Cathala Nathalie, Mombet Annick, Sanchez-Salas Rafael, Rozet Francois, Barret Eric, Giuliano Francois, Galiano Marc, Prapotnich Dominique, Kazzazi Amir, Djavan Bob, Jaffe Jamison, Cathelineau Xavier, Vallancien Guy
Department of Urology, Institute Montsouris/Université Paris Descartes, Paris, France.
Can J Urol. 2012 Aug;19(4):6328-35.
To evaluate erectile function among men who had undergone laparoscopic radical prostatectomy and received postoperative medical therapy for erectile dysfunction.
We performed a prospective study in men who underwent laparoscopic radical prostatectomy between September 2003 and November 2005 at our center and who received penile rehabilitation after surgery. All patients had antegrade interfascial dissection. They received 10 mg tadalafil on the fifth postoperative day and continued to receive it every other day, regardless of erectile function. Intracavernous injection of alprostadil was initiated at 3 or 6 months depending on response to treatment with tadalafil. Follow up evaluations were done at 3, 6, 12, 18 and 24 months. Oncologic and functional outcomes and compliance were assessed. Patients filled in International Index of Erectile Function-5 (IIEF-5) questionnaires.
Of 1078 men who underwent laparoscopic radical prostatectomy during this time, 586 patients met inclusion criteria, complied with the study medication, and had complete data for 24 months. The patients had a median preoperative baseline IIEF-5 score of 22. A total of 150 patients (26%) underwent unilateral nerve-sparing surgery, while 436 patients (74%) had bilateral nerve-sparing surgery. At 24 months, 35% of patients who underwent unilateral nerve-sparing surgery and 68% of patients who underwent bilateral nerve-sparing surgery reported having sufficient erectile function for intercourse without using intracavernous injection of alprostadil. At 24 months after surgery, the median IIEF-5 score was 13 (1-25) for the whole cohort, 5 (1-25) for patients who had undergone unilateral nerve-sparing surgery, and 15 (1-25) for patients who had undergone bilateral nerve-sparing surgery.
The findings suggest that adequate patient selection and postoperative medical intervention allows the preservation or recovery of erectile function after laparoscopic radical prostatectomy. Inaccurate selection of patients and postoperative assessment might explain inferior erectile function results following this surgery.
评估接受腹腔镜根治性前列腺切除术并接受术后勃起功能障碍药物治疗的男性的勃起功能。
我们对2003年9月至2005年11月在本中心接受腹腔镜根治性前列腺切除术且术后接受阴茎康复治疗的男性进行了一项前瞻性研究。所有患者均采用顺行筋膜间剥离术。他们在术后第5天开始服用10毫克他达拉非，无论勃起功能如何，每隔一天继续服用。根据对他达拉非治疗的反应，在3或6个月时开始进行海绵体内注射前列地尔。在3、6、12、18和24个月进行随访评估。评估肿瘤学和功能结果以及依从性。患者填写国际勃起功能指数-5（IIEF-5）问卷。
在此期间接受腹腔镜根治性前列腺切除术的1078名男性中，586名患者符合纳入标准，遵守研究用药规定，并拥有24个月的完整数据。患者术前IIEF-5评分中位数为22。共有150名患者（26%）接受了单侧神经保留手术，而436名患者（74%）接受了双侧神经保留手术。在24个月时，接受单侧神经保留手术的患者中有35%以及接受双侧神经保留手术的患者中有68%报告在不使用海绵体内注射前列地尔的情况下具有足够的勃起功能进行性交。术后24个月时，整个队列的IIEF-5评分中位数为13（1-25），接受单侧神经保留手术的患者为5（1-25），接受双侧神经保留手术的患者为15（1-25）。
研究结果表明合理的患者选择和术后医学干预可使腹腔镜根治性前列腺切除术后勃起功能得以保留或恢复。患者选择不准确和术后评估可能解释了该手术后勃起功能较差的结果。
