Erectile Function Recovery after Radical Prostatectomy in Men with High Risk Features
| Autor: | Pedro Recabal, Ronald J. Caras, Daniel Sjöberg, James A. Eastham, Karim Touijer, Melissa Assel, John E. Musser, Jonathan A. Coleman, Raul O. Parra, Peter T. Scardino, Vincent P. Laudone, John P. Mulhall |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Biochemical recurrence medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology 03 medical and health sciences Postoperative Complications 0302 clinical medicine Erectile Dysfunction Risk Factors medicine Humans Stage (cooking) Aged Retrospective Studies Prostatectomy business.industry Margins of Excision Prostatic Neoplasms Middle Aged Neurovascular bundle medicine.disease Primary tumor Surgery Prostate-specific antigen Erectile dysfunction 030220 oncology & carcinogenesis Neoplasm Grading Positive Surgical Margin business |
| Zdroj: | Journal of Urology. 196:507-513 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2016.02.080 |
| Popis: | We describe the efficacy of radical prostatectomy to achieve complete primary tumor excision while preserving erectile function in a cohort of patients with high risk features in whom surgical resection was tailored according to clinical staging, biopsy data, preoperative imaging and intraoperative findings.In a retrospective review we identified 584 patients with high risk features (prostate specific antigen 20 ng/ml or greater, clinical stage T3 or greater, preoperative Gleason grade 8-10) who underwent radical prostatectomy between 2006 and 2012. The probability of neurovascular bundle preservation was estimated based on preoperative characteristics. Positive surgical margin rates and erectile function recovery were determined in patients who had some degree of neurovascular bundle preservation.The neurovascular bundles were resected bilaterally in 69 (12%) and unilaterally in 91 (16%) patients. The remaining patients had some degree of bilateral neurovascular bundle preservation. Preoperative features associated with a lower probability of neurovascular bundle preservation were primary biopsy Gleason grade 5 and clinical stage T3 disease. Among the patients with some degree of neurovascular bundle preservation 125 of 515 (24%) had a positive surgical margin, and 75 of 160 (47%) men with preoperatively functional erections and available erectile function followup had recovered erectile function within 2 years.High risk features should not be considered an indication for complete bilateral neurovascular bundle resection. Some degree of neurovascular bundle preservation can be done safely by high volume surgeons in the majority of these patients with an acceptable rate of positive surgical margins. Nearly half of high risk patients with functional erections preoperatively recover erectile function after radical prostatectomy. |
| Databáze: | OpenAIRE |
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