPSC. The evaluation before surgery included standard bladder cancer staging, prostate specific antigen level, a digital rectal examination and a complete medical history, with attention to self-reported EF before surgery and the EF domain of the International Index of EF (IIEF) after surgery.
The EF domain score was 20 after PASC and 30 after TPSC; this correlates with mild to moderate ED in the PASC group vs normal erectile function in the TPSC group. After transurethral resection of the bladder tumours (TURBT) 10 of 14 in the PASC group were T1 or T2a, and in the TPSC group, five of six were T2a and one patient was T2b. From the cystectomy specimen, in the PASC group eight were understaged compared with the TURBT specimen (T2b/T4a vs T1/T2a), while in the TPSC group there was understaging two (T3a vs T2a/T2b); this was significantly different (P < 0.05). There was recurrence of urothelial carcinoma in one of 15 and one of six after PASC and TPSC, respectively.
The EF domain score after PASC was 10 points lower than after TPSC, representing a 30% increase in EF by preserving the entire prostate. We conclude that in patients with invasive bladder cancer, EF can be significantly preserved by prostate-sparing cystectomy. If adequate selection criteria are applied, EF can be preserved without compromising cancer control.
回顾接受全前列腺保留或部分前列腺保留膀胱切除术患者的长期结果，重点关注勃起功能（EF），因为整块根治性膀胱切除术（RC）无论是否进行尿道切除术一直是治疗浸润性膀胱癌的首选方法，但存在随后尿失禁和勃起功能障碍的固有风险，对生活质量有显著影响，尤其是在年轻患者中。
2003年至2005年间，我们评估了21名男性（平均年龄56岁），他们分别接受了保留前列腺尖部膀胱切除术（PASC，15例）或全前列腺保留膀胱切除术（TPSC，6例）。PASC组的平均随访时间为30个月，TPSC组为24个月。术前评估包括标准膀胱癌分期、前列腺特异性抗原水平、直肠指检和完整的病史，关注术前自我报告的EF以及术后国际勃起功能指数（IIEF）的EF领域得分。
PASC术后EF领域得分为20分，TPSC术后为30分；这与PASC组轻度至中度勃起功能障碍（ED）以及TPSC组正常勃起功能相关。在经尿道膀胱肿瘤切除术（TURBT）后，PASC组14例中有10例为T1或T2a期，TPSC组6例中有5例为T2a期，1例为T2b期。从膀胱切除标本来看，PASC组与TURBT标本相比有8例分期过低（T2b/T4a期 vs T1/T2a期），而TPSC组有2例分期过低（T3a期 vs T2a/T2b期）；这有显著差异（P < 0.05）。PASC组15例中有1例、TPSC组6例中有1例发生尿路上皮癌复发。
PASC术后EF领域得分比TPSC术后低10分，通过保留整个前列腺，勃起功能提高了30%。我们得出结论，在浸润性膀胱癌患者中，保留前列腺膀胱切除术可显著保留勃起功能。如果应用适当的选择标准，在不影响癌症控制的情况下可以保留勃起功能。
