Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Urol. 2012 Nov;188(5):1754-60. doi: 10.1016/j.juro.2012.07.045. Epub 2012 Sep 19.
While bladder neck sparing may improve post-prostatectomy urinary continence, there is concern that it may lead to more positive surgical margins and compromise cancer control. We compared the continence and cancer control outcomes of bladder neck sparing vs nonsparing techniques during robot-assisted laparoscopic radical prostatectomy.
Data were prospectively collected on 1,067 robot-assisted laparoscopic radical prostatectomies done from September 2005 through October 2011. We compared the procedures according to bladder neck sparing (791) and nonsparing (276). Continence was defined by zero pad responses on the EPIC (Expanded Prostate Cancer Index) item quantifying daily use. Biochemical recurrence was defined as prostate specific antigen 0.1 ng/ml or greater. Cox regression was performed to assess factors associated with post-prostatectomy continence and biochemical recurrence-free survival.
Median followup for bladder neck sparing vs nonsparing was 25.8 vs 51.7 months. Men treated with bladder neck sparing were more likely to have clinical T1c tumors (p <0.001) and less likely to have biopsy Gleason grade 6 or less disease (p = 0.023). They experienced fewer urinary leaks (p = 0.009) and shorter length of stay (p = 0.006). Regarding cancer control outcomes, there was no difference in bladder neck sparing vs nonsparing base (1.2% vs 2.6%, p = 0.146) and overall surgical margin positivity (each 13.8%, p = 0.985). On adjusted analyses bladder neck sparing vs nonsparing was associated with better continence (HR 1.69, 95% CI 1.43-1.99) and similar biochemical recurrence-free survival (HR 1.20, 95% CI 0.62-2.31, p = 0.596).
Bladder neck sparing is associated with fewer urinary leak complications, shorter hospitalization and better post-prostatectomy continence without compromising cancer control compared to bladder neck nonsparing.
保留膀胱颈可能会改善前列腺切除术后的尿控，但人们担心这可能会导致更多的阳性手术切缘，并影响癌症的控制。我们比较了机器人辅助腹腔镜前列腺根治术中保留与不保留膀胱颈技术的尿控和癌症控制结果。
2005 年 9 月至 2011 年 10 月期间，前瞻性地收集了 1067 例机器人辅助腹腔镜前列腺根治术的数据。我们根据保留（791 例）和不保留（276 例）膀胱颈的情况对手术进行了比较。尿控通过 EPIC（前列腺癌指数扩展）项目中量化每日使用的零垫反应来定义。生化复发定义为前列腺特异性抗原 0.1ng/ml 或更高。使用 Cox 回归评估与前列腺切除术后尿控和生化无复发生存相关的因素。
保留与不保留膀胱颈的中位随访时间分别为 25.8 个月和 51.7 个月。接受保留膀胱颈治疗的患者更可能患有临床 T1c 肿瘤（p<0.001），且不太可能患有活检 Gleason 评分 6 级或更低的疾病（p=0.023）。他们发生尿漏的情况更少（p=0.009），住院时间更短（p=0.006）。在癌症控制结果方面，保留与不保留膀胱颈的基底阳性率（分别为 1.2%和 2.6%，p=0.146）和总体手术切缘阳性率（均为 13.8%，p=0.985）无差异。在调整分析中，与不保留膀胱颈相比，保留膀胱颈与更好的尿控相关（HR 1.69，95%CI 1.43-1.99），与相似的生化无复发生存率相关（HR 1.20，95%CI 0.62-2.31，p=0.596）。
与不保留膀胱颈相比，保留膀胱颈可减少尿漏并发症、缩短住院时间并改善前列腺切除术后的尿控，同时不影响癌症的控制。
