Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience.
Bladder neck contracture after retropubic radical prostatectomy: incidence and risk factors from a large single-surgeon experience.
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DOI：
10.1111/j.1464-410x.2009.08700.x
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发表时间：
2009-12
影响因子：
4.5
通讯作者：
Catalona WJ
中科院分区：
文献类型：
--
作者：
Erickson BA;Meeks JJ;Roehl KA;Gonzalez CM;Catalona WJ
研究了一个大型的，单一外科医生的前列腺癌患者系列，这些患者接受了耻骨后根治性膀胱切除术（RRP）治疗术后膀胱颈挛缩（BNC）的男性。从1983年到2007年，4132名男性接受了由一名外科医生进行的前列腺癌RRP。所有患者均行BN重建伴粘膜外翻。使用6根2/0铬肠线在18 F Foley导管上进行膀胱至膜尿道吻合术。导管留置10天。来自这些男性的数据存储在前瞻性数据库中，在本研究中对RRP后的BNC男性进行了审查。将BNC患者与该系列中的所有其他男性进行比较，以确定BNC发展的风险因素。总体而言，110例患者（2.5%）发生了BNC。检查我们的最后500例患者，当代BNC率<1%。中位（范围）随访时间为44（12-233）个月。有BNC和无BNC的男性肿瘤特征相似，器官局限性疾病的发生率也相似（65% vs 70%，P = 0.27）。BNC患者术前前列腺特异性抗原（PSA）水平中位数较高（6.7 vs 5.7 mg/dL; P = 0.009），RRP后PSA失败的可能性更大（30% vs 16%，P < 0.001）。多因素分析显示，非神经保留（P = 0.003）和1992年以前的手术日期（P < 0.001）是BNC的显著预测因素。在18个月随访时，BNC患者的效力率（49% vs 63%，P < 0.003）和复发率（88% vs 94%，P = 0.07）较低。BNC很罕见，在我们的现代系列中发生率< 1%。预防BN的重要手术因素是避免BN闭合过紧，并通过水密闭合实现BN与尿道残端的良好对合。BNC在非神经保留手术和外科医生经验的早期更常见。
To examine a large, single-surgeon series of patients with prostate cancer who underwent retropubic radical prostatectomy (RRP) for men with postoperative bladder neck contractures (BNCs). From 1983 to 2007, 4132 men underwent RRP for prostate cancer by one surgeon. All patients had BN reconstruction with mucosal eversion. The bladder to membranous urethral anastomosis was made using six 2/0 chromic catgut sutures over an 18 F Foley catheter. The catheter was left in place for 10 days. Data from these men is stored in a prospective database, which was reviewed in this study for men with BNCs after RRP. Men with BNCs were compared with all other men in the series to determine risk factors for BNC development. Overall, BNCs developed in 110 patients (2.5%). Examining our last 500 patients there was a contemporary BNC rate of < 1%. The median (range) follow-up was 44 (12–233) months. Tumour characteristics were similar in the men with BNCs and those with no BNCs, and the rates of organ-confined disease were also similar (65% vs 70%, P = 0.27). Men with BNCs had higher median preoperative prostate-specific antigen (PSA) levels (6.7 vs 5.7 mg/dL; P = 0.009) and were more likely to have PSA failure after RRP (30% vs 16%, P < 0.001). On multivariate analysis, non-nerve sparing (P = 0.003) and a surgical date before 1992 (P < 0.001) were significant predictors of BNC. Patients with BNCs had lower potency rates (49% vs 63%, P < 0.003) and continence rates (88% vs 94%, P = 0.07) at the 18-month follow-up. BNCs are rare, occurring in < 1% in our modern series. The important surgical factors in preventing BNCs are to avoid closing the BN too tightly and attaining good apposition of the BN with the urethral stump with a watertight closure. BNCs are more common with non-nerve-sparing surgery and early in a surgeon's experience.