Urological Research Institute, Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
BJU Int. 2013 May;111(5):717-22. doi: 10.1111/j.1464-410X.2012.11315.x. Epub 2012 Jun 21.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Urinary incontinence and erectile dysfunction are the most bothersome sequelae affecting health-related quality of life in patients treated with radical prostatectomy for prostate cancer. While it has been widely reported that a nerve-sparing approach significantly improves postoperative erectile function, the impact of neurovascular bundle preservation on urinary continence recovery is still a matter of controversy. Our study clearly demonstrates that patients treated with nerve-sparing radical prostatectomy have higher chances of recovering full continence after surgery. The results indicate that, when technically and oncologically feasible, an attempt at a nerve-sparing approach should be planned in order to increase the probability of achieving full continence after radical prostatectomy.
To demonstrate that nerve-sparing radical prostatectomy (NSRP) is associated with higher rates of urinary continence (UC) recovery compared with non-nerve-sparing procedures in patients with surgically treated organ-confined prostate cancer.
The study included 1249 patients treated with radical prostatectomy between 2003 and 2010. Patients were divided into three preoperative risk groups: low (PSA < 10 ng/mL, cT1, biopsy Gleason sum ≤ 6), high (cT3 or biopsy Gleason 8-10 or PSA > 20 ng/mL) and intermediate (all the remaining). Postoperative UC recovery was defined as the absence of any protection device. The association between nerve-sparing status and UC recovery was assessed in univariable and multivariable Cox regression analyses after accounting for age at surgery, Charlson Comorbidity Index and preoperative risk group.
At a mean follow-up of 42.2 months (range 1-78), 993 patients (79.5%) recovered UC. Overall, UC recovery rate at 1 and 2 years was 76% and 79%, respectively. On univariable Cox regression analysis, age at surgery, preoperative risk group, medical comorbidities and nerve-sparing status were significantly associated with UC recovery (all P ≤ 0.001). On multivariable analysis, age, risk group and nerve-sparing status were also independently associated with UC recovery (all P < 0.003). Patients treated with bilateral NSRP had a 1.8-fold higher chance of full UC recovery.
Patients treated with bilateral NSRP have significantly higher chances of recovering full continence. Therefore, when oncologically and technically feasible, a nerve-sparing procedure should be attempted.
证明与非神经保留性手术相比，保留神经的根治性前列腺切除术（NSRP）与接受手术治疗的局限性前列腺癌患者更高的尿控（UC）恢复率相关。
本研究纳入了 2003 年至 2010 年间接受根治性前列腺切除术的 1249 例患者。患者被分为三个术前风险组：低危组（PSA＜10ng/mL、cT1、活检 Gleason 总和≤6）、高危组（cT3 或活检 Gleason 8-10 或 PSA＞20ng/mL）和中危组（其余所有患者）。术后 UC 恢复定义为无任何保护装置。在考虑手术时的年龄、Charlson 合并症指数和术前风险组后，在单变量和多变量 Cox 回归分析中评估神经保留状态与 UC 恢复之间的关联。
在平均随访 42.2 个月（范围 1-78）后，993 例患者（79.5%）恢复 UC。总体而言，1 年和 2 年的 UC 恢复率分别为 76%和 79%。在单变量 Cox 回归分析中，手术时的年龄、术前风险组、合并症和神经保留状态与 UC 恢复显著相关（均 P≤0.001）。多变量分析中，年龄、风险组和神经保留状态也与 UC 恢复独立相关（均 P＜0.003）。接受双侧 NSRP 治疗的患者完全 UC 恢复的可能性增加 1.8 倍。
接受双侧 NSRP 治疗的患者完全 UC 恢复的可能性显著增加。因此，在肿瘤学和技术上可行的情况下，应尝试进行神经保留性手术。
