选择双侧神经保留根治性前列腺切除术后阴茎康复的最佳人选。
Choosing the best candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy.
机构信息
Urological Research Institute, Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
出版信息
J Sex Med. 2012 Feb;9(2):608-17. doi: 10.1111/j.1743-6109.2011.02580.x. Epub 2011 Dec 21.
INTRODUCTION
Controversy exists regarding the ideal candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy (BNSRP).
AIM
To test the effect of penile rehabilitation according to preoperative patient characteristics.
METHODS
We included 435 consecutive patients treated with BNSRP between 2004 and 2008. Preoperative age, International Index of Erectile Function (IIEF) and Charlson Comorbidity Index (CCI) were used to subdivide patients into three groups according to foreseen risk of erectile dysfunction (ED) after surgery: low (age ≤65, IIEF-erectile function (EF) ≥26, CCI ≤1; N = 184), intermediate (age 66-69 or IIEF-EF 11-25, CCI ≤1; N = 115), and high (age ≥70 or IIEF-EF ≤10 or CCI ≥2; N = 136). The Kaplan-Meier method was used to test the difference in EF recovery rates among patients left untreated after surgery (N = 193), those receiving on-demand phosphodiesterase type 5 inhibitors (PDE5-I; N = 147), and those treated with chronic use of PDE5-I (taken every day or every other day for 3-6 months; N = 95). The same analyses were repeated within each risk category.
MAIN OUTCOME MEASURE
Erectile function (EF) was evaluated using the International Index of Erectile Function (IIEF). Recovery of EF after BNSRP was defined as an IIEF-EF domain score ≥22.
RESULTS
No difference in terms of EF recovery was found between patients receiving on-demand vs. daily PDE5-I (P = 0.09) in the overall population. Similarly, comparable efficacy of the two treatment schedules (on-demand vs. chronic) was demonstrated in patients with low and high risk of ED (all P ≥ 0.8). Conversely, daily therapy with PDE5-I showed significantly higher efficacy for the EF recovery rate compared with the on-demand PDE5-I administration schedule in patients with intermediate risk of ED (3-year EF recovery: 74% vs. 52%, respectively; P = 0.02).
CONCLUSION
The ideal candidates for penile rehabilitation after surgery are patients at intermediate risk of ED.
引言
在接受双侧保留神经的根治性前列腺切除术（BNSRP）后，对于阴茎康复的理想候选者存在争议。
目的
根据术前患者特征测试阴茎康复的效果。
方法
我们纳入了 2004 年至 2008 年间接受 BNSRP 治疗的 435 例连续患者。根据手术后继发勃起功能障碍（ED）的预期风险，使用术前年龄、国际勃起功能指数（IIEF）和 Charlson 合并症指数（CCI）将患者分为三组：低危组（年龄≤65 岁，IIEF-勃起功能（EF）≥26，CCI≤1；N=184）、中危组（年龄 66-69 岁或 IIEF-EF 11-25，CCI≤1；N=115）和高危组（年龄≥70 岁或 IIEF-EF≤10 或 CCI≥2；N=136）。采用 Kaplan-Meier 法测试术后未治疗（N=193）、按需使用磷酸二酯酶 5 抑制剂（PDE5-I；N=147）和慢性 PDE5-I 治疗（每天或隔天服用 3-6 个月；N=95）患者的 EF 恢复率之间的差异。在每个风险类别内重复了相同的分析。
主要观察指标
使用国际勃起功能指数（IIEF）评估勃起功能（EF）。BNSRP 后 EF 的恢复定义为 IIEF-EF 域评分≥22。
结果
在总体人群中，按需使用 PDE5-I 与每日 PDE5-I 之间的 EF 恢复无差异（P=0.09）。同样，在 ED 低危和高危患者中，两种治疗方案（按需与慢性）的疗效相当（所有 P≥0.8）。相反，与按需 PDE5-I 给药方案相比，高危 ED 患者中每日 PDE5-I 治疗显示出更高的 EF 恢复率（3 年 EF 恢复率：分别为 74%和 52%；P=0.02）。
结论
手术后继发性 ED 中危患者是阴茎康复的理想候选者。
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