Zhu Zaisheng, Zhu Yiyi, Shi Hongqi, Zhou Penfei, Xue Yadong, Hu Shengye
Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China.
Department of Endocrinology, Affiliated Second Hospital to Zhejiang University School of Medicine, Hangzhou, China.
Int Neurourol J. 2024 Dec;28(4):270-277. doi: 10.5213/inj.2448348.174. Epub 2024 Dec 31.
This study aimed to compare and analyze the feasibility and long-term efficacy of prostatic capsule-sparing (PCS) and nerve-sparing (NS) radical cystectomy in the treatment of bladder cancer.
From June 2004 to December 2021, our institution treated and followed 145 patients who underwent radical cystectomy with neobladder reconstruction for over a year. These patients were divided into 2 groups: PCS (n=74) and NS (n=71). To minimize potential biases, 1:1 propensity score matching was utilized to compare oncological outcomes, functional outcomes, and complications between the groups. Additionally, Kaplan-Meier analysis and the log-rank test were used to evaluate survival differences between the PCS and NS groups.
The median follow-up durations for PCS and NS were 155 and 122 months, respectively. After adjusting for propensity scores, a total of 96 patients (48 in each group) were included for further analysis. Kaplan-Meier curves showed no statistically significant differences in metastasis-free probability (P=0.206), cancer-specific survival (P=0.091), and overall survival (P=0.208). The daytime urinary control (UC) rate at 3, 6, and 12 months postoperatively was 72.9%, 91.7%, and 97.9% in the PCS group and 47.9%, 79.2%, and 91.7% in the NS group, respectively (P=0.012, P=0.083, and P=0.362). The nocturnal UC rate was 54.2%, 85.4%, and 95.8% in the PCS group, and 31.3%, 60.4%, and 83.3% in the NS group, respectively (P=0.023, P=0.006, and P=0.091). Regarding erectile function recovery, 62.5% of patients in the PCS group and 22.9% in the NS group returned to preoperative levels (P<0.001).
PCS outperformed NS in restoring UC and sexual function and did not affect oncological outcomes. However, PCS was associated with a higher risk of complications linked to bladder-neck obstruction.
本研究旨在比较和分析保留前列腺包膜（PCS）和保留神经（NS）的根治性膀胱切除术治疗膀胱癌的可行性和长期疗效。
2004年6月至2021年12月，我院对145例行根治性膀胱切除术并进行新膀胱重建且随访超过一年的患者进行了治疗和随访。这些患者分为两组：PCS组（n = 74）和NS组（n = 71）。为尽量减少潜在偏倚，采用1:1倾向评分匹配法比较两组之间的肿瘤学结局、功能结局和并发症。此外，采用Kaplan-Meier分析和对数秩检验评估PCS组和NS组之间的生存差异。
PCS组和NS组的中位随访时间分别为155个月和122个月。在调整倾向评分后，共纳入96例患者（每组48例）进行进一步分析。Kaplan-Meier曲线显示，无转移概率（P = 0.206）、癌症特异性生存（P = 0.091）和总生存（P = 0.208）方面无统计学显著差异。PCS组术后3、6和12个月的日间尿控（UC）率分别为72.9%、91.7%和97.9%，NS组分别为47.9%、79.2%和91.7%（P = 0.012、P = 0.083和P = 0.362）。PCS组夜间UC率分别为54.2%、85.4%和95.8%，NS组分别为31.3%、60.4%和83.3%（P = 0.023、P = 0.006和P = 0.091）。关于勃起功能恢复，PCS组62.5%的患者和NS组22.9%的患者恢复到术前水平（P < 0.001）。
PCS在恢复尿控和性功能方面优于NS，且不影响肿瘤学结局。然而，PCS与膀胱颈梗阻相关并发症的风险较高有关。
