Laparoscopic radical prostatectomy with the simultaneous implant of a penile prosthesis: ten years follow up.

IF 1.3 Q3 UROLOGY & NEPHROLOGY
Archivio Italiano di Urologia e Andrologia Pub Date : 2025-03-28 Epub Date: 2025-02-17 DOI:10.4081/aiua.2025.13541
Nicola Mondaini, Andrea Abramo, Caterina Romeo, Fabio Crocerossa, Francesco Cantiello, Rocco Damiano, Riccardo Bartoletti
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引用次数: 0

Abstract

Introduction: Even today, despite technological evolution, erectile dysfunction remains the most feared complication after radical prostatectomy surgery expecially for patients who report pre-existent refractory erectile dysfunction (ED) and patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3, who undergo non-nerve sparing radical prostatectomy (RP). To overcome this issue, Khoudary et al. performed the first simultaneous placement of a penile prosthesis during open RP in 1997, aiming at an early return to sexual function without any impact on oncological outcomes and without significant adverse effects. Ten years ago we performed laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) on ten patients in order to preserve the full length of the penis and to improve their satisfaction and quality of life (QoL) increasing the chances of ED resolution.

Objectives: Aim of this study is to illustrate the ten years follow up of this case series which has no terms of comparison in the world. Oncological and functional results were analyzed.

Materials and methods: In 2013 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis). Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each year thereafter. The main outcome measures were biochemical recurrence-free rate, penile length and quality of life.

Results: Eight patients with mean age 71 (range 66-75) were reached at the 10-year follow-up; one patient died of acute infarction 10 years after surgery and another one died of disease 7 years after surgery. Partners had, currently, mean age 60 (range 37-71). Mean preoperative PSA was 9.3 (6.3-13.7) and mean PSA at 10 years was 0.08 (range 0.01-1.2). International index erectile function IIEF before surgery was 11 (range 9-14) and 23 (range 22-25) at 10 years. Partner satisfaction rating increased from 7 (post-surgical) to 8 at 10 years. Penis length was unchanged after 10 years: mean intraoperative length was 9 cm (range 8.5-9.5) and mean length at 10 years was 8.8 cm (range 8-9.5).

Conclusions: In our cases, laparoscopic radical prostatectomy with the simultaneous implant of a penile prosthesis demonstrate to be an interesting option to offer to selected and highly motivated patients. Outcomes like preservation of the penis length, resuming of normal sexual activity 21 days after surgery, partner satisfaction and oncological safety at 10-year follow-up make it a valid surgical technique to be proposed in clinical practice if performed by an experienced team in prosthetic surgery.

腹腔镜根治性前列腺切除术同时植入阴茎假体:10年随访。
即使在今天,尽管技术不断发展,但勃起功能障碍仍然是根治性前列腺切除术后最可怕的并发症,特别是对于那些报告先前存在难治性勃起功能障碍(ED)的患者和那些接受非保留神经的根治性前列腺切除术(RP)的患者,如任何cT2c或cT3,他们有很高的囊外疾病风险。为了克服这一问题,Khoudary等人于1997年首次在开放性RP期间同时放置阴茎假体,目的是在不影响肿瘤预后和无显著不良反应的情况下早日恢复性功能。十年前,为了保持阴茎的完整长度,提高患者的满意度和生活质量(QoL),增加ED解决的机会,我们对10例患者进行了腹腔镜下腹腔外RP和同时阴茎假体植入术(PPI)。目的:本研究的目的是说明该病例系列的十年随访情况,该病例系列在世界上没有可比性。对肿瘤和功能结果进行分析。材料和方法:2013年,10例患者同时接受了PPI(使用AMS InhibiZone假体)。通过术前、出院时、术后第21至28天、第一年每3个月、此后每年的泌尿科就诊、问卷调查和客观测量对患者进行评估。主要观察指标为生化无复发率、阴茎长度和生活质量。结果:随访10年,共8例患者,平均年龄71岁(66-75岁);1例术后10年死于急性梗死,1例术后7年死于疾病。目前,合伙人的平均年龄为60岁(37-71岁)。术前平均PSA为9.3(6.3-13.7),10年平均PSA为0.08(0.01-1.2)。术前国际勃起功能指数IIEF为11(范围9-14),10年时为23(范围22-25)。术后10年伴侣满意度从7分提高到8分。10年后阴茎长度不变:术中平均长度为9 cm(范围8.5-9.5),10年平均长度为8.8 cm(范围8-9.5)。结论:在我们的病例中,腹腔镜根治性前列腺切除术同时植入阴茎假体证明是一种有趣的选择,可以提供给选定的和高度积极的患者。如保留阴茎长度,术后21天恢复正常的性活动,伴侣满意度和10年随访的肿瘤安全性等结果,如果由经验丰富的假体手术团队进行,则可以在临床实践中提出有效的手术技术。
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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来源期刊
CiteScore
2.10
自引率
35.70%
发文量
72
审稿时长
10 weeks
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