Department of Urology, University of California, Irvine, Orange, CA, USA.
J Endourol. 2012 Dec;26(12):1553-7. doi: 10.1089/end.2012.0345. Epub 2012 Nov 15.
Preservation of continence and sexual function continues to be a formidable quality-of-life issue regarding outcomes after radical prostatectomy. There is little argument that physical preservation of the nerves and sphincters is a critical component to achieving success in these domains. Previously demonstrated factors such as advancing age, deteriorating physical health status, and subnormal baseline potency negatively impact outcomes. Our hypothesis, however, has been that inflammatory response to surgery has a large impact on surgical outcomes of prostatectomy. Trauma-induced inflammation could account for variation in recovery despite nearly identical surgery on many patients, especially in high-volume surgeons. In other words, we suggest and maintain that younger and healthier patients tolerate and/or recover better from the trauma/inflammation of surgery. Those who do not recover as well may have altered inflammatory response to injury. A common response to decrease inflammation in response to physical injury would be as simple as to cool the injury with ice. Previous neurologic studies have suggested that using ice during surgical intervention can reduce the inflammatory damage. Therefore, we applied this concept that preemptive hypothermia could reduce inflammation to the robot-assisted prostatectomy procedure to potentially lead to improved continence and potency outcomes. In 2009, we introduced the concept of regional hypothermia via an endorectal cooling balloon during robot-assisted radical prostatectomy (RARP). We have published our single institution data demonstrating a significant reduction of overall incontinence. Defining continence as zero-pads, our overall 1-year incontinence has been reduced by 70% (from 13% to 4%). Severe incontinence, defined as two or more pads, was likewise reduced by 70% (from 2.9% to 0.9%). Regional hypothermia used during the time of surgery represents a novel strategy for minimizing inflammation and subsequent muscle and nerve damage in RARP.
保留尿控和性功能仍然是根治性前列腺切除术后生活质量的一个重要问题。几乎没有人会怀疑，保护神经和括约肌的完整性是实现这些目标的关键因素。以前已经证明，年龄增长、身体状况恶化和基线勃起功能障碍等因素会对结果产生负面影响。然而，我们的假设是，手术引起的炎症反应对前列腺切除术的手术结果有很大影响。手术创伤引起的炎症可能会导致许多患者的手术结果出现差异，尤其是在高容量手术医生中。换句话说，我们认为年轻和健康的患者能更好地耐受和/或从手术创伤/炎症中恢复。那些恢复不佳的患者可能对损伤的炎症反应发生了改变。一种常见的减少炎症反应的方法是通过冰敷来降低受伤部位的温度。以前的神经学研究表明，在手术干预中使用冰敷可以减少炎症损伤。因此，我们将这一概念即预先低温治疗可以减少炎症应用于机器人辅助前列腺切除术，以潜在地改善尿控和勃起功能恢复。2009 年，我们在机器人辅助根治性前列腺切除术（RARP）中引入了通过直肠内冷却球囊进行区域低温的概念。我们已经发表了我们的单机构数据，表明总体尿失禁显著减少。我们将零片定义为尿控，1 年总的尿失禁率降低了 70%（从 13%降至 4%）。严重尿失禁（定义为两片或更多片）同样降低了 70%（从 2.9%降至 0.9%）。手术期间使用区域低温是一种减少 RARP 中炎症以及随后的肌肉和神经损伤的新策略。
