Intraoperative electrophysiological confirmation of urinary continence after radical prostatectomy.
Intraoperative electrophysiological confirmation of urinary continence after radical prostatectomy.
复制标题
根治性前列腺切除术后尿失禁的术中电生理学确认。
作者：
Y. Kaiho;H. Nakagawa;Y. Ikeda;S. Namiki;K. Numahata;M. Satoh;S. Saito;K. Yoshimura;A. Terai;Y. Arai
目的
为了确定保留神经的根治性耻骨后尿道切除术（RP）对术后排尿困难的实际影响，我们使用术中电生理测试来确认神经血管束（NVB）的功能保留。
材料和方法
共85例接受RP治疗局限性前列腺癌的患者进行了研究。在RP期间，对NVB保存进行了宏观解剖学评估。然后进行电生理测试以确认NVB保存。电刺激NVB，通过监测海绵体内或尿道内压力的变化来观察反应。根据神经保留程度将所有患者分为3组，即双侧神经保留组、单侧神经保留组和非神经保留组。然后测定各组的术后复发率。使用自填问卷研究基线、术后3个月和6个月时的尿沉渣。
结果
通过电生理评估，20.6%的宏观解剖学确定的NVB复发被重新分类。对电生理检测准确分组的数据分析表明，保留双侧神经组术后排尿功能的维持明显高于保留单侧神经组和不保留神经组。然而，当仅考虑宏观解剖评估时，各组之间的泌尿功能无显著差异。
结论
电生理评估显示，双侧NVB保存有助于RP后排尿功能的早期恢复。因此，术中电生理评估可用于预测术后生活质量。
PURPOSE
To determine the actual effect of nerve sparing radical retropubic prostatectomy (RP) on postoperative urinary continence we used intraoperative electrophysiological testing to confirm functional preservation of the neurovascular bundle (NVB).
MATERIALS AND METHODS
A total of 85 patients undergoing RP for localized prostate cancer were studied. During RP NVB preservation was assessed macroanatomically. Electrophysiological testing was then performed to confirm NVB preservation. The NVB was electrostimulated and responses were observed by monitoring intracavernous or intraurethral pressure changes. All patients were classified into 3 groups according to the degree of nerve sparing, that is a bilateral nerve sparing group, a unilateral nerve sparing group and a nonnerve sparing group, based on macroanatomical assessment as well as on electrophysiological assessment. Postoperative continence in each group was then determined. Urinary continence at baseline, and 3 and 6 months postoperatively was studied using a self-administered questionnaire.
RESULTS
With electrophysiological assessment 20.6% of macroanatomically determined NVB preservations were reclassified. Analysis of the data on groups classified accurately by electrophysiological testing showed that the bilateral nerve sparing group maintained postoperative urinary function significantly more than the unilateral nerve sparing and nonnerve sparing groups. However, when only macroanatomical assessment was considered, no significant difference among the groups was found in urinary function.
CONCLUSIONS
Electrophysiological assessment revealed that bilateral NVB preservation contributes to early recovery of urinary continence after RP. Thus, intraoperative electrophysiological assessment is useful for predicting postoperative quality of life.
影响因子：
6.6
作者：
Wei, JT;Dunn, RL;Sanda, MG
通讯作者：
Sanda, MG