Doré B, Gremmo E, Ingrand P, Renardel-Irani A, Marroncle M, Irani J, Aubert J
Service d'Urologie, CHU de Poitiers.
J Urol (Paris). 1995;101(3):113-21.
The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.
作者进行了一项前瞻性非随机研究，以比较两种根治性耻骨后前列腺切除术方法，一种不保留膀胱颈（第1组 = 30例患者），另一种保留膀胱颈（第2组 = 15例患者）。对于15例保留膀胱颈的患者，根据Vest缝合方法简化了吻合术。对每组进行了对比尿动力学研究。两种技术的选择由每位外科医生个人决定。两组术前临床分期、Gleason评分结果相似。在生存、疾病进展以及最后一次随访（18 - 96个月）时的三个月PSA水平方面，两组之间没有显著差异。两组在手术时间、失血量、尿道插管时间、引流量和平均住院时间方面没有差异。唯一显著的差异是Vest缝合组术后输血单位数量（p < 0.001）。第2组保留的膀胱颈切缘均为阴性，即使最终存在分期过低或其他尖部切缘阳性情况。两组并发症无显著差异，第1组有10例膀胱颈狭窄（33%），第2组仅有2例（14.2%）（无统计学意义）。完全控尿率分别为73.3%和64.2%（无统计学意义）。膀胱颈切开后从未出现尿失禁。在尿动力学研究中，每组对比了9例患者，结果相似，但第2组尿道压力有升高趋势。评论指出，与采用直接单独缝合的传统技术相比，保留膀胱颈和简化的Vest牵引缝合术术后并发症和肿瘤学并发症并未增多。将疾病进展、控尿和膀胱颈狭窄率与文献进行了比较。尿动力学结果与其他研究观察到的结果相同。
