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Asian Journal of Urology 2023年第4期10卷 423-430页

作者： Umberto Carbonara Giuseppe Lippolis Luciano Rella Paolo Minafra Giuseppe Guglielmi Antonio Vitarelli Giuseppe Lucarelli Pasquale Ditonno Department of Emergency and Organ Transplantation Urology UnitAldo Moro UniversityBariItaly

Objective:In the last 10 years,robotic platforms allowed to resume of some alternative surgical approaches,including perineal robot-assisted radical prostatectomy(p-RARP).Herein,we present in detail the oncological and functional outcomes of patients who underwent p-RARP with a median follow-up of 30 ***:Patients presenting low-or intermediate-risk prostate cancer and prostate volume up to 60 mL who underwent p-RARP between November 2018 and November 2022 were ***,intraoperative,pathological,and postoperative data were collected and then ***:Thirty-seven p-RARP cases were *** patients presented mean age of 62 years and a mean Charlson comorbidity index of *** mass index of≥25 kg/m^(2)was reported by 24(64.9%)patients,as well as 7(18.9%)patients reported a past surgical *** prostate volume and median prostate-specific antigen were 41 mL and 6.2 ng/mL,*** median operative time was 242 *** positive surgical margin rate was 45.9%.In terms of postoperative complications,10 patients reported complications with any grade;however,a single case(2.7%)of major(Clavien-Dindo grade≥3)complication was *** patient with biochemical recurrence or distant metastasis was reported at 2 years of *** of continence rates were 67.6%,75.7%,and 92.9%,at 6 months,12 months,and 24 months after surgery,respectively.

关键词： Prostate cancer robotic Perineal radical prostatectomy Continence robot-assisted radical prostatectomy Nerve-sparing

The current status of robot-assisted radical prostatectomy

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Asian Journal of Andrology 2009年第1期11卷 90-93页

作者： Prokar Dasgupta Roger S. Kirby Department of Urology Guy＇s and St. Thomas ＇Hospitals and King＇s College London School of Medicine London SE1 9RTUK The Prostate Centre London WIG 8GT UK

robot-assisted radical prostatectomy （RARP） is a rapidly evolving technique for the treatment of localized prostate cancer. In the United States, over 65% of radical prostatectomies are robot-assisted, although the acceptance of this technology in Europe and the rest of the world has been somewhat slower. This article reviews the current literature on RARP with regard to oncological, continence and potency outcomes-the so-called ＇trifecta＇. Preliminary data appear to show an advantage of RARP over open prostatectomy, with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most studies show good postoperative continence and potency with RARP; however, this needs to be viewed in the context of the paucity of randomized data available in the literature. There is no definitive evidence to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging. Finally, evolving techniques of single-port robotic prostatectomy, laser- guided robotics, catheter-free prostatectomy and image-guided robotics are discussed.

关键词： da Vinci robot prostate cancer robot-assisted radical prostatectomy

Significance of preoperatively observed detrusor overactivity as a predictor of continence status early after robot-assisted radical prostatectomy

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Asian Journal of Andrology 2014年第6期16卷 869-872页

作者： Akihiro Yanagiuchi Hideaki Miyake Kazushi Tanaka Masato Fujisawa Division of Urology Kobe University Graduate School of Medicine 7-5-1 Kusunoki-Cho Chuo-Ku Kobe Japan.

Several recent studies have reported the involvement of bladder dysfunction in the delayed recovery of urinary continence following radical prostatectomy （RP）. The objective of this study was to investigate the significance of detrusor overactivity （DO） as a predictor of the early continence status following robot-assisted RP （RARP）. This study included 84 consecutive patients with prostate cancer undergoing RARP. Urodynamic studies, including filling cystometry, pressure flow study, electromyogram of the external urethral sphincter and urethral pressure profile, were performed in these patients before surgery. Urinary continence was defined as the use of either no or one pad per day as a precaution only. DO was preoperatively observed in 30 patients （35.7%）, and 55 （65.5%） and 34 （40.5%） were judged to be incontinent 1 and 3 months after RARP, respectively. At both 1 and 3 months after RARP, the incidences of incontinence in patients with DO were significantly higher than in those without DO. Of several demographic and urodynamic parameters, univariate analyses identified DO and maximal urethral closure pressure （MUCP） as significant predictors of the continence status at both 1 and 3 months after RARP. Furthermore, DO and MUCP appeared to be independently associated with the continence at both I and 3 months after RARP on multivariate analysis. These findings suggest that preoperatively observed DO could be a significant predictor of urinary incontinence early after RARP; therefore, it is recommended to perform urodynamic studies for patients who are scheduled to undergo RARP in order to comprehensively evaluate their preoperative vesicourethral functions.

