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既往接受过经尿道前列腺切除术的男性患者行机器人辅助或开放性根治性前列腺切除术。

Robotic or Open Radical Prostatectomy in Men with Previous Transurethral Resection of Prostate.

作者信息

Mustafa Mahmoud, Davis John W, Gorgel Sacit Nuri, Pisters Louis

机构信息

An-Najah National University, Faculty of Medicine and Health Science, Urology Department, Nablus, West bank, Palestine.

Anderson Cancer Center, Urology Department, University of Texas, Houston, Texas, United States.

出版信息

Urol J. 2017 Jan 18;14(1):2955-2960.

Abstract

PURPOSE

To assess and compare the surgical, oncological and functional outcomes of robotic and open radicalprostatectomy (RP) in patients with history of transurethral resection of prostate (TURP).

MATERIAL AND METHODS

Total of 48 patients with mean ± SD age of 64.5 ± 6.0 years who had undergone TURPprior to RP were included. Thirty-one (64.58%) patients underwent robotic RP (group I) and 17 patients underwentopen RP (group II). Variables evaluated included demographic characteristics, perioperative complications, functionaland oncological outcomes. Biochemical recurrence (BCR) was defined as a detectable level of serum PSAafter RP. Continence was defined as being pad free and potency as erection with or without medication enough forpenetration.

RESULTS

All patients had undetectable PSA after RP. Four patients (12.9%) from group I and 2 patients (11.8%)from group II had positive margins (P = .9). The rates of continence were 70% and 80.81% for group I and groupII respectively (P = .47). Potency rate was 68.2% in group I and 46.1% in group II (P =. 31). The PSA value at thelast follow-up was undetectable except in 2 patients who had PSA values of 0.2 and 1ng/mL respectively.

CONCLUSION

Robotic or open RP can be performed safely and effectively after TURP without compromising theoncological results. The outcomes of robotic RP are comparable to that of open RP. The patients who undergorobotic or open RP should be informed about increased likelihood of intra operative complications and worse postoperative functional outcomes with respect to continence and erectile function.

摘要

目的

评估并比较经尿道前列腺切除术(TURP)史患者行机器人辅助根治性前列腺切除术(RP)与开放性根治性前列腺切除术(RP)的手术、肿瘤学及功能学结果。

材料与方法

纳入48例平均年龄(64.5 ± 6.0岁)且在RP术前已接受TURP的患者。31例(64.58%)患者接受机器人辅助RP(I组),17例患者接受开放性RP(II组)。评估的变量包括人口统计学特征、围手术期并发症、功能学及肿瘤学结果。生化复发(BCR)定义为RP术后血清PSA可检测水平。控尿定义为无需使用尿垫,勃起功能定义为无论是否使用药物辅助均能勃起并足以完成性交。

结果

所有患者RP术后PSA均不可检测。I组4例(12.9%)患者和II组2例(11.8%)患者切缘阳性(P = 0.9)。I组和II组的控尿率分别为70%和80.81%(P = 0.47)。I组勃起功能恢复率为68.2%,II组为46.1%(P = 0.31)。除2例患者PSA值分别为0.2和1 ng/mL外,末次随访时PSA值均不可检测。

结论

TURP术后行机器人辅助或开放性RP均可安全有效地进行,且不影响肿瘤学结果。机器人辅助RP的结果与开放性RP相当。应告知接受机器人辅助或开放性RP的患者,术中并发症增加以及术后控尿和勃起功能方面功能学结果较差的可能性。

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