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经膀胱单孔机器人辅助根治性前列腺切除术后早期控尿和勃起功能恢复:单机构初步经验

Early Continence and Erectile Function Recovery Following Transvesical Single-Port Robot-Assisted Radical Prostatectomy: Initial Single Institution Experience.

作者信息

Ward Brandon L, Zhang Anthony Y, Leapman Michael S, Cavallo Jaime A, Kim Isaac Y

机构信息

Yale School of Medicine, Yale University, New Haven, CT 06492, USA.

School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.

出版信息

Cancers (Basel). 2025 Aug 27;17(17):2793. doi: 10.3390/cancers17172793.

Abstract

: Early recovery of urinary continence and sexual function remains a key focus following radical prostatectomy. The transvesical single-port robot-assisted radical prostatectomy (SP-TV-RARP) approach is a novel technique with very limited evidence that has been suggested to preserve the Retzius space and allow extraperitoneal access through the bladder. We aimed to evaluate early functional and oncologic outcomes following SP-TV-RARP at a single academic institution. : We retrospectively reviewed 21 patients who underwent SP-TV-RARP by a single surgeon between September 2024 and May 2025. Continence is defined as being pad-free, and return of erectile function is defined as having erections sufficient for penetration. Functional and oncologic outcomes were assessed using clinical follow-up documentation and analyzed with Kaplan-Meier analysis. : The median patient age was 65 years, and 52.4% had pT3 disease. Positive surgical margins were observed in 62% overall and 30% in men with organ-confined disease. No intraoperative or 30-day postoperative complications occurred. Approximately 43% of patients achieved continence within one day of urethral catheter removal, with 75% of patients being pad-free at 3 months. Median SHIM and AUA-SS scores did not significantly decline at 3 months compared to baseline. The median time to recovery of erectile function was 69 days, and 67% recovered at the last follow-up. Biochemical recurrence occurred in 2 patients (15.4%) within 6 months. : SP-TV-RARP appears safe and may facilitate early return of urinary continence and erectile function. Although inferior oncologic outcome is a potential concern during early adoption, functional outcomes were favorable. Further prospective evaluation is warranted to confirm long-term oncologic efficacy.

摘要

根治性前列腺切除术后,尿失禁和性功能的早期恢复仍然是关键关注点。经膀胱单孔机器人辅助根治性前列腺切除术(SP-TV-RARP)是一种新技术,相关证据非常有限,该技术被认为可保留Retzius间隙并允许通过膀胱进行腹膜外入路。我们旨在评估在单一学术机构中接受SP-TV-RARP后的早期功能和肿瘤学结局。

我们回顾性分析了2024年9月至2025年5月期间由同一位外科医生进行SP-TV-RARP手术的21例患者。尿失禁定义为无需使用尿垫,勃起功能恢复定义为勃起硬度足以进行性交。使用临床随访记录评估功能和肿瘤学结局,并采用Kaplan-Meier分析进行分析。

患者中位年龄为65岁,52.4%患有pT3期疾病。总体手术切缘阳性率为62%,器官局限性疾病患者中为30%。未发生术中或术后30天内的并发症。约43%的患者在拔除尿道导管后一天内实现尿失禁,75%的患者在3个月时无需使用尿垫。与基线相比,3个月时SHIM和AUA-SS评分中位数无显著下降。勃起功能恢复的中位时间为69天,67%的患者在最后一次随访时恢复。2例患者(15.4%)在6个月内发生生化复发。

SP-TV-RARP似乎是安全的,可能有助于尿失禁和勃起功能早日恢复。尽管在早期应用中肿瘤学结局较差是一个潜在问题,但功能结局良好。有必要进行进一步的前瞻性评估以确认长期肿瘤学疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/34de/12427196/595832885853/cancers-17-02793-g001.jpg

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