Görgen Antônio Rebello Horta, Burttet Lucas Medeiros, Cachoeira Eduardo Tosetto, Knijnik Pedro Glusman, Brum Pietro Waltrick, de Oliveira Paludo Artur, Cabral Renan Desimon, Rosito Tiago Elias, Berger Milton, Pavlovich Christian Paul, Neto Brasil Silva
Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Bairro Santa Cecília, Porto Alegre, RS, Brazil.
Programa de Pós-Graduação em Ciências Cirúrgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
World J Urol. 2022 Dec;40(12):2925-2930. doi: 10.1007/s00345-022-04196-9. Epub 2022 Oct 25.
To evaluate the neurovascular bundle preservation grades during robotic-assisted radical prostatectomy and compared to the trifecta combined outcome (oncologic control, continence, and sexual function) twelve months after the surgery.
Cohort of patients who underwent nerve-sparing robotic-assisted radical prostatectomy had the neurovascular bundle preservation retrospectively graded from 0 to 8 according to the Hopkins subjective visual classification. Patients then were divided into two groups, according to the median of nerve-sparing grading: those with score six or high and those with score less than six. Main outcome was the trifecta combined outcome and secondary outcomes was the individual trifecta criteria (prospective analysis). A secondary analysis with groups divided according to pre-operatory SHIM score was made.
One hundred robotic-assisted nerve-sparing radical prostatectomy were performed, of which 83 were included. There were 53 patients with grading greater than or equal to six (group 1) and 30 patients less than six (group 2). 66.6% patients (35/53) in group 1 had a trifecta combined outcome of compared to 33.3% (10/30) in group 2 (p = 0.017). Individually, the erectile function was higher in group 1 (73.6%) compared to group 2 (46.7%) (p = 0.014). Both the results of the combined endpoint trifecta and erection were also maintained in the group with preoperative SHIM ≥ 17.
The grading of preservation of the neurovascular bundle in radical prostatectomy is related to a better combined trifecta outcome one year after surgery.
评估机器人辅助根治性前列腺切除术中神经血管束的保留等级，并与术后十二个月的三联成功综合结果（肿瘤控制、控尿和性功能）进行比较。
对接受保留神经的机器人辅助根治性前列腺切除术的患者队列，根据霍普金斯主观视觉分类法将神经血管束保留情况进行回顾性分级，从0到8级。然后根据保留神经分级的中位数将患者分为两组：评分6分及以上者和评分低于6分者。主要结局是三联成功综合结果，次要结局是各个三联成功标准（前瞻性分析）。还根据术前性功能国际指数（SHIM）评分进行了分组的二次分析。
共进行了100例机器人辅助保留神经的根治性前列腺切除术，其中83例被纳入研究。有53例患者分级大于或等于6分（第1组），30例患者低于6分（第2组）。第1组66.6%的患者（35/53）获得了三联成功综合结果，而第2组为33.3%（10/30）（p = 0.017）。单独来看，第1组的勃起功能（73.6%）高于第2组（46.7%）（p = 0.014）。术前SHIM≥17的组中，三联成功综合终点和勃起功能的结果也都得到了维持。
根治性前列腺切除术中神经血管束的保留分级与术后一年更好的三联成功综合结果相关。