关键词： detrusor overactivity robot-assisted radical prostatectomy urinary incontinence

Nerve-sparing robot-assisted radical prostatectomy:Current perspectives

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Asian Journal of Urology 2021年第1期8卷 2-13页

作者： Anup Kumar Vipul RPatel Sridhar Panaiyadiyan Kulthe Ramesh Seetharam Bhat Marcio Covas Moschovas Brusabhanu Nayak Department of Urology Robotics and Renal TransplantVardhman Mahaveer Medical College and Safdarjang HospitalNew DelhiIndia Department of robotic Surgery AdventHealth Global Robotics InstituteCelebrationFLUSA Department of Urology All India Institute of Medical SciencesNew DelhiIndia

robotic-assisted radical prostatectomy(RARP)is the current standard of care with long term cure in organ-confined *** introduction of nerve-sparing(NS)to standard RARP has shown positive results in terms of functional outcomes in addition to the oncological *** article reviews the current perspectives of NS-RARP in terms of applied anatomy of the prostatic fascial planes,the neurovascular bundle(NVB),various NS techniques and postoperative functional outcomes.A non-systematic review was done using PubMed,Embase and Medline databases to retrieve and analyse articles in English,with following keywords“prostate cancer”,“robotic radical prostatectomy”,“nerve-sparing”.The Delphi method was used with an expert panel of robotic surgeons in urology to analyse the potency outcomes of various published comparative and non-comparative *** literature has shown that NS-RARP involves various techniques and approaches while there is a lack of randomized studies to suggest the superiority of one over the *** such as preoperative risk assessments,baseline potency,surgical anatomy of individual patients and surgeons’expertise play a major role in the outcomes.A tailored approach for each patient is required for applying the NS approach during RARP.

关键词： prostatectomy robot-assisted radical prostatectomy Nerve-sparing

Surgical approach affecting long-term urinary continence status after robot-assisted laparoscopic prostatectomy prospectively evaluated using self-reported functional status(Expanded Prostate Cancer Index Composite,EPIC-26)

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核磁共振成像和神经保留技术在机器人辅助腹腔镜手术治疗高危前列腺癌患者中的应用

当代泌尿学（英文） 2024年第1期18卷 61-65页

作者： Mathias Reichert Ame Strauß Joost Wilhelm Voß Hans Christoph von Knobloch Hannah Maria Neuenhofer Annemarie Uhlig Lutz Trojan Mirjam Naomi Mohr Department of Urology University Medical CenterGoettingenGermany Department of Pediatrics University HospitalBonnGermany

Purpose:The aim of the study was to examine the influence of the surgical approach for robot-assisted laparoscopic prostatectomy(RALP)on long-term urinary continence status in the era of self-reported functional status measures using the Expanded Prostate Can-cer Index Composite 26.Materials and methods:This is a prospective evaluation of 232 patients undergoing RALP between September,2019 and September,*** continence status and postoperative incontinence(pad usage)were evaluated 12 months after RALP using Expanded Prostate Cancer Index Composite 26 *** were categorized according to their surgical approach and outcome into the following groups:successful nerve sparing(NS),primarily without nerve sparing(***),and no nerve sparing by secondary resection(NNS by SR).The median levels of their questionnaire outcomes were evaluated and compared using the Wilcoxon rank sum test with continuity correction.Results:Urinary continence status 12 months after RALP differed significantly between the NS and ***(p=0.0071)and the NS and NNS by SR(p=0.0076)*** was no significant difference between the *** and NNS by SR(p=0.53)*** usage 12 months after RALP had no significant difference with regard to SR of the neurovascular bundle(p=0.14).Conclusions:Patient-reported outcomes of long-term urinary continence status seem to show no difference in postoperative conti-nence,regardless of whether a non-nerve-sparing result was planned or reached through ***,preservation of neurovascular bundle seems to lead to better long-term continence rates.

关键词： Expanded Prostate Cancer Index Composite 26 Nerve sparing Prostate cancer robot-assisted radical prostatectomy Surgical approach Urinary incontinence

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Asian Journal of Andrology 2014年第5期16卷 715-719,I0008页

作者： Jin-Guo Wang Jiaoti Huang Arnold I Chin Department of Urology First Hospital of Jilin University Changchun China Department of Pathology David Geffen School of Medicine Department of Urology Instituteof Urologic Oncology Broad Stem Cell Research Center David Geffen School of Medicine UCLA Los Angeles CA USA

To examine the outcomes of patients with high-risk prostate cancer （PCa） treated by robot-assisted radical prostatectomy （RARP） and evaluate the value of multi-parametric magnetic resonance imaging （MRI） in estimating tumor stage, extracapsular extension, and grade, and the application of nerve sparing （NS） techniques. Patient demographics, preoperative imaging, surgical parameters, pathological features, functional and recurrence outcomes were collected retrospectively in patients with high-risk PCa who underwent RARP between December 2009 and October 2013. Pathological whole mount slides to assess NS were compared with potency, recovery of continence, and surgical margins （SM）. Forty-four cases of high-risk PCa were identified with a median followup of 24 months and positive surgical margins （PSM） rate of 14%. Continence returned in 86%, with potency rate of 58%. Of the 25 cases with a preoperative multi-parametric MRI, MRI improved clinical staging from 28% to 88%, respectively. Following risk stratification of NS by microscopic analysis of whole mount pathology, patients with Group A （bilateral NS）, Group B （unilateral NS）, Group C （partial NS）, and Group D （non-NS） had 100%, 92%, 91%, and 50% continence rates, and 100%, 80%, 45%, and 0% potency rates, respectively, with an inverse correlation to PSM. RARP in men with high-risk PCa can achieve favorable oncologic and functional outcomes. Preoperative MRI may localize high-grade tumors and improve clinical staging. Extent of NS is influenced by clinical staging and may balance potency and continence with PSMs.

关键词： magnetic resonance imaging nerve sparing prostate cancer robot-assisted radical prostatectomy