攝護腺癌患者進行雙側全睪丸切除、白膜下睪丸切除或副睪保留睪丸切除手術：
何者有最低之術後併發症機率
顧明軒1、吳宏豪1、2、3、林志杰1、2、3、林子平1、2、3、黃逸修1、2、3、
郭俊逸1、2、3、黃志賢1、2、3、張延驊1、2、3、林登龍1、2、3、陳光國1、2、3
臺北榮民總醫院 泌尿部1；國立陽明大學醫學院泌尿學科2；書田泌尿科學研究中心3
Which orchiectomy technique has the least postoperative complications
in patients with prostate cancer: Total, subcapsular or epididymal sparing ?
Ming-Hsuan Ku1, Howard H. H. Wu1,2,3, Chi-Cheh Lin1,2,3, Tzu-Ping Lin1,2,3 , Eric YH Huang1,2,3,
Junne-Yih Kuo1,2,3, William J.S. Huang 1,2,3, Yen-Hwa Chang1,2,3 , Alex T.L. Lin 1,2,3, Kuang-Kuo Chen 1,2,3
Department of Urology, Taipei Veterans General Hospital 1,
Department of Urology 2, School of Medicine and Shu-Tien Urological Science Research Center 3,
National Yang-Ming University, Taipei, Taiwan
Purpose: Bilateral orchiectomy remains a treatment choice for achieving castration in patients with prostate cancer. Literature shows total, subcapsular or epididymal sparing orchiectomy can all achieve castration level. Our study was aimed to investigate which techniqe is the safest with the least postoperative complications.
Materials and Methods: We retrospectively reviewed our database from January, 2006 to December, 2016. Totally 200 patients with prostate cancer undergoing bilateral orchiectomy were enrolled. Patients were categorized by different orchiectomy technique: total, subcapsular or epididymal sparing orchiectomy. We investigated if there were any postoperative events requiring further surgical or radiological interventions, as well as readmissions, or any visits to our emergency department related to the surgery. Patient’s age, medical history, lab data and characteristics of prostate cancer including PSA level and bony metastastic condition were reviewed.
Results: In our study, 52 (26.0 %) patients had underwent total orchiectomy, 76 ( 38.0%) had underwent subcapsular orchiectomy and 72 (36.0 %) had underwent epididmal sparing orchiectomy. All of our patients had no posterative complications requiring further surgical or radiological interventions. Neither readmissions nor any visits to our emergency department related to the surgery were recorded in these patients..
44 (22.0%) patients had bilateral orchiectomy combined with palliative transurethral resection of the prostate (TURP): 30.8% in total orchiectomy, 21.1% in subcapsular orchiectomy and 16.6% in epididymal sparing orchiectomy. Penrose drains had been used in 24 (12.0%) patients for better scrotal drainage.
Exclusive of patients with combined surgery, mean hospital stay from the surgery to discharge was 3.74 days: 3.3 days in total orchiectomy, 3.63 days in subcapsular orchiectomy and 4.23 days in epididymal sparing orchiectomy ( p=0.862)
Conclusion: Total, subcapsular or epididymal sparing orchiectomy are all safe procedure with nearly no postoperative compliations requiring further surgical or radiologic interventions. The surgery could be performed combined with palliative TURP safely. Penrose drain may not be needed in orchiectomy. No significant difference in hospital stay from surgery to discharge among these techniques.