Liu Shan, Wen Xing-qiao
Department of Urology, Hospital of North Industry Group Corporation, Xi'an, Shaanxi, China.
Zhonghua Nan Ke Xue. 2014 Nov;20(11):1012-9.
To compare the perioperative data, pathological results and functional outcomes of transvesical single- site laparoscopic radical prostatectomy (TVSSLRP) with those of nerve-sparing extraperitoneal laparoscopic radical prostatectomy (nsELRP) in the treatment of low-risk prostate cancer (PCa).
Fifty patients with low-risk organ-confined PCa were randomly assigned to two groups of equal number to receive TVSSLRP and nsELRP, respectively. Comparisons were made between the two groups of patients in such demographic and baseline data as age, comorbidity, body mass index (BMI), serum prostate-specific antigen (PSA), prostate volume, bioptic Gleason score, clinical stage, IIEF-5 score, nocturnal penile tumescence (NPT), penile brachial index (PBI), and penile arterial blood flow velocity as well as in such surgery-related parameters as operation duration, blood loss, blood transfusion, intraoperative complications, positive surgical margin, catheterization time, hospital stay, and postoperative Gleason score, pathologic stage, urinal pad use, PSA level, IIEF-5 score, NPT, PBI and PABFV.
All the operations were successfully performed. There were no statistically significant differences between the two groups either in the demographic and baseline data or in intraoperative blood loss, blood transfusion rate, complications, and positive surgical margin. No intraoperative complications and positive surgical margins were found in either group. Compared with nsELRP, TVSSLRP achieved a significantly shorter operation duration ([151.46 ± 40.68] min vs [105.92 ± 26.21] min, P <0.05), catheterization time ([13.01 ± 1.64] d vs [11.24 ± 1.17] d, P <0.05), and hospital stay ([15.76 ± 4.65] d vs [12.92 ± 4.29] d, P <0.05). On the first day and at 1, 3 and 6 months after catheter removal, the urinary continence rates in the TVSSLRP and nsELRP groups were 84% vs 52% (P <0.05), 100% vs 84%, 100% vs 96%, and 100% vs 96%, respectively; and at 3, 6 and 12 months after surgery, the erectile potency rates were 48% vs 28% (P <0.05), 64% vs 52%, and 76% vs 68%, respectively, with an IIEF-5 score ≥ 18, all evidently higher in the TVSSLRP than in the nsELRP group. The penile brachial index and arterial blood flow velocity of the two groups of patients exhibited no significant differences before and after surgery, nor did postoperative complications (grade II) between the TVSSLRP and nsELRP groups (32% vs 40%, P >0.05). The Gleason score and pathologic stage were increased after surgery, but with remarkable differences between the two groups (P >0.05). No biochemical recurrence was found in either group during a 12-month follow-up.
With the advantages of safety and rapid postoperative recovery, both TVSSLRP and nsELRP are feasible for the treatment of low-risk organ-confined PCa, but the former may achieve an earlier recovery of urinary continence and erectile function than the latter.
比较经膀胱单切口腹腔镜根治性前列腺切除术（TVSSLRP）与保留神经的腹膜外腹腔镜根治性前列腺切除术（nsELRP）治疗低危前列腺癌（PCa）的围手术期数据、病理结果和功能结局。
将50例低危局限性PCa患者随机分为两组，每组25例，分别接受TVSSLRP和nsELRP。比较两组患者的年龄、合并症、体重指数（BMI）、血清前列腺特异性抗原（PSA）、前列腺体积、活检Gleason评分、临床分期、IIEF-5评分、夜间阴茎勃起（NPT）、阴茎肱动脉指数（PBI）和阴茎动脉血流速度等人口统计学和基线数据，以及手术时间、失血量、输血情况、术中并发症、手术切缘阳性、导尿时间、住院时间、术后Gleason评分、病理分期、尿垫使用情况、PSA水平、IIEF-5评分、NPT、PBI和阴茎动脉血流速度（PABFV）等手术相关参数。
所有手术均成功完成。两组患者的人口统计学和基线数据以及术中失血量、输血率、并发症和手术切缘阳性情况均无统计学显著差异。两组均未发现术中并发症和手术切缘阳性。与nsELRP相比，TVSSLRP的手术时间显著缩短（[151.46±40.68]分钟对[105.92±26.21]分钟，P<0.05）、导尿时间（[13.01±1.64]天对[11.24±1.17]天，P<0.05）和住院时间（[15.76±4.65]天对[12.92±4.29]天，P<0.05）。在拔除导尿管后的第1天以及第1、3和6个月，TVSSLRP组和nsELRP组的尿控率分别为84%对52%（P<0.05）、100%对84%、100%对96%和100%对96%；在术后第3、6和12个月，勃起功能恢复率分别为48%对28%（P<0.05）、64%对52%和76%对68%，IIEF-5评分≥18，TVSSLRP组均明显高于nsELRP组。两组患者的阴茎肱动脉指数和动脉血流速度在手术前后无显著差异，TVSSLRP组和nsELRP组术后并发症（II级）也无显著差异（32%对40%，P>0.05）。Gleason评分和病理分期术后均有升高，但两组间差异不显著（P>0.05）。在12个月的随访中，两组均未发现生化复发。
TVSSLRP和nsELRP治疗低危局限性PCa均安全可行，且术后恢复快，但前者尿控和勃起功能恢复较后者更早。
