Chen Xinnan, Zhao Kangkang, Wang Hao, Zhang Chengwei, Du Lin, Wang Wendi, Chen Tianyi, Qin Haixiang, Qiu Xuefeng, Guo Hongqian, Zhang Gutian
Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School Nanjing University Nanjing Jiangsu China.
Department of Urology The First People's Hospital of Yancheng Yancheng Jiangsu China.
BJUI Compass. 2024 Jun 6;5(8):776-782. doi: 10.1002/bco2.389. eCollection 2024 Aug.
To detail a novel technique of robotic-assisted simple prostatectomy that makes handling the gland protruding into the bladder neck easier and can preserve the urethra and retain ejaculation function as much as possible.
This is a prospective case series. Clinical data of 17 male patients who had large volume (>80 mL) benign prostatic hyperplasia (BPH) were enrolled to undergo trans-rectovesical pouch urethral-sparing robotic-assisted simple prostatectomy (usRASP). We adopted the approach through the space between the bladder neck and seminal vesicle to perform a usRASP that can avoid the detrusor skirt and fibrous matrix area of the retropubic prostate. Between the transitional zone and the peripheral zone of the large prostate, the hyperplastic prostatic gland tissue can be enucleated under direct vision while preserving the prostatic urethra and retaining the ejaculatory duct and bladder neck intact. All preoperative, perioperative and postoperative clinical data were collected, and descriptive analysis was performed.
The median intravesical prostatic protrusion was 19.3 mm (8.5-32.2). The median operative time was 100 min (75-140), and the median estimated blood loss was 100 mL (10-500). The median time to catheter removal was 7 days (5-7), with a median postoperative hospital stay of 2 days (2-4). After at least 6-month follow-up, the median maximum urine flow rate and postvoid residual volume were 40.1 mL/s (12.7-52.4) and 15 mL (5-23), respectively; the median International Prostate Symptom Score and Quality of Life score were 0 (0-6.3) and 1 (0-3), respectively; and the median total prostate-specific antigen was 0.84 ng/mL (0.15-1.01). All patients successfully underwent usRASP. Fifty-eight percent of patients with normal ejaculation function before surgery can still retain normal ejaculation function.
We described a new approach to performing usRASP. This new method remarkably improved the voiding function, maintained antegrade ejaculation and did not increase the post-operative complications.
详细介绍一种机器人辅助单纯前列腺切除术的新技术，该技术能更轻松地处理突入膀胱颈的腺体，并尽可能保留尿道和射精功能。
这是一个前瞻性病例系列。纳入17例患有大体积（>80 mL）良性前列腺增生（BPH）的男性患者的临床资料，接受经直肠膀胱袋保留尿道机器人辅助单纯前列腺切除术（usRASP）。我们采用经膀胱颈和精囊之间的间隙入路进行usRASP，该方法可避开耻骨后前列腺的逼尿肌裙和纤维基质区域。在大前列腺的移行区和外周区之间，增生的前列腺腺体组织可在直视下摘除，同时保留前列腺尿道，使射精管和膀胱颈保持完整。收集所有术前、术中和术后的临床资料，并进行描述性分析。
膀胱内前列腺突出的中位数为19.3 mm（8.5 - 32.2）。手术时间中位数为100分钟（75 - 140），估计失血量中位数为100 mL（10 - 500）。拔除导尿管的时间中位数为7天（5 - 7），术后住院时间中位数为2天（2 - 4）。至少随访6个月后，最大尿流率和残余尿量的中位数分别为40.1 mL/s（12.7 - 52.4）和15 mL（5 - 23）；国际前列腺症状评分和生活质量评分的中位数分别为0（0 - 6.3）和1（0 - 3）；总前列腺特异性抗原的中位数为0.84 ng/mL（0.15 - 1.01）。所有患者均成功接受usRASP。术前射精功能正常的患者中有58%仍可保留正常射精功能。
我们描述了一种进行usRASP的新方法。这种新方法显著改善了排尿功能，维持了顺行射精，且未增加术后并发症。
