FUAT KIZILAY, Serdar KALEMCİ, Barış ALTAY

Yüksek riskli prostat kanserinde robotik ve açık radikal prostatektominin erken-dönem erektil fonksiyon sonuçlarının karşılaştırılması

AMAÇ: Robot-yardımlı (RYRP) ve retropubik (RRP) radikal prostatektominin fonksiyonel sonuçlarını karşılaştıran çok sayıda çalışma olmasına rağmen, yüksek-riskli hasta grubu gibi seçilmiş bir hasta grubunda karşılaştıran çalışma sayısı kısıtlıdır. Bu çalışmada, yüksek-riskli prostat kanserli (PK) hastalarda bu iki yöntemin ereksiyon sonuçlarının karşılaştırılması amaçlandı. GEREÇ ve YÖNTEM: Yüksek-riskli PK nedeniyle RRP uygulanan 84 hasta ve RYRP uygulanan 60 hasta çalışmaya dahil edildi. Hastaların demografik verileri, perioperatif veriler, hastaya ve hastalığa özgü faktörler, preoperatif ve postoperatif 3. ay Uluslararası Erektil Fonksiyon İndeksi (IIEF) skorları, hasta dosyalarından retrospektif olarak kaydedildi. Çalışmanın birincil amacı, iki yöntem arasında erektil fonksiyondaki değişimin karşılaştırılmasıydı; ikincil amacı ise iki yöntem arasındaki perioperatif verilerin ve onkolojik sonuçların karşılaştırılmasıydı. İstatistiksel anlamlılık için 0,05’den küçük p değerleri kabul edildi BULGULAR: İki grubun demografik ve histopatolojik verileri benzerdi. İki grupta da postoperatif 3. ayda bakılan IIEF skorunda belirgin azalma mevcuttu (birinci grupta -10,42±2,72 ve ikinci grupta -9,82±1,86 puan, p=0,330). Bununla uyumlu şekilde her iki grupta da orta ve ileri düzeyde erektil disfonksiyonu olan hasta oranında artış mevcuttu ancak bu oranlar arasında anlamlı bir farklılık yoktu. Her iki grupta da hastaların yaklaşık yarısında potens korunmuştu. Ayrıca, operasyon süresi RRP lehine bulunurken (p=0,024), postoperatif kateterizasyon süresi ve tahmini kan kaybı, RYRP lehine bulundu (sırasıyla, p=0,019 ve p=0,036). SONUÇ: Radikal prostatektomi, yüksek-riskli PK hastalarında düşük komplikasyon oranları ve erken dönem kabul edilebilir potens oranlarıyla güvenle uygulanabilir. Açık ve robotik teknik arasında yüksek-riskli PK hastalarında erken dönem erektil fonksiyonların korunmasında önemli bir fark saptanmamıştır

Comparison of short-term erectile function results of robotic and open radical prostatectomy in high-risk prostate cancer

OBJECTIVE: The number of studies comparing the functional results of robot-assisted (RARP) and retropubic (RRP) radical prostatectomy, in a high-risk group of patients, is limited. In this study, we compared the erectile function results of these two methods in patients with high-risk prostate cancer (PCa). MATERIAL and METHODS: Eighty-four patients who underwent RRP and 60 patients who underwent RARP for high-risk PCa were included in this study. Demographic data, perioperative data, patient and disease specific factors, preoperative and postoperative 3rd month International Index of Erectile Function (IIEF) scores were recorded retrospectively from hospital registration system. The primary aim of the study was to compare the change in erectile function between two methods; the secondary aim was to compare the perioperative data and oncologic results between the two methods. P values less than 0.05 were accepted for statistical significance. RESULTS: Demographic and pathological data of the two groups were similar. There was a significant decrease in the IIEF score in the postoperative 3rd month in both groups (-10.42±2.72 in the first group and-9.82±1.86 in the second group, p=0.330). Consistent with this finding, there was an increase in the number of patients with intermediate and advanced erectile dysfunction in both groups, but there was no significant difference between these groups. In both groups, the potency was preserved in approximately half of the patients. In addition, the mean operation time was found in favor of RRP (p=0.024), while mean postoperative catheterization time and estimated blood loss were found in favor of RARP (p=0.019 and p=0.036, respectively). CONCLUSION: Radical prostatectomy can be performed safely in patients with high-risk PCa with low complication rates and acceptable early potency rates. There was no significant difference between the open and the robotic technique for the preservation of short-term erectile function.

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