Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands; Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands.
Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
Eur Urol Focus. 2023 Sep;9(5):824-831. doi: 10.1016/j.euf.2023.03.021. Epub 2023 Apr 7.
Nerve-sparing (NS) radical prostatectomy (RP) results in better functional outcomes. Intraoperative neurovascular structure-adjacent frozen section examination (NeuroSAFE) significantly increases the frequency of NS surgery. The effect of NeuroSAFE on postoperative erectile function (EF) and continence is not yet clear.
To describe EF and continence outcomes for men undergoing RP with the NeuroSAFE technique.
DESIGN, SETTING, AND PARTICIPANTS: Between September 2018 and February 2021, 1034 men underwent robot-assisted RP. Data for patient-reported outcomes were collected via validated questionnaires.
NeuroSAFE technique for RP.
Continence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) or Expanded Prostate Cancer Index Composite short form (EPIC-26) and defined as use of 0-1 pads/d. EF was evaluated using EPIC-26 or the International Index of Erectile Function short form (IIEF-5), with data converted according to the Vertosick method and categorized. Descriptive statistics were used to asses and describe tumor characteristics and continence and EF outcomes.
Of the 1034 men who underwent RP after introduction of the NeuroSAFE technique, 63% and 60% completed a preoperative and at least one postoperative questionnaire on continence and EF, respectively. Of the men who underwent unilateral or bilateral NS surgery, use of 0-1 pads/d was reported by 93% after 1 yr and 96% after 2 yr; the corresponding rates for men who underwent non-NS surgery were 86% and 78%. Overall, use of 0-1 pads/d was reported by 92% of the men at 1 yr and by 94% at 2 yr after RP. Men in the NS group had a good or intermediate Vertosick score after RP more often than the non-NS group. Overall, 44% of the men had a good or intermediate Vertosick score at 1 and 2 yr after RP.
After introduction of the NeuroSAFE technique, the continence rate was 92% at 1 yr and 94% at 2 yr after RP. The NS group had a greater percentage of men with an intermediate or good Vertosick score and a higher continence rate after RP in comparison to the non-NS group.
Our study shows that after introduction of the NeuroSAFE technique during removal of the prostate, the continence rate among patients was 92% at 1 year and 94% at 2 years after surgery. Some 44% of the men had a good or intermediate score for erectile function 1 and 2 years after surgery.
保留神经的（NS）根治性前列腺切除术（RP）可获得更好的功能结果。术中神经血管结构毗邻冷冻切片检查（NeuroSAFE）显著增加了 NS 手术的频率。NeuroSAFE 对术后勃起功能（EF）和控尿的影响尚不清楚。
描述接受 NeuroSAFE 技术的 RP 患者的 EF 和控尿结果。
设计、地点和参与者：2018 年 9 月至 2021 年 2 月，1034 名男性接受了机器人辅助 RP。通过经过验证的问卷收集患者报告的结果数据。
用于 RP 的 NeuroSAFE 技术。
使用国际尿失禁咨询问卷-尿失禁简短表（ICIQ-UI SF）或前列腺癌指数综合量表扩展形式（EPIC-26）评估控尿情况，并定义为使用 0-1 个尿垫/d。EF 使用 EPIC-26 或国际勃起功能指数简短表（IIEF-5）进行评估，数据根据 Vertosick 方法转换并分类。使用描述性统计来评估和描述肿瘤特征以及控尿和 EF 结果。
在引入 NeuroSAFE 技术后接受 RP 的 1034 名男性中，分别有 63%和 60%的男性在术前和至少一次术后完成了控尿和 EF 的问卷。在接受单侧或双侧 NS 手术的男性中，1 年后报告使用 0-1 个尿垫/d 的比例分别为 93%和 96%；而接受非 NS 手术的男性这一比例分别为 86%和 78%。总体而言，1 年后有 92%的男性和 2 年后有 94%的男性报告使用 0-1 个尿垫/d。接受 NS 手术的男性在 RP 后比非 NS 手术组更常获得良好或中等的 Vertosick 评分。总体而言，在 RP 后 1 年和 2 年，44%的男性获得了良好或中等的 Vertosick 评分。
在引入 NeuroSAFE 技术后，RP 后 1 年的控尿率为 92%，2 年的控尿率为 94%。与非 NS 组相比，NS 组在 RP 后有更多的男性具有中等或良好的 Vertosick 评分和更高的控尿率。
我们的研究表明，在前列腺切除术中引入 NeuroSAFE 技术后，患者的控尿率在术后 1 年为 92%，2 年为 94%。1 年和 2 年后，约有 44%的男性勃起功能获得良好或中等评分。
