接受機械手臂輔助腹腔鏡根除性攝護腺切除手術前後之壓力尿流速變化

余秉軒¹、林志杰^1,2、鍾孝仁^1,2、林子平^1,2、黃逸修^1,2、

黃子豪^1,2、黃奕燊^1,2、林登龍^1,2、黃志賢^1,2

¹臺北榮民總醫院泌尿部；²國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心 

The Change of Pressure-Flow Study Parameters in Patients before and after Robot-assisted Laparoscopic Radical Prostatectomy

Ping-Hsuan Yu¹, Chih-Chieh Lin^1,2, Hsiao-Jen Chung^1,2, Tzu-Ping Lin^1,2,

Eric Yi-Hsiu Huang^1,2, Tzu-Hao Huang^1,2, I-shen Huang^1,2,

Alex T.L. Lin^1,2, William J.S. Huang^1,2

¹ Department of Urology, Taipei Veterans General Hospital;

² Department of Urology, College of Medicine and Shu-Tien Urological Research Center,

National Yang Ming Chiao Tung University

Purpose:

From the anatomic point of view, the prostatectomy probably influences the innervation of bladder, which results in the change of lower urinary tracts symptoms (LUTS) after operation. With improvement of surgical methods, like robot-assisted laparoscopic radical prostatectomy (RaLP), the surgical outcome reveals better recovery as compared to the past. Here we investigated the difference of LUTS and parameters of pressure-flow studies before and after RaLP.

Materials and Methods:

Patients with localized prostate cancer who would undergo RaLP were prospectively recruited from January 2019 to July 2020. The age, initial PSA, Gleason scores, pre-OP staging and post-OP staging were recorded. Three questionnaires including International Prostate Symptom Score (IPSS), Urinary Distress Inventory (UDI-6), and Overactive Bladder Symptom Score (OABSS) were collected before and three months after the surgery. Also, the pressure-flow studies before and three months after the surgery were also performed.

Results:

Of overall 85 patients recruited in this study, the median age is 67 years old and the median initial PSA is 11.8ng/ml. Most patients have diseases with Gleason group 2 (40%) and MRI staging T3a (45.88%). Regarding the IPSS, the storage subscores reveal a significant increase after operation. Interestingly, not all the voiding subscores show significant decrease after operation. The incidence of urge urinary incontinence show significant increase after operation from both UDI-6 and OABSS. As for pressure-flow study, the bladder volume at first desire and strong desire decreases significantly after the operation (first desire: 134.11cc vs 112.06cc, p=0.016; strong desire: 220.18cc vs 174.40cc, p=0.000.) We also notice that the post-OP PdetQmax and bladder contractility index (BCI) both decrease after the surgery (PdetQmax: 52.79cmH2O vs 23.61cmH2O, p=0.000; BCI: 99.67 vs 74.84, p=0.000)

Conclusions:

According to the questionnaires and pressure-flow study, a trend of hypersensitivity is observed after the RaLP surgery, including increased storage symptoms in questionnaires and decreased bladder volume at first desire and strong desire in pressure-flow studies. Decreased detrusor contractility is also found after the surgery by the decreased PdetQmax and BCI value.