Yıl 2019, Cilt 14 , Sayı 3, Sayfalar 144 - 151 2019-10-01

Korumak ya da Korumamak? Robotik Radikal Prostatektomide Mesane Boynu
To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy

Murat Keske [1] , Abdullah Erdem Canda [2]


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.

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.

  • 1. Hu JC, Gu X, Lipsitz SR, Barry MJ, D'Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 2009;302:1557-64.
  • 2. Berryhill R Jr, Jhaveri J, Yadav R, Leung R, Rao S, El-Hakim A, et al. Robotic prostatectomy: a review of outcomes compared with laparoscopic and open approaches. Urology 2008;72:15- 23.
  • 3. Piechaud T, Annino F. Bladder neck dissection during roboticassisted laparoscopic radical prostatectomy. In: John H, Wiklund P, editors. Robotic urology. Berlin: Springer; 2013. p. 247-58
  • 4. Shelfo SW, Obek C, Soloway MS. Update on bladder neck preservation during radical retropubic prostatectomy: impact on pathologic outcome, anastomotic strictures, and continence. Urology. 1998;51:73–8.
  • 5. Deliveliotis C, Protogerou V, Alargof E, Varkarakis J. Radical prostatectomy: bladder neck preservation and puboprostatic ligament sparing–effects on continence and positive margins. Urology. 2002;60:855–8. 10.
  • 6. BraslisKG, PetschM, LimA, CivantosF, SolowayMS. Bladder neck preservation following radical prostatectomy: continence and margins. Eur Urol. 1995;28:202–8.
  • 7. Selli C, De Antoni P, Moro U, Macchiarella A, Giannarini G, Crisci A. Role of bladder neck preservation in urinary.
  • 8. Srougi M, Nesrallah LJ, Kauffmann JR, Nesrallah A, Leite KR. Urinary continence and pathological outcome after bladder neck preservation during radical retropubic prostatectomy: a randomized prospective trial. J Urol. 2001;165: 815–18. 13.
  • 9. Marcovich R, Wojno KJ, Wei JT, Rubin MA, Montie JE, Sanda MG. Bladder neck-sparing modification of radical prostatectomy adversely affects surgical margins in pathologic T3a prostate cancer. Urology. 2000;55:904–8.
  • 10. Rosen RC, Cappelleri JC, Smith MD, et al. Development and evaluation of an abridged, 5-item version of the International ndex of Erectile Function (IIEF-5) as a iagnostic tool for erectile dysfunction. Int J Impot Res 1999;11: 319–326. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.
  • 11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.
  • 12. Canda AE, Atmaca AF, Akbulut Z, Asil E, Kilic M, et al. Results of robotic radical prostatectomy in the hands of surgeons without previous laparoscopic radical prostatectomy experience. Turk J Med Sci. 2012;42(Suppl 1):1338–46.
  • 13. Koraitim MM. The male urethral sphincter complex revisited: an anatomical concept and its physiological correlate. J Urol 2008;179:1683–9.
  • 14. Klein EA. Early continence after radical prostatectomy. J Urol 1992;148:92–5.
  • 15. Mariangela Bellangino, Clare Verrill, Tom Leslie, Richard W. Bell, Freddie C. Hamdy, Alastair D. Lamb. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy. Curr Urol Rep. 2017 Nov 7;18(12):99. doi: 10.1007/s11934-017-0745-0.
  • 16. Tewari AK and Rao SR: Anatomical foundations and surgical manoeuvres for precise identification of the prostatovesical junction during robotic radical prostatectomy. BJU Int 2006; 98: 833.
  • 17. Bird VG, Reese J and Winfield HN: Identification and dissection of bladder neck during laparoscopic radical prostatectomy. Urology 2002; 60: 680.
  • 18. Acar C, Schoffelmeer CC, Tillier C, et al. Quality of life in patients with low-risk prostate cancer. A comparative retrospective study: Brachytherapy versus robot-assisted laparoscopic prostatectomy versus active surveillance. J Endourol 2014;28:117–124.
  • 19. Lutfi Tunc, Huseyin Gumustas, Yigit Akin, Sinan Atkin,Tuncay Peker, Ozlem Erdem, Ibrahim Bozkirli. A Novel Surgical Technique for Preserving the Bladder Neck During Robot-Assisted Laparoscopic Radical Prostatectomy: Preliminary Results. J Endourol. 2015 Feb;29(2):186-91. doi:10.1089/end.2014.0459. Epub 2014 Sep 5.
  • 20. Lee Z, Sehgal SS, Graves RV, et al. Functional and oncologic outcomes of graded bladder neck preservation during robotassisted radical prostatectomy. J Endourol 2014;28:48–55.
  • 21. Riccardo Bartoletti, Andrea Mogorovich, Francesco Francesca, Giorgio Pomara, Cesare Selli. Combined bladder neck preservation and posterior musculofascial reconstruction during robotic assisted radical prostatectomy: effects on early and long term urinary continence recovery. BMC Urol. 2017 Dec 15;17(1):119. doi: 10.1186/s12894-017-0308-1.
  • 22. Tewari A, Sooriakumaran P, Bloch DA, et al. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: A systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 2012;62:1–15.
  • 23. David F. Friedlander, Mehrdad Alemozaffar, Nathanael D. Hevelone, Stuart R. Lipsitz and Jim C. Hu. Stepwise Description and Outcomes of Bladder Neck Sparing During Robot- Assisted Laparoscopic Radical Prostatectomy. J Urol. 2012 Nov;188(5):1754-60. doi: 10.1016/j.juro.2012.07.045. Epub 2012 Sep 19.
Birincil Dil en
Konular Üroloji ve Nefroloji
Bölüm Özgün Araştırma
Yazarlar

