医学
神经血管束
筋膜
前列腺切除术
倾向得分匹配
外科
泌尿科
围手术期
前列腺癌
垫片(计算)
勃起功能障碍
癌症
内科学
作者
Ahmed S. Elsayed,Hannah B. Ely,Mai Abdelhakim,Ismail R. Saad,Zhe Jing,Umar Iqbal,Yousuf Ramahi,Julian Joseph,Holly Houenstein,Gaybrielle James,James O. Peabody,Omar Abdel Razzak,Ahmed A. Hussein,Khurshid A. Guru
标识
DOI:10.1016/j.urolvj.2022.100143
摘要
: We sought to report the oncologic and functional outcomes of endopelvic fascia (EPF), puboprostatic ligaments (PPL), and dorsal venous complex (DVC) preservation with hydrodissection of the neurovascular bundles (NVB) during robot-assisted radical prostatectomy (RARP). A retrospective review of our prospectively maintained prostate cancer database was performed. Patients who underwent bilateral or unilateral nerve sparing were identified. Propensity score matching was performed in a ratio of 1:1.6 between new technique (Group 1) and a historical group (Group 2). Data were reviewed for perioperative, oncologic, and functional outcomes. Cumulative incidence curves were used to depict perfect continence (0 pads), social continence (0-1 pads), and potency (SHIM≥17 with or without erectile aids). Multivariate models were used to elicit variables associated with continence and potency. : 76 patients in Group 1 and 126 patients in Group 2 were included. Median follow up was 17 months. Group 1 showed higher perfect continence rates at 1 month (9% vs 3%), 3 months (24% vs 19%), and 6 months (54% vs 34%) compared to Group 2 respectively (log rank p<0.01). Group 1 also showed higher social continence rates at 1 month (15% vs 3%), 3 months (77% vs 32%), and 6 months (87% vs 53%) compared to Group 2 respectively (log rank p<0.01). Group 1 had a similar potency rate compared to Group 2 (log rank p=0.25). Multivariate analysis showed that Group 1 was associated with improved perfect (Possibility ratio (PR) 1.82, 95% CI 1.29–2.58, p<0.01) and social continence (PR 2.54, 95% CI 1.83 – 3.52, p<0.01), but not potency. : EPF, PPL, and DVC preservation with hydrodissection of the NVB offered similar oncological outcomes, but earlier and improved urinary continence rates compared to standard dissection.
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