Division of Urologic Surgery, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA, USA.
Eur Urol. 2011 Apr;59(4):595-603. doi: 10.1016/j.eururo.2011.01.033. Epub 2011 Jan 27.
Large prostate size, median lobes, and prior benign prostatic hyperplasia (BPH) surgery may pose technical challenges during robot-assisted laparoscopic prostatectomy (RALP).
To describe technical modifications to overcome BPH sequelae and associated outcomes.
DESIGN, SETTINGS, AND PARTICIPANTS: A retrospective study of prospective data on 951 RALP procedures performed from September 2005 to November 2010 was conducted. Outcomes were analyzed by prostate weight, prior BPH surgical intervention (n=59), and median lobes >1 cm (n=42).
RALP.
Estimated blood loss (EBL), blood transfusions, operative time, positive surgical margin (PSM), and urinary and sexual function were measured.
In unadjusted analysis, men with larger prostates and median lobes experienced higher EBL (213.5 vs 176.5 ml; p<0.001 and 236.4 vs 193.3 ml; p=0.002), and larger prostates were associated with more transfusions (4 vs 1; p=0.037). Operative times were longer for men with larger prostates (164.2 vs 149.1 min; p=0.002), median lobes (185.8 vs 155.0 min; p=0.004), and prior BPH surgical interventions (170.2 vs 155.4 min; p=0.004). Men with prior BPH interventions experienced more prostate base PSM (5.1% vs 1.2%; p=0.018) but similar overall PSM. In adjusted analyses, the presence of median lobes increased both EBL (p=0.006) and operative times (p<0.001), while prior BPH interventions also prolonged operative times (p=0.014). However, prostate size did not affect EBL, PSM, or recovery of urinary or sexual function.
Although BPH characteristics prolonged RALP procedure times and increased EBL, prostate size did not affect PSM or urinary and sexual function.
前列腺体积较大、中叶存在以及既往良性前列腺增生（BPH）手术可能会给机器人辅助腹腔镜前列腺切除术（RALP）带来技术挑战。
描述克服 BPH 后遗症及相关结果的技术改良方法。
设计、地点和参与者：对 2005 年 9 月至 2010 年 11 月期间进行的 951 例 RALP 手术的前瞻性数据进行回顾性研究。根据前列腺重量（n=59）、既往 BPH 手术干预（n=59）和中叶＞1cm（n=42）对结果进行分析。
RALP。
估计失血量（EBL）、输血、手术时间、阳性切缘（PSM）和尿性功能及性功能。
在未调整分析中，前列腺较大和中叶存在的男性经历了更高的 EBL（213.5 与 176.5ml；p＜0.001 和 236.4 与 193.3ml；p=0.002），较大的前列腺与更多的输血相关（4 与 1；p=0.037）。前列腺较大的男性手术时间较长（164.2 与 149.1min；p=0.002）、中叶存在（185.8 与 155.0min；p=0.004）和既往 BPH 手术干预（170.2 与 155.4min；p=0.004）。有既往 BPH 干预的男性前列腺基底部 PSM 更多（5.1%与 1.2%；p=0.018），但总体 PSM 相似。在调整分析中，中叶的存在增加了 EBL（p=0.006）和手术时间（p＜0.001），而既往 BPH 干预也延长了手术时间（p=0.014）。然而，前列腺大小并未影响 EBL、PSM 或尿性功能和性功能的恢复。
尽管 BPH 特征会延长 RALP 手术时间并增加 EBL，但前列腺大小并不影响 PSM 或尿性功能和性功能。