Orcid: 0000-0001-6591-4506
Yazar: Murat Keske (Sorumlu Yazar)
Kurum: Kayseri State Hospital, Department of Urology
Ülke: Turkey


Orcid: 0000-0002-5196-653X
Yazar: Abdullah Erdem Canda
Kurum: Koç University, Faculty of Medicine, Department of Urology
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 1 Ekim 2019

Bibtex @araştırma makalesi { yud488845, journal = {Yeni Üroloji Dergisi}, issn = {1305-2489}, eissn = {2687-1955}, address = {dergi@avrasyauroonkoloji.org}, publisher = {Ali İhsan TAŞÇI}, year = {2019}, volume = {14}, pages = {144 - 151}, doi = {10.33719/yud.488845}, title = {To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy}, key = {cite}, author = {Keske, Murat and Canda, Abdullah Erdem} }
APA Keske, M , Canda, A . (2019). To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy. Yeni Üroloji Dergisi , 14 (3) , 144-151 . DOI: 10.33719/yud.488845
MLA Keske, M , Canda, A . "To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy". Yeni Üroloji Dergisi 14 (2019 ): 144-151 <https://dergipark.org.tr/tr/pub/yud/issue/47273/488845>
Chicago Keske, M , Canda, A . "To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy". Yeni Üroloji Dergisi 14 (2019 ): 144-151
RIS TY - JOUR T1 - To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy AU - Murat Keske , Abdullah Erdem Canda Y1 - 2019 PY - 2019 N1 - doi: 10.33719/yud.488845 DO - 10.33719/yud.488845 T2 - Yeni Üroloji Dergisi JF - Journal JO - JOR SP - 144 EP - 151 VL - 14 IS - 3 SN - 1305-2489-2687-1955 M3 - doi: 10.33719/yud.488845 UR - https://doi.org/10.33719/yud.488845 Y2 - 2019 ER -
EndNote %0 Yeni Üroloji Dergisi To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy %A Murat Keske , Abdullah Erdem Canda %T To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy %D 2019 %J Yeni Üroloji Dergisi %P 1305-2489-2687-1955 %V 14 %N 3 %R doi: 10.33719/yud.488845 %U 10.33719/yud.488845
ISNAD Keske, Murat , Canda, Abdullah Erdem . "To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy". Yeni Üroloji Dergisi 14 / 3 (Ekim 2019): 144-151 . https://doi.org/10.33719/yud.488845
AMA Keske M , Canda A . To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy. Yeni Üroloji Dergisi. 2019; 14(3): 144-151.
Vancouver Keske M , Canda A . To Spare or not to Spare? Bladder Neck and Robotic Radical Prostatectomy. Yeni Üroloji Dergisi. 2019; 14(3): 151-144.