To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy

Year 2019, Volume: 14 Issue: 3, 144 - 151, 01.10.2019

Murat Keske , Abdullah Erdem Canda

https://doi.org/10.33719/yud.488845

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.

Keywords

prostate , robotics , bladder neck spare

Korumak ya da Korumamak? Robotik Radikal Prostatektomide Mesane Boynu

Abstract

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.

Keywords

prostat , robotik , mesane boynu koruma

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