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经阴道NOTES杂交肾切除术:术后性功能结果。一项三中心配对研究。

Hybrid Transvaginal NOTES Nephrectomy: Postoperative Sexual Outcomes. A Three-center Matched Study.

作者信息

Butticè Salvatore, Sener Tarik Emre, Lucan Valerian Ciprian, Lunelli Luca, Laganà Antonio Simone, Vitale Salvatore Giovanni, Netsch Christopher, Tanidir Yiloren, Pappalardo Rosa, Magno Carlo

机构信息

Department of Human Pathology-Section of Urology, University of Messina, Messina, Italy.

Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.

出版信息

Urology. 2017 Jan;99:131-135. doi: 10.1016/j.urology.2016.09.023. Epub 2016 Sep 28.

Abstract

OBJECTIVE

To evaluate our experience in patients undergoing hybrid transvaginal natural orifices transluminal endoscopic surgery (NOTES) nephrectomy and evaluate the sexual functions in the postoperative period.

MATERIALS AND METHODS

Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics were recorded. Sexual function was evaluated using the Female Sexual Function Index questionnaire the day prior to the operation and 3 months after.

RESULTS

The mean age, tumor size, and operation duration were 66.16 ± 11.21, 8.51 ± 3.31 cm, and 119.94 ± 21.38 minutes, respectively. Five patients were immediately reoperated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the Female Sexual Function Index score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n = 60), arousal, sexual desire, orgasm, and satisfaction domains have no significant differences in pre- and postoperative periods.

CONCLUSIONS

Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the postoperative period. So patient selection, preoperative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.

摘要

目的

评估我们在患者接受经阴道自然腔道内镜手术(NOTES)联合肾切除术方面的经验,并评估术后性功能。

材料与方法

收集2010年3月至2015年10月在三个不同中心接受NOTES根治性肾切除术的71例肾肿瘤患者的前瞻性数据。记录患者和手术特征。在手术前一天和术后3个月使用女性性功能指数问卷评估性功能。

结果

平均年龄、肿瘤大小和手术持续时间分别为66.16±11.21岁、8.51±3.31cm和119.94±21.38分钟。5例患者因子宫静脉出血立即再次手术。并发症风险随肿瘤大小增加而显著增加。在整个队列中,即使女性性功能指数评分差异很小;除性满意度外,所有领域在术后均有统计学意义的下降。事实上,患者在直接询问时报告手术后性功能未改变且对结果满意。在亚组分析中,未生育患者(n = 60)的性唤起、性欲、性高潮和满意度领域在术前和术后无显著差异。

结论

NOTES联合肾切除术是一种可行、安全的手术,可用于治疗大型肾肿瘤。由于在阴道壁有切口用于取出标本,术后性功能可能会改变。因此,患者选择、术前评估和密切随访是必不可少的。考虑到这一点,我们强烈支持对大型肾肿瘤尤其是未生育患者使用经阴道NOTES联合肾切除术。

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