Larkin Health System, Miami, FL, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Robot Surg. 2023 Aug;17(4):1525-1530. doi: 10.1007/s11701-023-01548-4. Epub 2023 Mar 3.
Penile shortening is a recognized but neglected side effect of prostate cancer treatment. In this study we explore the effect of maximal urethral length preservation (MULP) technique on penile length preservation after robot assisted laparoscopic prostatectomy (RALP). In an IRB approved study, we prospectively evaluated the stretched flaccid penile length (SFPL) pre and post RALP in subjects with a diagnosis of prostate cancer. The multiparametric MRI (MP-MRI) was utilized for surgical planning if available preoperatively. Repeated measures t-test, linear regression and 2-way ANOVA analyses were performed. A total of 35 subjects underwent RALP. Mean age was 65.8 yr (SD: 5.9), preoperative SFPL was 15.57 cm (SD: 1.66) and postoperative SFPL was 15.41 cm (SD: 1.61) p = 0.68. No change in the postoperative SFPL was recorded among 27 subjects (77.1%) while 5 subjects (14.3%) had 0.5 cm shortening, and 3 subjects (8.6%) had 1 cm shortening. Pathologic stage, preoperative MP-MRI and body mass index (BMI) were significant predictors of postoperative SFPL on linear regression analysis, p = 0.001. Among 26 subjects with pathologic stage 2 disease, no statistical difference was seen in repeated measures t-test between pre and postoperative SFPL, 15.36 vs 15.3 cm, p = 0.08. All subjects were continent by 6 months postoperatively, with no complications. We demonstrate that incorporating MULP technique and preoperative MP-MRI preserves SFPL in subjects undergoing a RALP.
阴茎缩短是前列腺癌治疗中一种公认但被忽视的副作用。在这项研究中，我们探讨了最大尿道长度保留（MULP）技术对机器人辅助腹腔镜前列腺切除术（RALP）后阴茎长度保留的影响。在一项经过机构审查委员会批准的研究中，我们前瞻性评估了诊断为前列腺癌的患者 RALP 前后的伸展松弛阴茎长度（SFPL）。如果术前有条件，使用多参数 MRI（MP-MRI）进行手术规划。进行重复测量 t 检验、线性回归和 2 路方差分析。共有 35 名患者接受了 RALP。平均年龄为 65.8 岁（标准差：5.9），术前 SFPL 为 15.57cm（标准差：1.66），术后 SFPL 为 15.41cm（标准差：1.61），p=0.68。27 名患者（77.1%）术后 SFPL 无变化，5 名患者（14.3%）缩短 0.5cm，3 名患者（8.6%）缩短 1cm。线性回归分析显示，术后 SFPL 的病理分期、术前 MP-MRI 和体重指数（BMI）是显著预测因素，p=0.001。在 26 名病理分期为 2 期的患者中，重复测量 t 检验显示术前和术后 SFPL 无统计学差异，分别为 15.36cm 和 15.3cm，p=0.08。所有患者术后 6 个月均保持控尿，无并发症。我们证明，在接受 RALP 的患者中，采用 MULP 技术和术前 MP-MRI 可保留 SFPL。
