Korumak ya da Korumamak? Robotik Radikal Prostatektomide Mesane Boynu

Özet

Amaç: Mesane boynu korunan ve korunmayan hastalarda robotik radikal prostatektomi (RARP) sonuçlarının karşılaştırılması.Materyal ve metod: Tek cerrahın gerçekleştirdiği ve ilk 50 vakanın öğrenme eğrisi nedenli çalışma dışı bırakıldığı ameliyatlar alındı. Grup 1 (mesane boynu korunan, n=141) ve Grup 2 (mesane boynu korunmayan, n=73) olgularda sırasıyla ortalama hasta yaşı Grup 1 ve 2’de 64.4 ve 65.2 (p=0.396), serum PSA düzeyi 12.1 ve 12.6 (p=0.846), bilateral nörovasküler demet (NVB) koruma 89 (63.1%) ve 53 (72.6%) ve unilateral NVB koruma 32 (22.6%) ve 14 (19.1%) idi.Bulgular: Grup 1 ve 2’de sırasıyla ortalama prostat ağırlığı 56.03 ve 72.9 gr (p=0.001), posterior rabdosfinkter rekonstrüksiyonu (rocco sütürü) oranı 11.3% ve 9.6% (p=0.694), ortalama konsol süresi 154.2 ve 164.3 dakika (p=0.164), intraoperatif kan kaybı 91.8 ve 103.7 cc (p=0.098), hastanede yatış süresi 4.01 ve 4.04 gün (p=0.879), üretral kateter çekim süresi 8.6 ve 9.5 gün (p=0.04), pozitif cerrahi sınır oranı 43 (%30.4) ve 19 (%26.0) (p=0.494), ortalama çıkarılan lenf nodu sayıları 13 ve 14 (p=0.602) idi. Postoperatif 7., 14. ve 21. günlerde sistogramda kaçak olmayan ve üretral kateteri çekilen hasta sayısı sırasıyla Grup 1’de 78 (66.1%), 37 (31.3%) ve 3 (2.5%); Grup 2 de 61 (83.5%), 10 (13.6%) ve 2 (2.7%) idi. En az 1 yıllık takip süresi olan hastalardan (n=185), erken kontinans (sonda çekilmesini takiben kontinan) oranları Grup 1 ve Grup 2 de sırasıyla 58% ve 31% idi (p=0.001). Total kontinan hasta sayısı sırasıyla Grup 1 ve 2’de postoperatif 1. ayda 70% ve 41% (p=0.002); 3. ayda 81% ve 60% (p=0.004); 6. ayda 92% ve 82% (p=0.053) idi. Sonuç: Mesane boynu koruyucu RARP postoperatif erken üriner kontinans kazanılmasında avantaja sahiptir.

Abstract

Aim: To present the outcomes of robotic radical prostatectomy (RARP) in patients with and without bladder neck sparing.Methods: A single surgeon series of cases after having an experience of >50 procedures were included. Group-1 included patients with bladder neck spared, n=141 and Group-2 included patients with bladder neck not spared, n=73. Mean patient age, preoperative serum PSA, bilateral neurovascular bundle (NVB) sparing and unilateral NVB-sparing were 64.4 versus 65.2 years (p=0.396); 12.1 versus 12.6 ng/ml (p=0.846); 89 (63.1%) versus 53 (72.6%) and 32 (22.6%) versus 14 (19.1%), respectively in Groups 1 and 2. Results: Mean prostate weights were 56.03 gr and 72.9 gr in Groups 1 and 2, respectively (p=0.001). Rocco suture was performed in 11.3% and 9.6% of Groups 1 and 2, respectively (p=0.694). Mean console time, intraoperative blood loss, duration of hospital stay and urethral catheter removal time in Groups 1 and 2 were 154.2 vs 164.3 min (p=0.164); 91.8 vs 103.7 cc (p=0.098); 4.01 vs 4.04 days (p=0.879) and 8.6 vs 9.5 days (p=0.04), respectively. Positive surgical margin rates were similar (43 (%30.4) vs 19 (%26.0) in both groups (p=0.494). Mean lymph node yield were 13 vs 14 in Groups 1 and 2, respectively (p=0.602). Cystography on postoperative day-7, day-14 and day-21 showed no leakage and urethral catheter was removed in 122 (86.5%), 15 (10.6%) and 4 (2.8%) of Group-1, and 61 (83.5%), 10 (13.6%) and 2 (2.7%) of Group-2, respectively. Of the available 185 patients, following removal of the catheter, immediate continence rate was 58% and 31% in Groups 1 and 2, respectively (p=0.001). On postop 1st-month, 70% and 41% of the patients in Groups 1 and 2, respectively were fully continent (p=0.002). On postop 3rd-month, 81% and 60% of the patients in Groups 1 and 2, respectively were fully continent (p=0.004). On postop 6th-month, 92% and 82% of the patients in Groups 1 and 2, respectively were fully continent (p=0.053). Conclusion: Bladder neck sparing RARP procedure has an advantage in terms of gaining postoperative early urinary continence.