Nason G J, O'Kelly F, White S, Dunne E, Smyth G P, Power R E
Department of Urology, Beaumont Hospital, Dublin 9, Ireland.
Department of Urology, Mater Private Hospital, Dublin 7, Ireland.
Ir J Med Sci. 2017 Nov;186(4):835-840. doi: 10.1007/s11845-016-1522-7. Epub 2016 Oct 28.
Radical prostatectomy for prostate cancer is associated with significant complications, such as urinary incontinence and erectile dysfunction. Debate remains regarding the influence of surgical technique on these important functional outcomes.
The aim of this study was to compare the early functional outcomes following robotic-assisted (RARP), laparoscopic (LRP), and open radical prostatectomy (ORP) in a rapid access cohort.
A retrospective review of a prospectively maintained database was performed between 2011 and 2014. Functional status was objectively assessed using the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and a self-reported continence score.
Two hundred and ninety-two patients underwent RP (85 RARP, 100 LRP, 107 ORP). The mean age was 61.3 years with a mean initial PSA was 6.2 ng/ml. There was no difference noted in urinary function between ORP, LRP, and RARP at 3 months (p = 0.894), 6 months (p = 0.244), 9 months (p = 0.068) or 12 months (p = 0.154). All men noted a deterioration in erectile function; however, there was no difference at 3 months (p = 0.922), 6 months (p = 0.723), 9 months (p = 0.101) or 12 months (p = 0.395), CONCLUSION: Equivalent good early functional outcomes are being achieved in patients undergoing RP irrespective of surgical approach. Longer follow-up in a prospective randomized fashion is required to fully assess the most appropriate surgical technique.
前列腺癌根治性前列腺切除术会引发严重并发症,如尿失禁和勃起功能障碍。关于手术技术对这些重要功能结局的影响,仍存在争议。
本研究旨在比较快速通道队列中机器人辅助根治性前列腺切除术(RARP)、腹腔镜根治性前列腺切除术(LRP)和开放性根治性前列腺切除术(ORP)后的早期功能结局。
对2011年至2014年间前瞻性维护的数据库进行回顾性分析。使用国际前列腺症状评分(IPSS)、国际勃起功能指数(IIEF-5)和自我报告的控尿评分对功能状态进行客观评估。
292例患者接受了根治性前列腺切除术(85例RARP,100例LRP,107例ORP)。平均年龄为61.3岁,平均初始前列腺特异性抗原(PSA)为6.2 ng/ml。在术后3个月(p = 0.894)、6个月(p = 0.244)、9个月(p = 0.068)或12个月(p = 0.154)时,ORP、LRP和RARP之间的排尿功能无差异。所有男性均出现勃起功能恶化;然而,在术后3个月(p = 0.922)、6个月(p = 0.723)、9个月(p = 0.101)或12个月(p = 0.395)时,差异无统计学意义。
无论采用何种手术方式,接受根治性前列腺切除术的患者均能获得相当良好的早期功能结局。需要进行前瞻性随机对照的长期随访,以全面评估最合适的手术技术。