Stracener J, Schow D A, Renfer L, Rozanski T A, Thompson I M
Department of Radiology, Madigan Army Medical Center, Tacoma, WA, USA.
Mil Med. 1998 Mar;163(3):174-6.
A fundamental difference between the surgical techniques of radical retropubic and radical perineal prostatectomy is the method by which the vesicourethral anastomosis is accomplished. In the latter procedure, because the anastomosis is performed under direct vision, some authors have suggested that continence may be improved while reducing the risk of obstruction. The merit of this observation has not been established. To evaluate the characteristics of the vesicourethral anastomosis in retropubic and perineal prostatectomy, postoperative cystograms of 59 patients who underwent these procedures were reviewed in a blinded fashion. A normal, tapering bladder neck to the proximal urethra was noted in 80% of patients undergoing perineal prostatectomy compared with 2% of patients undergoing the retropubic approach. Various grades of diamond-shaped or bulbous irregularity of the vesicourethral anastomosis were seen in 98% of patients undergoing retropubic prostatectomy, and a system of grading of these abnormalities was established. These data suggest that a more physiologic-appearing bladder neck and proximal urethra is achieved with radical perineal prostatectomy. Further study is required to determine the impact of this radiologic finding on urinary function and continence.
耻骨后根治性前列腺切除术和经会阴根治性前列腺切除术这两种手术技术的根本区别在于膀胱尿道吻合的方法。在经会阴手术中，由于吻合是在直视下进行的，一些作者认为这样可能在降低梗阻风险的同时改善控尿能力。但这一观点的价值尚未得到证实。为了评估耻骨后和经会阴前列腺切除术中膀胱尿道吻合的特点，我们以盲法回顾了59例行这些手术患者的术后膀胱造影。经会阴前列腺切除术患者中80%可见膀胱颈至近端尿道呈正常的逐渐变细形态，而耻骨后手术患者中这一比例为2%。耻骨后前列腺切除术患者中98%可见不同程度的膀胱尿道吻合口呈菱形或球茎状不规则，我们建立了这些异常情况的分级系统。这些数据表明，经会阴根治性前列腺切除术可使膀胱颈和近端尿道呈现出更接近生理状态的外观。需要进一步研究来确定这一影像学发现对排尿功能和控尿能力的影响。
