Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 14068, Republic of Korea.
Sci Rep. 2020 Oct 19;10(1):17595. doi: 10.1038/s41598-020-74513-y.
Various neurovascular bundle-sparing techniques have been introduced to maximize recovery of erectile function after robot-assisted radical prostatectomy (RARP). The clipless intrafascial neurovascular bundle-sparing technique aims to preserve periprostatic structures and neurovascular bundles as much as possible by avoiding clipping of the vascular pedicles. This study reports 1-year functional and oncologic outcomes and postoperative complications in 105 patients with intact preoperative erectile function who underwent a modified clipless intrafascial neurovascular bundle-sparing RARP. Intact erectile function was defined as score ≥ 21 on the Sexual Health Inventory for Men questionnaire or ability to have sexual intercourse. Median follow-up was 26.5 months (IQR 15.25-48). Postoperative erectile function recovery rates were 71.4%, 81.9%, 88.6%, 92.4%, and 94.3% at 1, 3, 6, 9, and 12 months, respectively. The rate of positive surgical margins was 16.2% overall and 11.8% in patients with stage pT2 disease. The biochemical recurrence rate was 6.7% overall. The modified clipless intrafascial neurovascular bundle-sparing technique is safe and feasible and can achieve excellent recovery of erectile function after RARP. Further large-scale prospective comparative studies are warranted.
各种保留神经血管束的技术已被引入，以最大限度地恢复机器人辅助根治性前列腺切除术（RARP）后的勃起功能。无夹结扎筋膜内神经血管束保留技术旨在通过避免血管蒂夹闭来尽可能保留前列腺周围结构和神经血管束。本研究报告了 105 例术前勃起功能完整的患者接受改良无夹结扎筋膜内神经血管束保留 RARP 的 1 年功能和肿瘤学结果以及术后并发症。完整的勃起功能定义为男性性健康问卷（SHIM）评分≥21 分或有性交能力。中位随访时间为 26.5 个月（IQR15.25-48）。术后 1、3、6、9 和 12 个月勃起功能恢复率分别为 71.4%、81.9%、88.6%、92.4%和 94.3%。总的切缘阳性率为 16.2%，pT2 期患者为 11.8%。总的生化复发率为 6.7%。改良无夹结扎筋膜内神经血管束保留技术是安全可行的，可实现 RARP 后勃起功能的良好恢复。需要进一步进行大规模前瞻性对比研究。
