Siltari Aino, Riikonen Jarno, Murtola Teemu J
Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Pharmacology, University of Helsinki, Faculty of Medicine, Helsinki, Finland.
Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; TAYS Cancer Center, Department of Urology, Tampere, Finland.
J Sex Med. 2021 Feb;18(2):327-338. doi: 10.1016/j.jsxm.2020.11.003. Epub 2020 Dec 23.
Urinary incontinence and sexual dysfunction are common after robot-assisted radical prostatectomy (RALP). New surgical techniques to improve these functions after the operation are under evaluation for example, preservation of endopelvic fascia during RALP. However, the benefits of this technique have not been critically scrutinized in a randomized setting.
In this study, we compared endopelvic fascia preserving operation with the standard surgical procedure in a randomized trial at the Tampere University Hospital, Finland.
A total of 158 men with localized prostate cancer and scheduled for RALP were randomized 1:1 into endopelvic fascia-preserving RALP or a control group that is, standard operation. All operations were performed by a single surgeon.
Urinary and sexual function were evaluated by the Expanded Prostate Cancer Index Composite-26 questionnaire at baseline and 3, 6, and 12 months after the surgery.
There was no difference in urinary incontinence or sexual function between the groups at any time point (urinary incontinence domain at 12 months after RALP for fascia preserving and control group 73.6 ± 3 vs 78.9 ± 2.5 and sexual domain 43 ± 3.2 vs 40.3 ± 3, respectively). Clinical and pathologic tumor characteristics, duration of surgery, blood loss, rate of complications, and time to hospital discharge were similar between the study arms. Compliance of filling out the Expanded Prostate Cancer Index Composite-26 questionnaire varied from 91% to 98%, with no difference between study arms.
Based on our results, endopelvic fascia preservation alone during RALP is not recommended over the standard surgical method.
STRENGTHS & LIMITATIONS: This is a randomized clinical study with sufficient statistical power. As a limitation, only a minority of participants underwent magnetic resonance imaging before the operation, thus we could not evaluate the role of urethral length or shape of the prostate. Urinary and sexual function results are based on questionnaires filled out by the patients, however, participants completed the surveys independently unassisted by health care personnel.
Endopelvic fascia-preserving RALP does not improve urinary continence or sexual function as compared with the standard surgical technique. Future studies aiming to improve functional outcomes after RALP should focus on evaluating other technique modifications. Siltari A, Riikonen J, Murtola TJ. Preservation of Endopelvic Fascia: Effects on Postoperative Incontinence and Sexual Function - A Randomized Clinical Trial. J Sex Med 2021;18:327-338.
机器人辅助根治性前列腺切除术（RALP）后尿失禁和性功能障碍很常见。目前正在评估改善术后这些功能的新手术技术，例如，RALP期间保留盆腔内筋膜。然而，在随机对照研究中，尚未对该技术的益处进行严格审查。
在本研究中，我们在芬兰坦佩雷大学医院进行的一项随机试验中，比较了保留盆腔内筋膜手术与标准手术方法。
总共158例患有局限性前列腺癌且计划进行RALP的男性被1:1随机分为保留盆腔内筋膜的RALP组或对照组，即标准手术组。所有手术均由一名外科医生进行。
在任何时间点，两组之间的尿失禁或性功能均无差异（RALP术后12个月，保留筋膜组和对照组的尿失禁领域分别为73.6±3和78.9±2.5，性功能领域分别为43±3.2和40.3±3）。研究组之间的临床和病理肿瘤特征、手术持续时间、失血量、并发症发生率及出院时间相似。填写《扩展前列腺癌指数综合-26问卷》的依从率在91%至98%之间，研究组之间无差异。
根据我们的结果，不建议在RALP期间单独保留盆腔内筋膜，而应采用标准手术方法。
这是一项具有足够统计效力的随机临床研究。作为局限性，只有少数参与者在手术前接受了磁共振成像检查，因此我们无法评估尿道长度或前列腺形状的作用。尿失禁和性功能结果基于患者填写的问卷，然而，参与者是在没有医护人员协助的情况下独立完成调查的。
与标准手术技术相比，保留盆腔内筋膜的RALP并不能改善尿失禁或性功能。未来旨在改善RALP后功能结局的研究应侧重于评估其他技术改进。西尔塔里A，里科宁J，穆尔托拉TJ。保留盆腔内筋膜：对术后尿失禁和性功能的影响——一项随机临床试验。《性医学杂志》2021年；18:327-33
