Galfano Antonio, Panarello Daniele, Secco Silvia, Di Trapani Dario, Barbieri Michele, Napoli Giancarlo, Strada Elena, Petralia Giovanni, Bocciardi Aldo M
Unit of Urology, ASST Niguarda Hospital, Milan, Italy -
Department of Urology, University of Genoa, Genoa, Italy.
Minerva Urol Nefrol. 2018 Aug;70(4):408-413. doi: 10.23736/S0393-2249.18.03069-2. Epub 2018 Mar 28.
The objective of our study is to evaluate the effect of prostatic volume on the outcomes of Retzius-sparing robot-assisted radical prostatectomy (RSP).
All the consecutive patients undergoing RSP up to January 2015 were included. The series was divided into three groups based on prostate weight at radical prostatectomy specimen (<40 g, 40-60 g, >60 g). Perioperative, oncological and functional data were prospectively recorded. Potency was defined as erections sufficient for penetration; continence as no pad or one safety liner. Oncological results were reported as positive surgical margins (PSMs) and 1-year biochemical disease-free survival (PSA<0.2 ng/mL).
We evaluated 750 patients (366 with <40 g prostates, 272 with 40-60 g prostates, 112 with >60 g prostates). Median follow-up was 22 months; PSA was higher in larger prostates (6.6 vs. 6.8 vs. 8 ng/mL). Nerve-sparing and bladder-neck sparing procedures were in similar percentages. Larger prostates required longer surgeries (90 vs. 100 vs. 100 minutes, P=0.002). Perioperative results were similar (blood loss, discharge, complications, catheter removal). Larger prostates had more frequently localized disease (pT2 in 49.5% vs. 60.7% vs. 68.5%; P=0.001); PSMs were similar both in pT2 (15.5% vs. 9.4% vs. 11.8%) and in pT3 cases (40.1% vs. 42% vs. 34%). In the three study groups, immediate continence was reached by 88%, 89.5% and 81.3% (P=0.045), while no differences were observed concerning continence (93.4%, 94.1%, 94.7%; P=0.892) or potency after follow-up.
RSP is feasible in patients with prostates of any volume, with similar oncological and functional outcomes. Despite being inferior to the figures obtained in low volume prostates, the very high immediate continence rates observed in larger prostates encourage the use of this approach also in larger prostates.
我们研究的目的是评估前列腺体积对保留Retzius间隙机器人辅助根治性前列腺切除术（RSP）结果的影响。
纳入截至2015年1月所有连续接受RSP的患者。根据根治性前列腺切除标本的前列腺重量将该系列分为三组（<40克、40 - 60克、>60克）。前瞻性记录围手术期、肿瘤学和功能数据。勃起功能定义为足以进行性交的勃起；控尿功能定义为无需使用尿垫或仅使用一片安全衬垫。肿瘤学结果报告为手术切缘阳性（PSM）和1年无生化疾病生存（PSA<0.2 ng/mL）。
我们评估了750例患者（366例前列腺重量<40克，272例前列腺重量40 - 60克，112例前列腺重量>60克）。中位随访时间为22个月；前列腺体积较大者的PSA水平较高（6.6对6.8对8 ng/mL）。保留神经和保留膀胱颈手术的比例相似。前列腺体积较大者手术时间更长（90对100对100分钟，P = 0.002）。围手术期结果相似（失血、出院情况、并发症、拔除导尿管）。前列腺体积较大者局限性疾病更为常见（pT2期分别为49.5%对60.7%对68.5%；P = 0.001）；pT2期和pT3期病例的PSM相似（分别为15.5%对9.4%对11.8%以及40.1%对42%对34%）。在三个研究组中，即时控尿率分别为88%、89.5%和81.3%（P = 0.045），而随访后的控尿情况（93.4%、94.1%、94.7%；P = 0.892）或勃起功能无差异。
RSP在任何体积前列腺的患者中都是可行的，肿瘤学和功能结果相似。尽管不如小体积前列腺患者的结果，但在大体积前列腺患者中观察到的非常高的即时控尿率鼓励在大体积前列腺患者中也采用这种方法。
