Zhou Jia-Quan, Xu Cong-Jie, Liu Shuan, Kang Xin-Li, Wang Yang
Department of Urology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.
Transl Androl Urol. 2023 Feb 28;12(2):300-307. doi: 10.21037/tau-23-26. Epub 2023 Feb 15.
Suspected localized prostate cancer (PCa) patients with dysuria Complete intrafascial prostatectomy (CIP) can remove the whole prostate gland with the maximal retain of adjacent normal tissues around the prostate, and can be applied in some suspected localized prostate cancer (PCa) patients with dysuria. However, precious few studies have assessed the efficacy and safety of CIP in these patients without preoperative needle biopsies.
In this retrospective single-arm cohort study, all 22 suspected PCa patients with dysuria who underwent CIP at our hospital were enrolled. The clinical data including age, prostate-specific antigen (PSA), free-serum PSA, prostate volume, perioperative and postoperative complications were collected. The PSA level at 6 weeks after CIP and recoveries of urinary continence and erectile function were acquired in the follow-up procedures, and were used as the main measurements of efficacy and safety for CIP respectively.
The patients had an average age of 71.91±8.29 years and an average preoperative PSA level of 10.75±4.25 ng/mL. The operations for all 22 patients were successfully completed. The average operation time was 135.20±41.44 min (range, 40.0-215.0 min), and the average blood loss volume was 128.64±145.09 mL. In total, 17 patients (77.27%) had PCa confirmed by postoperative pathology, and 5 patients (22.73%) had benign prostatic hyperplasia. The PSA level dropped to 0.010±0.004 ng/mL at 6 weeks after surgery. According to the loose criteria to assess urinary incontinence, the patients achieved continence rates of 63.6% immediately after the operation, 95.5% at 1 month, and 100% at 3 months. According to the strict criteria, the continence rates immediately, and at 1, 3, 6, and 9 months after surgery were 27.3%, 63.6%, 90.9%, 95.5%, and 100%, respectively. None of the patients complained of urinary obstruction symptoms after surgery. Before CIP, all the patients had erectile dysfunction and an International Index of Erectile Function 5 (IIEF-5) score of 9.64±5.91. After surgery, the patients had IIEF-5 scores at 3, 6, and 12 months of 5.45±4.43, 6.95±5.30, and 7.57±5.69, respectively.
Although the study had some limitations, CIP may be a prudent option for patients with suspected localized PCa who also present with dysuria.
怀疑患有局限性前列腺癌（PCa）且伴有排尿困难的患者 完全筋膜内前列腺切除术（CIP）可以切除整个前列腺腺体，同时最大程度地保留前列腺周围的相邻正常组织，并且可应用于一些怀疑患有局限性前列腺癌（PCa）且伴有排尿困难的患者。然而，极少有研究评估在这些未经术前穿刺活检的患者中CIP的疗效和安全性。
在这项回顾性单臂队列研究中，纳入了我院所有22例接受CIP的怀疑患有PCa且伴有排尿困难的患者。收集了包括年龄、前列腺特异性抗原（PSA）、游离血清PSA、前列腺体积、围手术期和术后并发症等临床数据。在随访过程中获取了CIP术后6周时的PSA水平以及尿失禁和勃起功能的恢复情况，并分别将其用作评估CIP疗效和安全性的主要指标。
患者的平均年龄为71.91±8.29岁，术前平均PSA水平为10.75±4.25 ng/mL。所有22例患者的手术均成功完成。平均手术时间为135.20±41.44分钟（范围为40.0 - 215.0分钟），平均失血量为128.64±145.09 mL。总共有17例患者（77.27%）术后病理确诊为PCa，5例患者（22.73%）为良性前列腺增生。术后6周时PSA水平降至0.010±0.004 ng/mL。根据评估尿失禁的宽松标准，患者术后即刻的控尿率为63.6%，1个月时为95.5%，3个月时为100%。根据严格标准，术后即刻、1、3、6和9个月时的控尿率分别为27.3%、63.6%、90.9%、95.5%和100%。所有患者术后均未抱怨有尿路梗阻症状。在CIP术前，所有患者均有勃起功能障碍，国际勃起功能指数5（IIEF - 5）评分为9.64±5.91。术后，患者在3、6和12个月时的IIEF - 5评分分别为5.45±4.43、6.95±5.30和7.57±5.69。
尽管该研究存在一些局限性，但对于怀疑患有局限性PCa且伴有排尿困难的患者，CIP可能是一个谨慎的选择。
