Harris M J, Thompson I M
Urology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Urology. 1996 Nov;48(5):762-8. doi: 10.1016/S0090-4295(96)00252-X.
We applied the advances in anatomic techniques as developed for the radical retropubic prostatectomy to the perineal approach to radical prostatectomy. The anatomic radical perineal prostatectomy maximizes cancer control and minimizes postoperative incontinence and impotence. This technique capitalizes on the many advantages associated with the perineal approach to the prostate.
The anatomic radical perineal prostatectomy addresses the posterior surface and posterior bladder neck regions prior to urethral division at the prostatic apex. Anatomic dissection of the striated urethral sphincter and preservation of the bladder neck, as well as a "watertight" anastomosis, are accomplished with excellent exposure. Cavernosal nerve preservation is possible in appropriately selected patients. Data are accumulated prospectively and reported herein.
Prostate-specific antigen detectability is seen in 2% and 4% of pT2 and pT2 to T3b cases, respectively at an average follow-up of 1 year. Immediate full continence is seen in 30% of cases; ultimately, 97.5% achieve full urinary control. Nerve-sparing techniques result in spontaneous erectile activity in 73%. Average length of hospital stay is less than 2 days, with most recent patients discharged on the day after surgery.
The anatomic radical perineal prostatectomy is a safe and effective method of treating men with clinically localized prostate cancer and should be part of every urologist's surgical armamentarium.
我们将耻骨后根治性前列腺切除术所采用的解剖技术进展应用于经会阴根治性前列腺切除术。解剖性经会阴前列腺切除术可最大限度地控制癌症，并将术后尿失禁和阳痿的发生率降至最低。该技术利用了经会阴途径处理前列腺的诸多优势。
解剖性经会阴前列腺切除术在前列腺尖部分离尿道之前，先处理前列腺后表面和膀胱颈后区域。通过良好的暴露，完成横纹尿道括约肌的解剖分离、膀胱颈的保留以及“水密”吻合。在适当选择的患者中可以保留海绵体神经。数据是前瞻性收集并在此报告的。
在平均随访1年时，pT2和pT2至T3b病例中分别有2%和4%可检测到前列腺特异性抗原。30%的病例术后立即实现完全控尿；最终，97.5%的患者实现完全排尿控制。保留神经技术使73%的患者恢复自发勃起功能。平均住院时间少于2天，大多数近期患者在术后次日出院。
解剖性经会阴前列腺切除术是治疗临床局限性前列腺癌男性患者的一种安全有效的方法，应成为每位泌尿外科医生手术技术储备的一部分。
