Single Center Comparison of Anastomotic Strictures After Radical Perineal and Radical Retropubic Prostatectomy
Single Center Comparison of Anastomotic Strictures After Radical Perineal and Radical Retropubic Prostatectomy
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DOI：
10.1016/j.urology.2009.10.009
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发表时间：
2010-08-01
期刊：
影响因子：
2.1
通讯作者：
Melchior, Sebastian W.
中科院分区：
文献类型：
--
作者：
Gillitzer, Rolf;Thomas, Christian;Melchior, Sebastian W.
目的分析根治性会阴前列腺切除术（RPP）和耻骨后前列腺切除术（RRP）后吻合口狭窄（AS）的发生率和处理方法，并确定可能的诱发因素。方法1997年至2007年，我们对局限性前列腺癌进行了866例RPP和2052例RRP。中位随访时间为52个月（12-136）。我们分析了术前血清前列腺特异性抗原、前列腺大小、临床和病理肿瘤分期、新辅助激素剥夺、既往经尿道前列腺切除术、输血需求、吻合口功能不全，结果RPP和RRP后AS的发生率为3.8%（33/863），RPP和RRP后AS的发生率为3.8%（33/863）。和5.5%（113/2048）（P = .067）。在多变量分析中，RRP是AS的统计学显著风险因素（P = .0002）。在生存分析中，在中位随访时，RPP的AS发生率低于RRP（P = 0.0229）。RPP和RRP后，内镜下AS切开或切除术的原发反应分别为94%（31/33）和72.6%（82/113）。多因素Logistic回归分析显示，活检Gleason评分、既往经尿道前列腺电切术、前列腺体积、病理肿瘤分期和分级、输血需求、AUR和手术技术是AS发生的独立危险因素。分别有45.4%（20/44）和10.9%（5/46）的AUR患者术后发生AS（P <0.05）。原发性内窥镜AS切开或切除术均非常成功。采用耻骨上膀胱造口术治疗术后AUR会导致AS形成的高风险，应避免。泌尿学76：417-422，2010年。(C)2010年爱思唯尔公司
OBJECTIVES To analyze the incidence and management of anastomotic strictures (ASs) after radical perineal prostatectomy (RPP) and retropubic prostatectomy (RRP) and to identify possible predisposing factors.METHODS Between 1997 and 2007, we performed 866 RPP and 2052 RRP for localized prostate cancer. Median follow-up was 52 months (12-136). We analyzed preoperative serum prostate-specific antigen, prostate size, clinical and pathologic tumor stage, neoadjuvant hormone deprivation, previous transurethral resection of the prostate, transfusion requirement, anastomotic insufficiency, and acute urinary retention (AUR) and its subsequent management to identify possible predisposing factors for AS formation.RESULTS The rate of AS after RPP and RRP was 3.8% (33/863) and 5.5% (113/2048), respectively (P = .067). In multivariate analysis, RRP was a statistically significant risk factor for AS (P = .0002). On survival analysis, the incidence of AS was lower for RPP as compared with RRP at median follow-up (P = .0229). Primary response to endoscopic AS incision or resection was 94% (31/33) and 72.6% (82/113) after RPP and RRP, respectively. On multivariate logistic regression analysis biopsy Gleason score, previous transurethral resection of the prostate, prostate volume, pathologic tumor stage and grade, transfusion requirement, AUR, and surgical technique were independent risk factors for the development of AS. An AS developed in 45.4% (20/44) and 10.9% (5/46) of the postoperative AUR cases treated with a suprapubic cystostomy tube and a transurethral Foley catheter, respectively (P < .05).CONCLUSIONS ASs occur more frequently after RRP in comparison with RPP. Primary endoscopic AS incision or resection are both highly successful. Treating postoperative AUR with a suprapubic cystostomy poses a high risk for AS formation and should be avoided. UROLOGY 76: 417-422, 2010. (C) 2010 Elsevier Inc.