Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
BJU Int. 2012 Jul;110(2 Pt 2):E57-63. doi: 10.1111/j.1464-410X.2011.10660.x. Epub 2011 Oct 12.
Retro-apical transection of urethra during RARP in an Asian population was found to be feasible. A dedicated team, using robot-assisted surgery, with a skillful assistant are required for the procedure to become standard practice. We would recommend the retro-apical approach for all patients receiving RARP, as it was not found to increase surgical risk or complication. The continence rate at 3 months and 6 months were similar between two groups (70% and 95% in retro-apical group vs 60% and 90% in anterior-apical group).
To assess the feasibility of retro-apical transection of the urethra during robot-assisted radical prostatectomy (RARP) in an Asian population.
Eighty consecutive patients with clinically localized prostate cancer underwent RARP performed by a single surgeon. Patients who underwent retro-apical or anterior-apical urethral transection during RARP were allocated to Group 1 or Group 2, respectively. Preoperative clinical characteristics were recorded, pelvic bone measurements taken and prostatic apex shape was assessed using magnetic resonance imaging. Operating characteristics were compared between the groups and pathological outcomes were assessed.
Of the 80 patients, 75% were in Group 1 and 25% in Group 2. Pelvic bone size and apex shape were similar between the two groups. Group 2 had a significantly higher mean (sd) preoperative body mass index (BMI) than Group 1 (27.43 [4.15] vs 23.50 [2.71] kg/m(2); P < 0.001) and significantly higher prostate weight than Group 1 (52.00 [31.89] vs 36.55 [11.57] g; P < 0.05). More of those in Group 2 than in Group 1 had undergone previous transurethral resection of the prostate ([TURP] 25% vs 1.67%; P = 0.003) and the mean tumour volume in Group 2 was significantly higher than in Group 1 (15.17 vs 8.10 mL; P = 0.049). The incidence of retro-apical transection of the urethra was 62.5% and 82.5% in the initial 40 cases and subsequent 40 cases, respectively (P = 0.02).
High BMI, larger prostate volume and previous TURP, but not pelvic bone size or apex shape, might hinder retro-apical transection of the urethra.
评估机器人辅助前列腺癌根治术（RARP）中经尿道后尿道尖端横断术在亚洲人群中的可行性。
连续 80 例临床局限性前列腺癌患者接受了单一外科医生进行的 RARP。接受 RARP 时经尿道后尿道尖端或前尿道尖端横断术的患者分别分配到第 1 组或第 2 组。记录术前临床特征，测量骨盆骨骼，使用磁共振成像评估前列腺尖端形状。比较两组之间的手术特点和病理结果。
80 例患者中，75%为第 1 组，25%为第 2 组。两组骨盆大小和尖端形状相似。第 2 组的平均（标准差）术前体重指数（BMI）明显高于第 1 组（27.43[4.15]比 23.50[2.71]kg/m 2；P＜0.001），前列腺重量也明显高于第 1 组（52.00[31.89]比 36.55[11.57]g；P＜0.05）。第 2 组中接受经尿道前列腺切除术（TURP）的比例明显高于第 1 组（25%比 1.67%；P=0.003），第 2 组的平均肿瘤体积明显大于第 1 组（15.17 比 8.10mL；P=0.049）。在最初的 40 例和随后的 40 例中，经尿道后尿道尖端横断术的发生率分别为 62.5%和 82.5%（P=0.02）。
高 BMI、较大的前列腺体积和既往 TURP，但不是骨盆骨骼大小或尖端形状，可能会妨碍经尿道后尿道尖端横断术。
