Glybochko P V, Alyaev Yu G, Rapoport L M, Grigorev N A, Bezrukov E A, Tsarichenko D G, Sirota E S, Martirosyan G A
Research Institute for Uronephrology and Human Reproductive Health, I.M. Sechenov First MSMU, Moscow, Russia.
Department of Urology, I.M. Sechenov First MSMU, Moscow, Russia.
Urologiia. 2017 Apr(1):43-49. doi: 10.18565/urol.2017.1.43-49.
Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients psycho-emotional status reducing the quality of life and treatment satisfaction.
To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period.
The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to DAmico risk classification.
Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence.
Waterjet dissection of NVB significantly improves patients postoperative quality of life due to early recovery of urinary continence and EF.
根治性前列腺切除术后的勃起功能障碍（ED）和尿失禁（UI）对患者的心理情绪状态产生不利影响，降低了生活质量和治疗满意度。
调查保留神经的耻骨后根治性前列腺切除术（NS-RRP）和保留神经的腹腔镜根治性前列腺切除术（NS-LRP）术后早期恢复控尿和勃起功能（EF）的比例。
该研究纳入了116名保持性活动和性行为能力的患者。64名患者接受了标准的神经血管束（NVB）切除术（34例行RRP，30例行LRP），52名患者使用水刀分离器（WD）进行NVB切除术（30例行RRP，22例行LRP）。所有手术均由一名具有超过350例RRP和150例LRP经验的外科医生进行。根据达米科风险分类，研究患者患有低、中度风险的前列腺癌。
我们的研究结果表明，接受NVB水刀分离术的患者在术后8周时IIEF-5评分显著高于标准NS-RP术后（高出2.8分）。随访6个月后，评分增加了3.5分。接受NS-RP + WD的患者在术后3个月实现了成功性交（无论是否使用PDE5抑制剂）。在接受标准NS-RP的患者组中，实现成功性交所需时间更长。接受NS-RP + WD的患者中有67%在拔除尿道导管后1个月随访时完全控尿，而接受标准NS-RP治疗的大多数患者（41%）有轻度压力性尿失禁。随访3个月后，接受NS-RP + WD的患者中只有1名患者有轻度压力性尿失禁，绝大多数患者（95%）完全控尿。在拔除尿道导管6个月后，两组在恢复尿控方面无显著差异。
NVB水刀分离术由于能早期恢复尿控和EF，显著改善了患者术后的生活质量。
