Jo Jung Ki, Hong Sung Kyu, Byun Seok Soo, Zargar Homayoun, Autorino Riccardo, Lee Sang Eun
Department of Urology, Hanyang University Hospital, Seoul, Korea.
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Yonsei Med J. 2016 Sep;57(5):1145-51. doi: 10.3349/ymj.2016.57.5.1145.
To assess the impact of intravesical prostatic protrusion (IPP) on the outcomes of robot-assisted laparoscopic prostatectomy (RALP).
The medical records of 1094 men who underwent RALP from January 2007 to March 2013 were analyzed using our database to identify 641 additional men without IPP (non-IPP group). We excluded 259 patients who presented insufficient data and 14 patients who did not have an MRI image. We compared the following parameters: preoperative transrectal ultrasound, prostate specific antigen (PSA), clinicopathologic characteristics, intraoperative characteristics, postoperative oncologic characteristics, minor and major postoperative complications, and continence until postoperative 1 year. IPP grade was stratified by grade into three groups: Grade 1 (IPP≤5 mm), Grade 2 (5 mm<IPP≤10 mm), and Grade 3 (IPP>10 mm).
Of the 821 patients who underwent RALP, 557 (67.8%) experienced continence at postoperative 3 months, 681 (82.9%) at 6 months, and 757 (92.2%) at 12 months. According to IPP grade, there were significant differences in recovering full continence at postoperative 3 months, 6 months, and 12 months (p<0.001). On multivariate analysis, IPP was the most powerful predictor of postoperative continence in patients who underwent RALP (p<0.001). Using a generalized estimating equation model, IPP also was shown to be the most powerful independent variable for postoperative continence in patients who underwent RALP (p<0.001).
Patients with low-grade IPP have significantly higher chances of recovering full continence. Therefore, the known IPP grade will be helpful during consultations with patients before RALP.
评估膀胱内前列腺突出（IPP）对机器人辅助腹腔镜前列腺切除术（RALP）手术结果的影响。
利用我们的数据库分析了2007年1月至2013年3月期间接受RALP手术的1094名男性患者的病历，以确定另外641名无IPP的男性患者（非IPP组）。我们排除了259例数据不足的患者和14例没有MRI图像的患者。我们比较了以下参数：术前经直肠超声、前列腺特异性抗原（PSA）、临床病理特征、术中特征、术后肿瘤学特征、术后轻微和严重并发症，以及术后1年的控尿情况。IPP分级按等级分为三组：1级（IPP≤5mm）、2级（5mm＜IPP≤10mm）和3级（IPP＞10mm）。
在821例接受RALP手术的患者中，557例（67.8%）在术后3个月实现控尿，681例（82.9%）在6个月实现控尿，757例（92.2%）在12个月实现控尿。根据IPP分级，术后3个月、6个月和12个月完全恢复控尿存在显著差异（p＜0.001）。多因素分析显示，IPP是接受RALP手术患者术后控尿的最强预测因素（p＜0.001）。使用广义估计方程模型，IPP也是接受RALP手术患者术后控尿的最强独立变量（p＜0.001）。
低度IPP患者完全恢复控尿的机会显著更高。因此，已知的IPP分级在RALP术前与患者的咨询过程中会有所帮助。
