Department of Urology, Federal Armed Forces Hospital of Ulm, Ulm, Germany.
J Endourol. 2012 Sep;26(9):1136-41. doi: 10.1089/end.2012.0074. Epub 2012 May 31.
To determine whether previous transurethral resection of the prostate (TURP) compromises the surgical outcome and pathologic findings in patient who underwent either radical robot-assisted laparoscopic prostatectomy (RALP) or open retropubic radical prostatectomy (RRP) after TURP, because TURP is reported to complicate radical prostatectomy and there are conflicting data.
From July 2008 to July 2010, 357 patients underwent RALP. Of these, 19 (5.3%) patients had undergone previous TURP. Operative and perioperative data of patients were compared with those of matched controls selected from a database of 616 post-RRP patients. Matching criteria were age, clinical stage, the level of preoperative prostate-specific-antigen, the biopsy Gleason score, the American Society of Anesthesiologists classification score, and prostate volume assessed during transrectal ultrasonography. All RRP and RALP procedures were performed by experienced surgeons.
Mean time to prostatectomy was 67.4 months in the RALP group and 53.1 months in the RRP group. Mean operative time was 217 ± 51.9 minutes for RALP and 174 ± 57.7 minutes for RRP (P<0.05). The overall positive surgical margin rate was 15.8% in both groups (pT(2) tumors: 10.5% for RALP and 5.3% for RRP; P=1.0). Mean estimated blood loss was 333 ± 144 mL in RALP patients and 1103 ± 636 mL in RRP patients (P<0.001). The difference between preoperative and postoperative hemoglobin levels was 3.22 ± 0.98 g/dL for RALP and 5.85 ± 1.95 g/dL for RRP (P=0.0002). The RALP and RRP groups also differed in terms of hospital stay (8.58 ± 1.17 vs 11.74 ± 5.22 days; P=0.0037), duration of catheterization (7.95 ± 5.69 vs 11.78 ± 6.97 days; P=0.0016), postoperative complications according to the Clavien classification system (6 vs 15 patients; P=0.0027), and transfusion rate (0% vs 10.5%; P<0.001).
RALP offers advantages over open radical prostatectomy after previous surgery. Although both techniques are associated with adequate surgical outcomes, RALP appeared to be preferable in our population of patients with previous prostate surgery.
确定先前经尿道前列腺电切术（TURP）是否会影响接受机器人辅助腹腔镜前列腺根治切除术（RALP）或开放耻骨后前列腺根治切除术（RRP）治疗的患者的手术结果和病理发现，因为 TURP 据报道会使前列腺根治术复杂化，而且存在相互矛盾的数据。
2008 年 7 月至 2010 年 7 月，共有 357 例患者接受了 RALP。其中，19 例（5.3%）患者曾接受过 TURP。将患者的手术和围手术期数据与数据库中 616 例接受 RRP 治疗的患者的匹配对照进行比较。匹配标准为年龄、临床分期、术前前列腺特异性抗原水平、活检 Gleason 评分、美国麻醉医师协会分类评分和经直肠超声评估的前列腺体积。所有的 RRP 和 RALP 手术均由经验丰富的外科医生进行。
RALP 组的前列腺切除术平均时间为 67.4 个月，RRP 组为 53.1 个月。RALP 的平均手术时间为 217±51.9 分钟，RRP 为 174±57.7 分钟（P<0.05）。两组的总阳性切缘率均为 15.8%（pT2 肿瘤：RALP 为 10.5%，RRP 为 5.3%；P=1.0）。RALP 组患者的估计失血量为 333±144mL，RRP 组为 1103±636mL（P<0.001）。RALP 组和 RRP 组患者术前和术后血红蛋白水平的差值分别为 3.22±0.98g/dL 和 5.85±1.95g/dL（P=0.0002）。RALP 组和 RRP 组在住院时间（8.58±1.17 与 11.74±5.22 天；P=0.0037）、导尿管留置时间（7.95±5.69 与 11.78±6.97 天；P=0.0016）、Clavien 分类系统术后并发症（6 例与 15 例；P=0.0027）和输血率（0%与 10.5%；P<0.001）方面也存在差异。
RALP 在先前手术后提供了优于开放根治性前列腺切除术的优势。尽管两种技术都能获得足够的手术结果，但 RALP 在我们的前列腺手术患者人群中似乎更具优势。
