Impact of Prostate Median Lobe Anatomy on Robotic-assisted Laparoscopic Prostatectomy

被引:38
作者
Meeks, Joshua J. [1 ]
Zhao, Lee [1 ]
Greco, Kristin A. [1 ]
Macejko, Amanda [1 ]
Nadler, Robert B. [1 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Dept Urol, Chicago, IL 60611 USA
关键词
RADICAL PROSTATECTOMY; OUTCOMES;
D O I
10.1016/j.urology.2008.08.484
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES Robotic-assisted laparoscopic prostatectomy (RALP) is becoming widely used for the management of prostate cancer. Although prostate size does not affect operative times for RALP, the effect of a large median prostate lobe has not been described. METHODS One hundred fifty-four men underwent RALP by one surgeon between 2005 and 2007. Patients were categorized into 2 groups based on the presence or absence of a large median prostate lobe identified during RALP. The RALP was divided into sections from bladder mobilization to vesicourethral anastomosis. Operative times and outcomes were recorded prospectively. RESULTS Of the 154 patients, 29 (18%) of the men had large median prostate lobes. Men with large median lobes were slightly older, but had similar prostate-specific antigen, body mass index, clinical and pathologic stage, biopsy and prostatectomy Gleason grade, tumor volumes, and Surgical margin rate compared with men without median lobes. Yet, prostate weight, estimated blood loss, and hospital stay was significantly greater in men with large median lobes. The overall operative time for the RALP was greater in men with a large median lobe caused by an increased time required for posterior bladder neck and seminal vesicle dissection. There was no difference in complications such as urine leaks, bladder neck contractures, and migration of Hem-o-lok clips into the bladder. Continence at 3 and 6 months after RALP were not significantly different in men with large median lobes. CONCLUSIONS Despite equivalent oncological outcomes, we demonstrate a significant increase in operative times among men with large median lobes. UROLOGY 73: 323-327, 2009. Published by Elsevier Inc.
引用
收藏
页码:323 / 327
页数:5
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