Tasci Ali Ihsan, Simsek Abdulmuttalip, Torer Bugra Dogukan, Sokmen Dogukan, Sahin Selcuk, Tugcu Volkan
Arch Esp Urol. 2014 Nov;67(9):731-9.
Nerve-sparing radical prostatectomies provide excellent control of cancer, but the recovery of continence and sexual function are uncertain. We report the operative details and surgical techniques of a robot-assisted radical prostatectomy (RARP) experiences for organ confined prostate cancer.
Between the years of 2009 and 2012, 68 patients with clinically localized prostate cancer underwent fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis. None of the patients were incontinent. 48 of them had an IIEF-5 potency score equal or greater than 22, without receiving phosphodiesterase-5 inhibitors. Our techniques included preservation of the bladder neck, preservation of the endopelvic fascia and puboprostatic ligaments, a nerve-sparing intrafascial approach, selective suturing of the dorsal venous complex, and anterior and posterior reconstruction. We evaluated the patients at the 1st, 3rd, 6th, and 12th postoperative months to determine if these techniques are correlated with early recovery of urinary continence and potency.
The mean operation time was 258.2±78.5 minutes, and the mean estimated blood loss was 111.2±22.9 cc during the operation. A nerve-sparing procedure was performed bilaterally in 62 (91.2 %) cases and unilaterally in 6 (8.8%) cases. The mean drain extraction time was 2.3±0.9 days, and the mean hospital stay was 3.4±1.1 days. The catheter was removed on postoperative day 9.9±0.9. The surgical margin was positive in 10 (14.7%) patients. The continence rates at 1, 3, 6, and 12 months were 74.2%, 76.9%, 80.6%, and 95.6%, respectively. During the same period, among the patients without ED, the potency rates were 29.4%, 38.2%, 54.1%, and 75%, respectively All operations were completed successfully, and there were no major complications.
A more comprehensive approach for reporting prostate cancer surgery outcomes is needed. Our study findings suggest that fascia-sparing techniques positively influence the early recovery of urinary continence. However, randomized controlled trials with large samples are needed.
保留神经的根治性前列腺切除术能有效控制癌症，但控尿和性功能的恢复情况尚不确定。我们报告了机器人辅助根治性前列腺切除术（RARP）治疗局限性前列腺癌的手术细节和技术经验。
2009年至2012年间，68例临床局限性前列腺癌患者接受了保留筋膜的筋膜内保留神经机器人辅助根治性前列腺切除术及解剖性膀胱尿道吻合术。所有患者均无尿失禁。其中48例国际勃起功能指数-5（IIEF-5）评分等于或高于22，且未接受磷酸二酯酶-5抑制剂治疗。我们的技术包括保留膀胱颈、保留盆腔内筋膜和耻骨前列腺韧带、保留神经的筋膜内入路、选择性缝合背深静脉复合体以及前后重建。我们在术后第1、3、6和12个月对患者进行评估，以确定这些技术是否与早期控尿和性功能恢复相关。
手术平均时间为258.2±78.5分钟，术中平均估计失血量为111.2±22.9毫升。62例（91.2%）患者双侧进行了保留神经手术，6例（8.8%）患者单侧进行了保留神经手术。平均引流管拔除时间为2.3±0.9天，平均住院时间为3.4±1.1天。术后第9.9±0.9天拔除导尿管。10例（14.7%）患者手术切缘阳性。1、3、6和12个月时的控尿率分别为74.2%、76.9%、80.6%和95.6%。同期，在无勃起功能障碍的患者中，性功能恢复率分别为29.4%、38.2%、54.1%和75%。所有手术均成功完成，无重大并发症。
需要一种更全面的方法来报告前列腺癌手术结果。我们的研究结果表明，保留筋膜技术对早期控尿恢复有积极影响。然而，需要进行大样本的随机对照试验。
