Hospital Universitari de Bellvitge, Barcelona, Spain.
Global Robotic Institute, Florida Hospital, Celebration, FL, USA.
BJU Int. 2018 Nov;122(5):837-844. doi: 10.1111/bju.14517. Epub 2018 Sep 14.
To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP).
In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan-Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF).
The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033).
Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.
展示在挽救性机器人辅助根治性前列腺切除术（RARP）中保留神经血管束（NVB）的可行性、肿瘤学和功能结果。
在本机构审查委员会批准的回顾性分析中，2008 年 1 月至 2016 年 3 月期间，80 名患者因初次治疗后局部复发而接受了挽救性 RARP，由一位外科医生（V.P.）进行。这些患者根据神经保留程度（NS）分为两组：良好 NS 组（保留 NVB 的≥50%）和不良 NS 组（保留 NVB 的<50%）。使用标准的经腹六孔技术，使用达芬奇手术系统（直觉外科公司，加利福尼亚州森尼韦尔），采用顺行或逆行方法进行 NVB 保留。术前使用经过验证的问卷（男性性健康问卷 [SHIM] 和美国泌尿外科学会评分）。挽救性 RARP 后的勃起功能定义为能够成功勃起且勃起时间超过 50%的次数，而挽救性 RARP 后的完全控尿定义为使用 0 个尿垫。使用 Kaplan-Meier 方法进行生存和预测估计，回归模型用于识别勃起功能、控尿和生化失败（BCF）的预测因子。
无论先前的 SHIM 评分如何，良好 NS 组在 12 个月时的勃起功能恢复率更高（25.6%比 4.3%；P=0.036），良好 NS 倾向于预测挽救性 RARP 后的勃起功能（P=0.065）。两组的完全控尿率和 BCF 率相似，非放疗原发性治疗是挽救性 RARP 后 12 个月控尿的唯一预测因子（P=0.033）。
我们的数据支持在高容量机构中为选择性患者进行挽救性 RARP 中保留 NVB 的可行性和安全性，以及随后对足够勃起进行适当性交的恢复。
