Williams Stephen B, Morales Blanca E, Huynh Linda M, Osann Kathryn, Skarecky Douglas W, Ahlering Thomas E
1 Division of Urology, The University of Texas Medical Branch , Galveston, Texas.
2 Department of Urology, University of California Irvine Health , Orange, California.
J Endourol. 2017 Nov;31(11):1170-1175. doi: 10.1089/end.2017.0542. Epub 2017 Oct 4.
To compare the recovery of erections and potency following the transection of accessory pudendal arteries (APAs) in men undergoing robot-assisted radical prostatectomy (RARP) compared with men with normal vascular anatomy.
A total of 880 consecutive patients who underwent RARP from January 1, 2007 to December 31, 2014 were included with prospectively collected data in cross-sectional analysis. Erectile function (EF) was assessed preoperatively and postoperatively at 3, 6, 12, and 24 months using the International Index of Erectile Function (IIEF)-5, a percent erection fullness compared to preoperative status, and two Expanded Prostate Cancer Index (EPIC) questions: (1) are erections firm enough for penetration and (2) are they satisfactory?
Two hundred thirty-one (33.1%) men had APAs transected. There were no significant differences in baseline demographics or clinical characteristics in men with or without APAs transected. Multivariate analyses demonstrated that age (confidence interval [95% CI]: 0.94, 0.99) and baseline IIEF-5 (95% CI: 1.15, 1.26) strongly correlated with recovery of erections and potency. Transection of APAs was not a significant predictor of erectile dysfunction (ED).
Good surgical technique dictates the preservation of APAs. However, when preservation is questioned, we found that APA transection had no measurable effect on recovery of erections or potency regardless of age, preoperative ED, or number of APAs transected.
比较接受机器人辅助根治性前列腺切除术（RARP）的男性与血管解剖结构正常的男性在切断阴部副动脉（APAs）后勃起功能和性功能的恢复情况。
纳入2007年1月1日至2014年12月31日期间连续接受RARP的880例患者，并对前瞻性收集的数据进行横断面分析。使用国际勃起功能指数（IIEF）-5、与术前状态相比的勃起充盈百分比以及两个扩展前列腺癌指数（EPIC）问题，在术前以及术后3、6、12和24个月评估勃起功能（EF）：（1）勃起硬度是否足以进行性交？（2）勃起是否令人满意？
231例（33.1%）男性的APAs被切断。切断APAs的男性与未切断APAs的男性在基线人口统计学或临床特征方面无显著差异。多变量分析表明，年龄（置信区间[95%CI]：0.94，0.99）和基线IIEF-5（95%CI：1.15，1.26）与勃起功能和性功能的恢复密切相关。APAs的切断不是勃起功能障碍（ED）的显著预测因素。
良好的手术技术要求保留APAs。然而，当保留存在疑问时，我们发现无论年龄、术前ED情况或切断的APAs数量如何，切断APAs对勃起功能或性功能的恢复均无显著影响。
