雷氏空間保留法於機器人輔助腹腔鏡前列腺切除術的應用可增加早期排尿控制- 彰基的初始經驗
方琬云、郭謹瑋、王百孚
彰化基督教醫院 外科部 泌尿科
Robot-assisted laparoscopic radical prostatectomy with Retzius-sparing method in patients with locally advanced and high-risk prostate cancer: Preliminary experience in a single institute
Wanyun Fang, ChinWei Kuo, BaiFu Wang
Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Purpose
To report the technique, as well as functional and oncologic results of our preliminary experience of patients with locally advanced and high risk prostate cancer underwent Retzius-sparing method for robot-assisted laparoscopic prostatectomy.
Materials and methods
Between February 2014 and Aug 2018, 18 patients with locally advanced or high risk prostate cancer had recieved RALP with Retzius-sparing method at our institute. Demographic, perioperative, and postoperative data were recorded. Continence status was assessed immediately after urethral catheter removal; at the first and every three months after RALP. Peri-prostatic structures, including endopelvic fascia and dorsal venous complex, as well as bladder neck were all preserved. The whole procedure of dissection and vesicourethral anastomosis was accomplished by totally posterior approach. Complications were classified according to the Clavien-Dindo classification.
Results
Median follow-up was 15.78 months; median age was 68.11 years old. Retzius-sparing method was performed in all 18 patients, and 4 of them (22.22%) were continent immediately within one week and 7 of them (38.89%) were continent one month after operation. In nerve-sparing group, the three month continence rate was 60%. On the other hand, 66.67% of total patients were continent after 3 months. The mean duration of the catheterization was 7.5 days. Furthermore, there were no complications were noted such as intra-peritoneal urine leakage, bladder neck contracture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications. Nadir of PSA was achieved in 11 patients (61.1%) and no further systemic therapy was necessary. Otherwise systemic therapy with ADT and radio therapy were arrange in patient without nadir or with chemical recurrence.
Conclusion:
Our preliminary experience of using Retzius-sparing method for RALP in atients with locally advanced or high-risk prostate cancer provided relatively satisfied oncological outcome in selected patients, but higher incontinent rate may be considered.