机器人辅助根治性前列腺切除术后的早期生化复发、尿失禁和性功能结果
Early biochemical recurrence, urinary continence and potency outcomes following robot-assisted radical prostatectomy.
作者信息
Berg Kasper Drimer, Thomsen Frederik Birkebæk, Hvarness Helle, Christensen Ib Jarle, Iversen Peter
机构信息
Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Denmark.
出版信息
Scand J Urol. 2014 Aug;48(4):356-66. doi: 10.3109/21681805.2014.893534. Epub 2014 Mar 3.
OBJECTIVE
The aim of this study was to describe recovery of urinary continence and potency and report oncological and functional outcomes using the survival, continence and potency (SCP) system for patients undergoing robot-assisted radical prostatectomy (RARP).
MATERIAL AND METHODS
From 2009 to 2012, 232 patients underwent RARP. Self-reported continence, erection sufficient for intercourse (ESI) and scores on the five-item version of the International Index of Erectile Function-5 (IIEF-5) were registered by questionnaire and physician's interview preoperatively and at 3, 6 and 12 month follow-up, and subsequently on a yearly basis. Continence was defined as 0 pads, and potency as ESI or IIEF-5 greater than 17 with or without the aid of phosphodiesterase type 5 inhibitors. Oncological success was defined as absence of biochemical failure (BF) [prostate-specific antigen (PSA) ≥ 0.2 ng/ml]. The SCP system was used to evaluate combined oncological and functional outcomes.
RESULTS
In total, 184 patients were followed for more than 1 year. The 12 month BF-free survival rate was 97.7%. Median time to regain continence was 6.2 months; 12 months postoperatively 79.9% used 0 pads/day. Of patients with preoperative ESI, 77.6% (67.9-86.1) and 34.4% (24.1-47.5) maintained ESI 12 months postoperatively after bilateral and unilateral nerve-sparing surgery (NS), respectively. NS (p < 0.0001), increasing prostate volume (p = 0.014) and lower age (p < 0.0001) were positively associated with recovery of potency. Using the SCP system and defining potency as ESI, functional and oncological success 12 months after surgery was achieved in 69 out of 135 (51.1%) preoperative continent and potent patients who underwent unilateral or bilateral NS, and did not require adjuvant treatment; when defining potency as IIEF greater than 17, this figure was 45 out of 108 (41.7%). As expected, the proportions were significantly higher for bilateral than for unilateral NS (p ≤ 0.0014).
CONCLUSION
RARP provides good early BF-free survival, continence and potency recovery rates for patients eligible for NS.
目的
本研究旨在描述尿失禁和性功能的恢复情况，并使用生存、尿失禁和性功能（SCP）系统报告接受机器人辅助根治性前列腺切除术（RARP）患者的肿瘤学和功能结局。
材料与方法
2009年至2012年，232例患者接受了RARP。通过问卷调查和医生访谈，在术前以及术后3、6和12个月随访时，随后每年记录患者自我报告的尿失禁情况、性交时勃起功能足够（ESI）以及国际勃起功能指数-5（IIEF-5）五项版本的评分。尿失禁定义为使用0片尿垫，性功能定义为无论是否使用5型磷酸二酯酶抑制剂，ESI或IIEF-5大于17。肿瘤学成功定义为无生化复发（BF）[前列腺特异性抗原（PSA）≥0.2 ng/ml]。使用SCP系统评估肿瘤学和功能结局。
结果
总共184例患者随访超过1年。12个月无生化复发生存率为97.7%。恢复尿失禁的中位时间为6.2个月；术后12个月，79.9%的患者每天使用0片尿垫。术前有ESI的患者中，双侧和单侧保留神经手术（NS）后，分别有77.6%（67.9 - 86.1）和34.4%（24.1 - 47.5）的患者术后12个月维持ESI。NS（p < 0.0001）、前列腺体积增加（p = 0.014）和年龄较小（p < 0.0001）与性功能恢复呈正相关。使用SCP系统并将性功能定义为ESI时，135例术前控尿且性功能正常、接受单侧或双侧NS且无需辅助治疗的患者中，69例（51.1%）在术后12个月实现了功能和肿瘤学成功；将性功能定义为IIEF大于17时，108例中有45例（41.7%）。正如预期的那样，双侧NS的比例显著高于单侧NS（p≤0.0014）。
结论
对于适合NS的患者，RARP可提供良好的早期无生化复发生存率、尿失禁和性功能恢复率。
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