Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Eur Urol. 2009 Dec;56(6):972-80. doi: 10.1016/j.eururo.2009.09.017. Epub 2009 Sep 12.
Robotic-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted despite a daunting learning curve with bladder neck dissection as a challenging step for newcomers.
To describe an anatomic, reproducible technique of bladder neck preservation (BNP) and associated perioperative and long-term outcomes.
DESIGN, SETTINGS, AND PARTICIPANTS: From September 2005 to May 2009, data from 619 consecutive RALP were prospectively collected and compared on the basis of bladder neck dissection technique with 348 BNP and 271 standard technique (ST).
RALP with BNP.
Tumor characteristics, perioperative complications, and post-operative urinary control were evaluated at 4, 12 and 24 months using (1) the Expanded Prostate Cancer Index (EPIC) urinary function scale scored from 0-100; and (2) continence defined as zero pads per day.
Mean age for BNP versus ST was 57.1±6.6 yr versus 58.9±6.7 yr (p=0.033), while complication rates did not vary significantly by technique. Estimated blood loss was 183.7±95.8 ml versus 224.6±108 ml (p=0.938) in men who underwent BNP versus ST. The overall positive margin rate was 12.8%, which did not differ at the prostate base for BNP versus ST (1.4% vs. 2.2%, p=0.547). Mean urinary function scores for BNP versus ST at 4, 12, and 24 mo were 64.6 versus 57.2 (p=0.037), 80.6 versus 79.0 (p=0.495), and 94.1 versus 86.8 (p<0.001). Similarly, BNP versus ST continence rates at 4, 12, and 24 mo were 65.6% versus 26.5% (p<0.001), 86.4% versus 81.4% (p=0.303), and 100% versus 96.1% (p=0.308).
BNP versus ST is associated with quicker recovery of urinary function and similar cancer control.
尽管机器人辅助腹腔镜根治性前列腺切除术（RALP）的学习曲线陡峭，但由于膀胱颈部解剖是新手面临的挑战，它仍迅速得到采用。
描述一种解剖学上可重复的膀胱颈部保留（BNP）技术，以及相关的围手术期和长期结果。
设计、设置和参与者：2005 年 9 月至 2009 年 5 月，前瞻性收集了 619 例连续接受 RALP 治疗的数据，并根据膀胱颈部解剖技术分为 BNP 组（348 例）和标准技术（ST）组（271 例）。
RALP 联合 BNP。
使用（1）从 0 到 100 评分的扩展前列腺癌指数（EPIC）尿功能量表；和（2）每天零尿垫定义的尿控，在 4、12 和 24 个月时评估肿瘤特征、围手术期并发症和术后尿控情况。
BNP 组与 ST 组的平均年龄分别为 57.1±6.6 岁和 58.9±6.7 岁（p=0.033），但两组的并发症发生率无显著差异。BNP 组与 ST 组的估计失血量分别为 183.7±95.8ml 和 224.6±108ml（p=0.938）。BNP 组与 ST 组在前列腺基底的阳性切缘率分别为 1.4%和 2.2%（p=0.547），差异无统计学意义。BNP 组与 ST 组在 4、12 和 24 个月时的尿功能评分分别为 64.6 分和 57.2 分（p=0.037）、80.6 分和 79.0 分（p=0.495）、94.1 分和 86.8 分（p<0.001）。同样，4、12 和 24 个月时 BNP 组与 ST 组的尿控率分别为 65.6%和 26.5%（p<0.001）、86.4%和 81.4%（p=0.303）、100%和 96.1%（p=0.308）。
BNP 组与 ST 组相比，尿功能恢复更快，癌症控制效果相似。
