Gianduzzo Troy Richard John, Dundee Philip Ellard
The Wesley Hospital Brisbane Australia.
The University of Melbourne Melbourne Australia.
BJUI Compass. 2025 Feb 4;6(2):e489. doi: 10.1002/bco2.489. eCollection 2025 Feb.
The objective of this study is to report the first multi-centred Australian series of 200 cases of Retzius-sparing radical prostatectomy (RSRP).
Between April 2017 and June 2024, 200 RSRP procedures (197 robotic, three laparoscopic) were performed separately by the authors in five centres across two Australian cities (Melbourne, Victoria and Brisbane, Queensland). Data were collected prospectively with ethics committee approval (UCH-HREC 2019.01.279) at weeks 1, 4-6, and three-monthly. Exclusion criteria included prostate size >80 cc, significant middle lobe, large anterior tumour, previous TURP or any clinical factor deemed to make RSRP unsuitable. These criteria were relaxed as experience was gained.
Median (interquartile range) age, body mass index and PSA were 65 (60-70) years, 26 (25-29) kg/m and 5.2 (4.0-7.0) ng/mL. Low, intermediate and high D'Amico risk groups were 3.5%, 75.0% and 21.5%, respectively. Median (interquartile range) skin-to-skin operative time was 163 (125-210) min and blood loss 200 (100-350) mL. There were 17 (8.5%) Clavien-Dindo grade 1-2 complications and 8 (4%) grade 3 complications. Final pT stage was 60.5% pT2 and 39.5% pT3. The overall positive surgical margins (PSM) rate was 14.5% including 3.3% pT2 and 29.1% pT3. At 1 week post catheter removal 53.5% were pad-free, increasing to 58.5% and 65.0% at 4 and 6 weeks, then 79.5%, 84.6%, 88.2% and 91.3% at 3, 6, 9 and 12 months, respectively. When a security pad is included, 71.5% and 85.5% of men were continent at 4 and 6 weeks, then 94%, 96%, 96% and 97% at 3, 6, 9 and 12 months, respectively. Three men required a suburethral sling and one an artificial urinary sphincter. Ninety of 140 (60.4%) preoperatively potent men were potent at 12 months with or without phosphodiesterase-5 inhibitors.
RSRP provides excellent early continence and can be introduced safely with good oncological results by experienced minimally- invasive surgeons.
本研究的目的是报告澳大利亚首个多中心的200例保留雷兹ius间隙的根治性前列腺切除术（RSRP）病例系列。
2017年4月至2024年6月期间，作者在澳大利亚两个城市（维多利亚州墨尔本和昆士兰州布里斯班）的五个中心分别进行了200例RSRP手术（197例机器人手术，3例腹腔镜手术）。在伦理委员会批准（UCH - HREC 2019.01.279）下，于第1周、4 - 6周及之后每三个月前瞻性收集数据。排除标准包括前列腺体积>80 cc、显著中叶、较大前部肿瘤、既往经尿道前列腺切除术（TURP）或任何被认为使RSRP不适合的临床因素。随着经验积累，这些标准有所放宽。
年龄、体重指数和前列腺特异性抗原（PSA）的中位数（四分位间距）分别为65（60 - 70）岁、26（25 - 29）kg/m²和5.2（4.0 - 7.0）ng/mL。低、中、高D'Amico风险组分别为3.5%、75.0%和21.5%。皮肤到皮肤的手术时间中位数（四分位间距）为163（125 - 210）分钟，失血量为200（100 - 350）mL。有17例（8.5%）Clavien - Dindo 1 - 2级并发症和8例（4%）3级并发症。最终pT分期为pT2占60.5%，pT3占39.5%。总体手术切缘阳性（PSM）率为14.5%，其中pT2为3.3%，pT3为29.1%。拔除导尿管后1周，53.5%的患者无需使用尿垫，4周和6周时分别增至58.5%和65.0%，3个月、6个月、9个月和12个月时分别为79.5%、84.6%、88.2%和91.3%。若包括安全尿垫，4周和6周时分别有71.5%和85.5%的男性控尿，3个月、6个月、9个月和12个月时分别为94%、96%、96%和97%。3名男性需要尿道下悬带，1名需要人工尿道括约肌。140例术前有性功能的男性中，90例（60.4%）在12个月时无论是否使用磷酸二酯酶5抑制剂仍有性功能。
RSRP能实现良好的早期控尿，经验丰富的微创外科医生可安全开展该手术，且肿瘤学效果良好。
