INSERM U955 EQ7, Department of Urology, CHU Henri Mondor, Créteil, France.
BJU Int. 2011 Jan;107(2):274-9. doi: 10.1111/j.1464-410X.2010.09462.x.
To determine the proportion of patients who are continent, potent and cancer-free (trifecta rate) 2 years after extraperitoneal laparoscopic radical prostatectomy (ELRP).
We included patients who underwent an ELRP at our department and who were followed for at least 2 years. Those who were impotent or incontinent before the surgery were excluded from the analysis. Overall, 911 men were included. All patients prospectively completed objective, self-administered questionnaires before the medical visit, concerning their voiding and sexual disorders, before surgery and 12 and 24 months after ELRP. Biochemical recurrence was defined as any detectable serum PSA (≥ 0.2 ng/mL). Potency was defined as the ability to achieve an erection sufficient for penetration with or without the use of phosphodiesterase-5 enzyme inhibitor. Urinary continence was defined as absence, or occasional use, of a pad for anticipated vigorous activity. The primary study endpoint was the trifecta rate (cancer control, continence and potency) at 2 years after the surgery. Factors associated with the trifecta outcome were assessed in univariate analysis.
Median age and PSA level were 62.2 years and 9.9 ng/mL, respectively. A trifecta outcome was achieved in 29.7 and 54.4% of patients at 12 and 24 months, respectively. The 2-year trifecta rate reached 63.5% in patients undergoing bilateral nerve-sparing surgery and 73.5% in men aged < 60 years. Age < 60 years, PSA level < 10 ng/mL, organ-confined disease and bilateral nerve-sparing procedure were significantly associated with the 2-year trifecta outcome. A total of 84.8% of patients were both cancer-free and continent at 24 months, regardless of erectile function.
Two years after ELRP, the trifecta outcome is achieved in 54.4% of patients who remained potent and continent. This rate reaches 63.5% in patients undergoing a bilateral nerve-sparing procedure. Combined results of good cancer control and continence recovery are reported in 84.8% of patients, regardless of erectile function.
确定经腹腔外腹腔镜根治性前列腺切除术（ELRP）后 2 年内患者达到控尿、勃起功能正常和无癌症（三联征）的比例。
我们纳入了在我科接受 ELRP 且随访时间至少 2 年的患者。在术前已存在勃起功能障碍或尿失禁的患者被排除在分析之外。共有 911 名男性被纳入研究。所有患者在就诊前前瞻性地完成了关于排尿和性功能障碍的客观、自我管理问卷，在术前、ELRP 后 12 个月和 24 个月进行评估。生化复发定义为任何可检测到的血清 PSA（≥0.2ng/mL）。勃起功能定义为能够实现足以进行插入的勃起，无论是否使用磷酸二酯酶-5 酶抑制剂。尿控定义为无需或偶尔使用垫进行预期的剧烈活动。主要研究终点为术后 2 年的三联征（癌症控制、控尿和勃起功能正常）率。单因素分析评估与三联征结果相关的因素。
中位年龄和 PSA 水平分别为 62.2 岁和 9.9ng/mL。在 12 个月和 24 个月时，分别有 29.7%和 54.4%的患者达到三联征。在接受双侧神经保留手术的患者中，2 年三联征率为 63.5%，年龄<60 岁的患者为 73.5%。年龄<60 岁、PSA 水平<10ng/mL、器官局限疾病和双侧神经保留手术与 2 年三联征结果显著相关。无论勃起功能如何，在 24 个月时，84.8%的患者同时无癌症且控尿。
在 ELRP 后 2 年，54.4%的仍保持勃起功能正常且控尿的患者达到三联征。在接受双侧神经保留手术的患者中，这一比例达到 63.5%。无论勃起功能如何，84.8%的患者同时实现了良好的癌症控制和控尿恢复。
