施行機械手臂輔助根除性攝護腺切除手術於曾接受經尿道攝護腺切除手術之病患的治療經驗
陳威任1, 黃逸修1,2,3, 鍾孝仁1,2,3, 林登龍1,2,3, 陳光國1,2,3
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科 3書田泌尿科學研究中心
Perioperative and Functional Outcomes in Patients Underwent Robotic-assisted Radical Prostatectomy Following A Prior Transurethral Resection of Prostate
Wei-Jen Chen1, Eric Yi-Hsiu Huang1,2,3, Hsiao-Jen Chung1,2,3, Alex T.L. Lin1,2,3, Kuang-Kuo Chen1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan
Purpose: Retropubic radical prostatectomy (RRP) after prior transurethral resection of the prostate (TURP) was associated with increased intraoperative and postoperative morbidity in literature review. Robotic assisted radical prostatectomy (RaRP) provides a better surgical view compared to conventional RRP. Ideally, it might provide a better vision to navigate the difficult surgical planes of previous surgeries. In this study, we compared the peri- and post-operative outcomes of RaRP in patients underwent a prior TURP.
Materials and Methods: We retrospectively enrolled 249 patients who received RaRP from 2009 to 2016 by two experienced robotic surgeons in our hospital. Sixteen patients accepted a prior TURP. Total 16 patients had previous history of TURP (study group). The perioperative parameters, pathologic characteristics, complications, and voiding function outcomes were compared between the study group and those who didn’t underwent a prior TURP (control group).
Results: Among the 16 patients, 3 patients had benign pathology of TURP in 5, 8 and 11 years prior to RaRP. One patient was diagnosed to have cT1a, Gleason 1+1 prostate cancer after TURP. The other 12 patients was diagnosed Gleason grade≧6 prostate cancer after TURP and they had a mean time of 4 months (1.1-8.4 months) between TURP and RaRP. Mean operative time was similar between the study and control group (245.3 vs. 249.9 minutes, p=0.711), mean blood loss was similar (85.8 vs. 93.5 cc, p=0.824), post operation Foley indwelling time and hospital stay were also similar (6.7 vs. 4.3 days, p=0.153; 7.0 vs. 6.2 days, p=0.192). We performed bilateral neurovascular bundle (NVB) sparing, unilateral NVB sparing in 62.5%, 18.8% of study group patients, which was not less than control group (bilateral NVB sparing/unilateral NVB sparing=64.8%/26.6%, p=0.852). The positive surgical margin rate was similar between study and control group (18.8% vs. 27.0%, p=0.571). The overall complication rate in study group was 31.25% (Clavien grade I: 5 patients), and 15.45% in control group (Clavien grade I: 30 patients, Clavien grade II: 2 patients, Clavien grade IIIa: 1 patient, Clavien grade IIIb: 3 patients). Although the complication rate in study group seemed higher then control group, it did not reach statistical significance (p=0.231). Regarding post-operative continence, no difference could be observed between the 2 groups in terms of post-operative pad free rate (62% vs 68%, p=0.8412).
Conclusions: RaRP might be challenging after a prior TURP. However, the peri- and post-operative outcomes were not compromised in experienced hands.