機器人輔助根除性攝護腺切除術前是否有接受良性攝護腺肥大手術病人預後之比較：單一醫學中心之經驗
歐詠豪1、林宜佳1,2、黃一勝1,2、莊光達1,2、葉忠信1,2、鄭以弘1、仇光宇1,2、陳宏恩1、蔡德甫1,2、何肇晏1、吳子翔1、葉志胤1、朱懿柏1
新光吳火獅紀念醫院 外科部 泌尿科1
輔仁大學 醫學系2
The comparing outcomes in patients with or without a history of benign prostatic hyperplasia surgery before robotic assisted radical prostatectomy:
Experience in a single center.
AO WENG HOU1, Yi-Chia Lin1,2, Thomas I.S. Hwang 1,2, Guang-Dar Juang1,2, Chung-Hsin Yeh1,2, Yi-hong Cheng1, Hung-En Chen1, Te-Fu Tsai1,2, Chao-Yen Ho1, Tzu-Hsiang Wu1, Chih-Yin Yeh1,Yi-Bo Chu1
Division of Urology, Department of Surgery, Shin Kong WHS Memorial Hospital1
School of Medicine, Fu-Jen Catholic University2
Purpose:
Robotic assisted radical prostatectomy (RARP) has gradually replaced open and laparoscopic radical prostatectomy in recent years. Patients undergo RARP experience better intraoperative and postoperative results with comparable oncological and functional outcomes. However, RARP after bladder outlet surgery (BOS) for benign prostatic hyperplasia (BPH) remains a surgical challenge. Due to the lack of evidence on this subject in the literature, we aim to report the 6-year comparing outcomes in patients with or without a history of BPH surgery before RARP in a single center.
Materials and Methods:
From June 2014 to February 2020, 129 patients who underwent RARP were identified retrospectively in our hospital. 3 patients were excluded due to the benign prostate confirmed by pathological report. Surgical, oncological, pathological and functional outcomes in patients in who underwent RARP after BOS were compared to those without a history of BOS.
Results:
27 patients were in BOS group and 99 patients in the counterpart. Patient who underwent RARP after BOS were older (BOS vs No BOS: 71.30 vs 65.61 years, P<0.0001) and had a smaller prostate (BOS vs No BOS: 31.84 vs 44.22 gm, p=0.002). The BOS group had longer operative time (BOS vs No BOS: 272.00 vs 235.88 minutes, P=0.041). They had a higher vesicourethral anastomotic stricture rate (BOS vs No BOS: 9.09 vs 0 %, p=0.004), Moreover, the initial PSA level after RARP was lower in BOS group (BOS vs No BOS: 0.14 vs 1.71, p=0.029). There was no difference in pathological and functional outcomes between 2 groups.
Conclusion:
In this study, RARP after previous BOS remains a worse surgical outcome with higher risk of vesicourethral anastomotic stricture. Those are not statistically significant results in pathological and functional outcomes may be due to the unequal sample sizes between groups and the retrospective design. Further efforts should be made to obtain higher levels of evidence. We should well inform the patient about the operative risk who have the history of transurethral surgery for enlarged prostate undergo RARP.