Department of Urology, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.
Surgeon. 2011 Apr;9(2):65-71. doi: 10.1016/j.surge.2010.07.005. Epub 2010 Sep 16.
Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established procedure for treatment of prostate cancer (PCa). Intrafascial nerve-sparing EERPE (nsEERPE) aims to preserve the neurovascular bundle and subsequently erectile function. This study assessed the functional and oncological outcomes of nsEERPE with particular regard to younger patients.
Data on 353 men undergoing EERPE between February 2006 and December 2009 was collected prospectively. Non-nerve-sparing EERPE was performed in men diagnosed with PCa with a Gleason score >6 and/or PSA >10 μg/l. nsEERPE was undertaken in men diagnosed PCa with PSA ≤10 μg/l and Gleason score ≤6. Biochemical failure (BF) was defined as PSA ≥0.2 μg/l after nadir or never reached nadir. Men were deemed continent if dry or using 1 confidence pad. Erections satisfactory for intercourse (ESI) or unsatisfactory for intercourse (EUI) were recorded.
102 Men (29%) had nsEERPE and 126 (36%) EERPE. pT2 positive surgical margin (PSM) rates were 20.5% for nsEERPE and 21.3% for EERPE (P = 1). Continence rates following nsEERPE were 59%, 86%, 97% and 52%, 76%, 86% following EERPE at 3, 6 and 12 months of follow-up respectively (P > 0.05). Erectile function rates for nsEERPE were 24%, 52%, 71% compared to 6%, 14%, 29% for EERPE at 3, 6 and 12 months respectively (P < 0.001). Erectile function in men <60 y having nsEERPE was 75% at 12 months.
Continence returned more rapidly and erectile function was improved following nsEERPE vs. EERPE. These results suggest that nsEERPE can be performed with particularly good oncological and functional outcome in <60 y men.
内镜经腹前列腺癌根治术（EERPE）是一种治疗前列腺癌（PCa）的成熟手术。筋膜内保留神经的 EERPE（nsEERPE）旨在保留神经血管束，从而维持勃起功能。本研究特别关注年轻患者，评估了 nsEERPE 的功能和肿瘤学结果。
前瞻性收集了 2006 年 2 月至 2009 年 12 月期间接受 EERPE 的 353 名男性的数据。非神经保留 EERPE 用于诊断为 PCa 且 Gleason 评分>6 和/或 PSA>10μg/l 的男性。nsEERPE 用于诊断为 PSA≤10μg/l 和 Gleason 评分≤6 的 PCa 男性。生化失败（BF）定义为 PSA 在最低值后≥0.2μg/l 或从未达到最低值。如果男性使用 1 片卫生巾时为干燥或轻度潮湿，则认为其具有控尿能力。记录勃起功能是否满意（ESI）或不满意（EUI）进行性交。
102 名男性（29%）接受了 nsEERPE，126 名男性（36%）接受了 EERPE。nsEERPE 的阳性切缘（PSM）率为 20.5%，EERPE 的 PSM 率为 21.3%（P=1）。nsEERPE 后的控尿率分别为 59%、86%、97%，EERPE 分别为 52%、76%、86%，在 3、6 和 12 个月的随访时。nsEERPE 的勃起功能率分别为 24%、52%、71%，EERPE 分别为 6%、14%、29%，在 3、6 和 12 个月的随访时。<60 岁接受 nsEERPE 的男性在 12 个月时勃起功能为 75%。
与 EERPE 相比，nsEERPE 后控尿更快，勃起功能得到改善。这些结果表明，nsEERPE 可以在<60 岁的男性中取得良好的肿瘤学和功能结果。
