Salomon L, Droupy S, Yiou R, Soulié M
Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
Service d'urologie et d'andrologie, CHU de Nîmes, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France.
Prog Urol. 2015 Nov;25(15):1028-66. doi: 10.1016/j.purol.2015.07.013.
To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer.
Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta.
Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach.
Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.
描述局限性前列腺癌根治性前列腺切除术后的功能结果及功能障碍的治疗。
根据科学相关性从美国国立医学图书馆的Medline数据库（PubMed）进行文献检索。研究重点为控尿、性功能、勃起功能障碍、夫妻性生活、尿失禁、术后尿失禁的治疗、勃起功能障碍及“三连胜”（指手术切缘阴性、淋巴结阴性和术后病理分期小于T3期）。
当肿瘤学风险与功能结果相平衡时，根治性前列腺切除术是一个复杂且具有挑战性的手术。尽管手术技术最近有所发展，但根治性前列腺切除术后尿失禁（pRP-UI）仍然是最具破坏性的并发症之一，影响9% - 16%的患者。括约肌损伤和膀胱功能障碍是pRP-UI最常见的原因。影响治疗选择的pRP-UI严重程度评估仍未得到很好的标准化，但至少应包括尿垫试验和自我管理问卷。植入人工尿道括约肌AMS800仍然是中重度pRP-UI患者的金标准治疗方法。诸如Pro-ACT球囊男性吊带等侵入性较小的技术的发展为轻中度pRP-UI提供了替代治疗选择。现在大多数研究组认为球海绵体压迫吊带是轻度至中度pRP-UI患者的首选治疗方法。最合适的二线治疗策略尚未明确确定。已经对诸如可调节人工尿道括约肌、吊带和干细胞注射等最新疗法进行了研究。维持满意的性生活是大多数面临前列腺癌及其治疗的男性的主要关注点。在治疗前列腺癌之前评估夫妻性生活至关重要，以便提供全面信息并考虑符合夫妻期望的早期治疗方案。积极的药物性勃起康复治疗（术后一个月内按需进行海绵体内注射或使用5型磷酸二酯酶抑制剂[PDE5i]）或被动治疗（术后每日使用PDE5i）可能会改善勃起质量，尤其是对PDE5i有反应的情况。当勃起尚未恢复时，性反应未受影响的方面（性高潮）可能为夫妻提供一种保持亲密关系的替代方式。雄激素阻断是维持或恢复满意性生活的主要障碍。“三连胜”是一种以单一方式呈现根治性前列腺切除术结果的简单工具：在保留双侧神经血管的情况下，无论采用何种手术方式，“三连胜”率均为60%。
当肿瘤学风险与功能结果相平衡时，根治性前列腺切除术是一个复杂且具有挑战性的手术。存在多种术后尿失禁和勃起功能障碍的治疗方法。必须治疗术后功能障碍以改善患者的生活质量。
