Ramírez Backhaus Miguel, Juan Escudero Joaquín, Palmero Martí Jose Luis, Ortíz Rodríguez Isabel M, Rubio Briones José, Stolzenburg Jens-Uwe, Benedicto Redón Antonio, Domínguez Escrig José, Collado Serra Argimiro, Gómez-Ferrer Álvaro, Casanova Juan, Rodríguez Torreblanca Carmelo, Solsona Narbón Eduardo
Urology Department, Fundación IVO, Valencia, Spain.
Arch Esp Urol. 2012 Sep;65(7):675-83.
Laparoscopic Radical Prostatectomy (LRP) is technically a very demanding procedure and potentially even more challenging in patients with previous transurethral resection (TURP). This study evaluates the impact of previous TURP on the short-term functional outcome of patients undergoing extraperitoneal LRP.
Retrospective analysis of a prospectively collected database, comprising a single-surgeon cohort of 155 consecutive LRP cases, 19 of which had previous history of TURP. Demographics, clinical and functional outcomes were evaluated and compared among patients with and without previous TURP. Multivariate analysis was performed to identify potential variables independently associated with continence outcomes. Incontinence was defined as the need of more than 1 pad/day. Potency was defined as the ability for sexual intercourse with or without the use of phosphodiesterase inhibitors.
Demographic and clinical variables were comparable among the two study groups. Neurovascular bundle preservation was possible in 26% and 37% of patients with and without previous TURP, respectively. No major complications were recorded and the incidence of minor complications was comparable. Overall continence rate at 3 months was 82,58%, for the entire cohort. Subset analysis demonstrated a 3-month continence rate of 73.7% vs. 83.8% (p>0.05) in patients with and without TURP, respectively. Multivariate analysis demonstrated age, BMI and ASA were variables independently associated with continence outcomes. In the cohort of patients with previous TURP, 2 out of 7 undergoing preservation recovered erections, with a mean follow up of 15.5 months, comparable to the 30% achieved in patients without TURP and nerve sparing procedure.
Laparoscopic Radical Prostatectomy in patients with previous TURP is feasible, with complication rates and short-term functional outcomes comparable to those in patients without previous resection.
腹腔镜根治性前列腺切除术（LRP）在技术上是一项要求很高的手术，对于既往接受过经尿道前列腺切除术（TURP）的患者而言，可能更具挑战性。本研究评估既往TURP对接受腹膜外LRP患者短期功能结局的影响。
对前瞻性收集的数据库进行回顾性分析，该数据库包含由同一外科医生连续完成的155例LRP病例队列，其中19例有既往TURP病史。对有和无既往TURP的患者的人口统计学、临床和功能结局进行评估和比较。进行多变量分析以确定与控尿结局独立相关的潜在变量。尿失禁定义为每天使用超过1片尿垫。性功能定义为无论是否使用磷酸二酯酶抑制剂都有进行性交的能力。
两个研究组的人口统计学和临床变量具有可比性。既往有和无TURP的患者中，分别有26%和37%的患者能够保留神经血管束。未记录到重大并发症，轻微并发症的发生率相当。整个队列3个月时的总体控尿率为82.58%。亚组分析显示，有和无TURP的患者3个月时的控尿率分别为73.7%和83.8%（p>0.05）。多变量分析显示年龄、体重指数和美国麻醉医师协会分级是与控尿结局独立相关的变量。在既往有TURP的患者队列中，7例接受保留神经手术的患者中有2例恢复勃起，平均随访15.5个月，这与未接受TURP和保留神经手术的患者中30%的勃起恢复率相当。
既往有TURP的患者行腹腔镜根治性前列腺切除术是可行的，并发症发生率和短期功能结局与未接受过既往切除术的患者相当。
