Impact of Pelvic Radiation Therapy on Inflatable Penile Prosthesis Reoperation Rates.
Impact of Pelvic Radiation Therapy on Inflatable Penile Prosthesis Reoperation Rates.
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盆腔放射治疗对充气阴茎假体再手术率的影响。
DOI：
10.1016/j.jsxm.2018.09.009
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Kashanian,JamesA
中科院分区：
文献类型：
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作者：
Golan,Ron;Patel,NealA;Sun,Tianyi;Barbieri,ChristopherE;Sedrakyan,Art;Kashanian,JamesA
考虑到放射治疗(RT)损害软组织微血管，损害伤口愈合，并导致海绵体纤维化，在接受放射治疗的男性患者中，充气式阴茎假体(IPP)的结果可能会受到不利影响。目的比较接受过放射治疗的男性和接受根治性前列腺癌切除术(RP)的患者之间的IPP结果。方法从监测、流行病学和最终结果(SEER)-Medicare数据库中查询2002年至2013年期间接受RT(n=83,277)或RP(n=32,608)的前列腺癌(PCA)患者。主要结果衡量主要结果是再次手术，通过移除、翻修或替换IPP来定义。结果我们确定了350名接受RT后IPP的男性和653名接受RP后IPP的男性。接受RT的男性年龄更大(P<；.01)，合并疾病也更多(P<；.01)。90天(P=0.78)、1年(P=0.52)或3年(P=0.48)的总再手术率没有显著差异。事件发生时间分析表明，RT与总体再手术可能性的增加无关(风险比[HR]1.46，95%可信区间[CI]0.94-2.29，P=0.09)。从放疗到IPP的时间与总体再手术率之间没有相关性。临床意义与接受RP.强度和限制的非放疗患者队列相比，先前接受放疗的PCa患者并不影响IPPS的翻修率或切除率。强度和限制包括对当代全国队列中结果的分析，并进行强有力的随访。使用诊断和程序代码，我们完全能够捕获再操作。局限性包括缺乏再次手术的特定指征，以及外科医生的经验或技术无法控制。结论IPP是一种安全有效的勃起功能障碍治疗方法，应提供给有盆腔放射病史但内科治疗失败的男性。
IntroductionConsidering that radiation therapy (RT) compromises soft tissue microvasculature, impairs wound healing, and causes cavernosal fibrosis, inflatable penile prosthesis (IPP) outcomes may be adversely affected in men treated with RT.AimTo compare IPP outcomes among those who had undergone prior RT vs a cohort who underwent radical prostatectomy (RP) before insertion of IPP.MethodsThe Surveillance, Epidemiology, and End Results (SEER)-Medicare Database was queried for men with prostate cancer (PCa) who underwent RT (n = 83,277) or RP (n = 32,608) with subsequent IPP insertion between 2002 and 2013. Men who had undergone both RT and RP were excluded from the analysis.Main Outcome MeasureThe primary outcome was reoperation, defined by removal, revision, or replacement of the IPP.ResultsWe identified 350 men who received an IPP following RT and 653 who received an IPP following RP. Men who underwent RT were older (P< .01) and had more comorbidities (P< .01). There were no significant differences in overall reoperation rates at 90 days (P= .78), 1 year (P= .52), or 3 years (P= .48). Time-to-event analysis demonstrated that RT was not associated with an increased likelihood of overall reoperation (hazard ratio [HR] 1.46, 95% confidence interval [CI] 0.94–2.29,P= .09). There was no association between time from RT to IPP and overall reoperation rates.Clinical ImplicationsPrior RT for the treatment of PCa does not impact the revision or removal rates of IPPs as compared with a cohort of non-radiated patients who underwent RP.Strength & LimitationsThe strength includes the analysis of outcomes among a contemporary, nationwide cohort with robust follow-up. Using diagnosis and procedure codes, we were thoroughly able to capture reoperations. Limitations include the lack of specific indications for reoperation and inability to control for surgeon experience or technique.ConclusionIPP is a safe and effective treatment of erectile dysfunction that should be offered to men with a history of pelvic radiation who have failed medical therapy.