Department of Oncologic and Surgical Sciences, Urologic Clinic, University of Padua, Italy.
J Sex Med. 2010 Feb;7(2 Pt 1):839-45. doi: 10.1111/j.1743-6109.2009.01589.x. Epub 2009 Nov 12.
To date, no study has analyzed the predictors of potency recovery in a robot-assisted laparoscopic radical prostatectomy (RALP) series. A novel risk stratification for erectile function recovery after retropubic radical prostatectomy (RRP) has been proposed recently by Briganti et al. from the University Vita-Salute San Raffaele in Milan, Italy.
To evaluate the potency rate in a series of consecutive patients who underwent bilateral nerve-sparing RALP, to identify the preoperative predictors of erectile function recovery, and to validate the risk-group stratification of Briganti et al.
The clinical records of all patients who underwent RALP for clinically localized prostate cancer between April 2005 and April 2009 were prospectively collected in the Prostate Cancer Padua Database. For the present study, we extracted all consecutive cases receiving a bilateral nerve-sparing technique with a minimum follow-up > or =12 months.
Twelve-month potency rate after RALP, defined as an International Index of Erectile Function 6 (IIEF-6) score > or =18.
Data showed that 129 out of 208 enrolled patients (62%) were potent 12 months after surgery. Age (hazard ratio [HR]: 2.8; P < 0.001), Charlson score (HR: 2.9; P = 0.007), and baseline IIEF-6 score (HR: 0.8; P < 0.001) were independent predictors of potency recovery at multivariate analysis. According to Briganti et al.'s risk-group stratification, the 12-month potency rate following RALP was 81.9% in the low-risk group, 56.7% in the intermediate-risk group, and 28.6% in the high-risk group (P < 0.001).
In the era of robotic surgery, the key point for the success of the nerve-sparing technique remains the accurate selection of patients. Age < or =65 years, absence of associated comorbidities, and good preoperative erectile function are the most important preoperative factors to select those patients for whom bilateral nerve-sparing RALP can achieve the best results.
迄今为止，尚无研究分析机器人辅助腹腔镜前列腺根治性切除术（RALP）系列中勃起功能恢复的预测因素。意大利米兰 Vita-Salute San Raffaele 大学的 Briganti 等人最近提出了一种新的耻骨后前列腺根治性切除术（RRP）后勃起功能恢复的风险分层。
评估连续接受双侧神经保留 RALP 的患者的勃起功能恢复率，确定勃起功能恢复的术前预测因素，并验证 Briganti 等人的风险分组分层。
2005 年 4 月至 2009 年 4 月期间，前瞻性地收集了所有在前列腺癌帕多瓦数据库中接受局部前列腺癌临床治疗的 RALP 患者的临床记录。对于本研究，我们提取了所有接受双侧神经保留技术且随访时间≥12 个月的连续病例。
RALP 后 12 个月的勃起功能恢复率，定义为国际勃起功能指数 6（IIEF-6）评分>或=18。
数据显示，208 名入组患者中有 129 名（62%）在术后 12 个月时具有勃起功能。多因素分析显示，年龄（危险比[HR]：2.8；P<0.001）、Charlson 评分（HR：2.9；P=0.007）和基线 IIEF-6 评分（HR：0.8；P<0.001）是勃起功能恢复的独立预测因素。根据 Briganti 等人的风险分层，RALP 后 12 个月的勃起功能恢复率在低危组为 81.9%，中危组为 56.7%，高危组为 28.6%（P<0.001）。
在机器人手术时代，神经保留技术成功的关键仍然是准确选择患者。年龄≤65 岁、无合并症和良好的术前勃起功能是选择那些接受双侧神经保留 RALP 可获得最佳结果的患者的最重要的术前因素。
