ANTEGRADE APPROACH TO RADICAL RETROPUBIC PROSTATECTOMY IN PATIENTS WITH DIFFICULT APICAL DISSECTION

被引:13
作者
PETROS, JA
CATALONA, WJ
机构
[1] Division of Urologic Surgery, Washington Univ. Sch. of Med., St. Louis, MO
关键词
PROSTATECTOMY; DISSECTION; IMPOTENCE; URINARY INCONTINENCE;
D O I
10.1016/S0022-5347(17)38511-7
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Among 335 radical retropubic prostatectomies an antegrade dissection was used in 30 because of difficulty in developing the usual planes of dissection during apical dissection. The adequacy of tumor resection, preservation of sexual potency and urinary continence were compared in patients who underwent the antegrade dissection and those who underwent the standard retrograde nerve-sparing radical retropubic prostatectomy. Histopathological evaluation revealed no significant difference in the over-all completeness of tumor excision between the group having an antegrade dissection (16 of 30, 53% completely excised) and those having a retrograde dissection (177 of 305, 58% completely excised) (p = 0.62). Patients with clinically localized but pathological stage C disease undergoing an antegrade dissection and a nerve-sparing procedure had a significantly higher incidence of positive lateral margins (9 of 12, 75%) than the comparable group undergoing a retrograde dissection (40 of 99, 40%) (p = 0.02). The incidence of positive apical margins was similar in both groups, with 5 of 14 (36%) of the antegrade stage C cases (36%) having positive apical margins compared to 37 of 117 of the retrograde stage C cases (32%) (p = 0.65). Sexual potency was preserved in 5 of 6 patients (83%) treated with an antegrade dissection who had both neurovascular bundles preserved and were followed for at least 6 months, compared to 86 of 142 (61%) who underwent retrograde dissection (difference not significant, p = 0.26). Potency was preserved in 6 of 13 evaluable patients (46%) undergoing unilateral antegrade nerve-sparing procedure compared to 21 of 48 evaluable patients (44%) undergoing unilateral retrograde nerve-sparing procedure (p = 0.88). Of 22 patients followed for 1 year 21 (95%) have regained urinary continence. We conclude that the antegrade approach to radical retropubic prostatectomy provides results that are comparable to those achieved with the standard retrograde approach but that when an antegrade approach is chosen because of periprostatic fibrosis, bilateral preservation of the neurovascular bundles may result in a higher incidence of positive surgical margins.
引用
收藏
页码:994 / 997
页数:4
相关论文
共 7 条
[1]   TOTAL PROSTATECTOMY WITH PRELIMINARY LIGATION OF THE VASCULAR PEDICLES [J].
CAMPBELL, EW .
JOURNAL OF UROLOGY, 1959, 81 (03) :464-467
[2]   NERVE-SPARING RADICAL PROSTATECTOMY - EVALUATION OF RESULTS AFTER 250 PATIENTS [J].
CATALONA, WJ ;
BIGG, SW .
JOURNAL OF UROLOGY, 1990, 143 (03) :538-544
[3]   THE VOLUME AND ANATOMICAL LOCATION OF RESIDUAL TUMOR IN RADICAL PROSTATECTOMY SPECIMENS REMOVED FOR STAGE-A1 PROSTATE-CANCER [J].
EPSTEIN, JI ;
OESTERLING, JE ;
WALSH, PC .
JOURNAL OF UROLOGY, 1988, 139 (05) :975-979
[4]   ALTERNATIVE METHOD OF NERVE-SPARING WHEN PERFORMING RADICAL RETROPUBIC PROSTATECTOMY [J].
KURSH, ED ;
BODNER, DR .
UROLOGY, 1988, 32 (03) :205-209
[5]  
MITTEMEYER B T, 1978, Urology, V12, P313, DOI 10.1016/0090-4295(78)90396-5
[6]   PROSTATE SHAPE, EXTERNAL STRIATED URETHRAL SPHINCTER AND RADICAL PROSTATECTOMY - THE APICAL DISSECTION [J].
MYERS, RP ;
GOELLNER, JR ;
CAHILL, DR .
JOURNAL OF UROLOGY, 1987, 138 (03) :543-550
[7]  
STAMEY TA, 1988, J UROLOGY, V139, P1235