Retzius-sparing radical prosatectomy: First 200 Australian cases

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass Pub Date : 2025-02-04 DOI:10.1002/bco2.489

Troy Richard John Gianduzzo, Philip Ellard Dundee

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Abstract

Objectives

The objective of this study is to report the first multi-centred Australian series of 200 cases of Retzius-sparing radical prostatectomy (RSRP).

Patients and methods

Between April 2017 and June 2024, 200 RSRP procedures (197 robotic, three laparoscopic) were performed separately by the authors in five centres across two Australian cities (Melbourne, Victoria and Brisbane, Queensland). Data were collected prospectively with ethics committee approval (UCH-HREC 2019.01.279) at weeks 1, 4–6, and three-monthly. Exclusion criteria included prostate size >80 cc, significant middle lobe, large anterior tumour, previous TURP or any clinical factor deemed to make RSRP unsuitable. These criteria were relaxed as experience was gained.

Results

Median (interquartile range) age, body mass index and PSA were 65 (60–70) years, 26 (25–29) kg/m² and 5.2 (4.0–7.0) ng/mL. Low, intermediate and high D'Amico risk groups were 3.5%, 75.0% and 21.5%, respectively. Median (interquartile range) skin-to-skin operative time was 163 (125–210) min and blood loss 200 (100–350) mL. There were 17 (8.5%) Clavien–Dindo grade 1–2 complications and 8 (4%) grade 3 complications. Final pT stage was 60.5% pT2 and 39.5% pT3. The overall positive surgical margins (PSM) rate was 14.5% including 3.3% pT2 and 29.1% pT3. At 1 week post catheter removal 53.5% were pad-free, increasing to 58.5% and 65.0% at 4 and 6 weeks, then 79.5%, 84.6%, 88.2% and 91.3% at 3, 6, 9 and 12 months, respectively. When a security pad is included, 71.5% and 85.5% of men were continent at 4 and 6 weeks, then 94%, 96%, 96% and 97% at 3, 6, 9 and 12 months, respectively. Three men required a suburethral sling and one an artificial urinary sphincter. Ninety of 140 (60.4%) preoperatively potent men were potent at 12 months with or without phosphodiesterase-5 inhibitors.

Conclusion

RSRP provides excellent early continence and can be introduced safely with good oncological results by experienced minimally- invasive surgeons.

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保留retzius的根治性前列腺切除术：前200例澳大利亚病例

本研究的目的是报道澳大利亚第一个多中心系列的200例保留retzius的根治性前列腺切除术（RSRP）。在2017年4月至2024年6月期间，作者在澳大利亚两个城市（墨尔本，维多利亚和昆士兰州布里斯班）的五个中心分别进行了200次RSRP手术（197次机器人手术，3次腹腔镜手术）。经伦理委员会批准（UCH-HREC 2019.01.279），在第1周、第4-6周和第3个月前瞻性收集数据。排除标准包括前列腺大小80cc、显著的中叶、较大的前叶肿瘤、既往TURP或任何被认为不适合RSRP的临床因素。随着经验的积累，这些标准放宽了。结果年龄、体重指数和PSA的中位数（四分位数间距）分别为65（60-70）岁、26 (25-29)kg/m2和5.2 (4.0-7.0)ng/mL。低、中、高D'Amico风险组分别为3.5%、75.0%和21.5%。皮肤对皮肤手术时间中位数为163 (125-210)min，出血量为200 (100-350)mL。Clavien-Dindo 1-2级并发症17例（8.5%），3级并发症8例（4%）。最终pT分期为60.5% pT2和39.5% pT3。总体手术切缘阳性（PSM）率为14.5%，其中pT2为3.3%，pT3为29.1%。拔管1周时，53.5%的患者无尿垫，4周和6周时分别增加到58.5%和65.0%，3、6、9和12个月时分别增加到79.5%、84.6%、88.2%和91.3%。当使用安全垫时，71.5%和85.5%的男性在4周和6周时保持稳定，而在3、6、9和12个月时分别为94%、96%、96%和97%。三名男子需要在喉下吊带，一人需要人工尿道括约肌。140名术前有效的男性中有90名（60.4%）在使用或不使用磷酸二酯酶-5抑制剂的12个月时有效。结论RSRP具有良好的早期尿失禁效果，可由经验丰富的微创外科医生安全引入，肿瘤效果良好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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