Murat KESKE, Abdullah Erdem CANDA, Ali Fuat ATMACA, Nurullah HAMİDİ, Mevlana Derya BALBAY

Transüretral prostat rezeksiyonu geçirmiş olmak robotik radikal prostatektomi sonuçlarını nasıl etkiler?

Giriş: Bu çalışmada robot yardımlı radikal prostatektomi (RYRP) yapılan hastalarda geçirilmiş transüretral prostat rezeksiyonu (TUR-P) cerrahisinin perioperatif sonuçlar üzerine etkisi araştırılmıştır.Materyal ve Metod: Şubat 2009-Aralık 2017 arasında 3 cerrah tarafından gerçekleştirilen toplam 752 vakanın verileri retrospektif olarak incelendi. Her bir cerrahın ilk 100 vakası öğrenme eğrisi nedeniyle çalışma dışı bırakıldı. Tüm hastalar (n=452) RYRP öncesinde TUR-P öyküsü olup olmamasına göre iki gruba ayrıldı. Grup 1=TUR-P öyküsü olanlar (n=38), Grup 2=TUR-P öyküsü olmayanlar, (n=414). Bulgular: Sırasıyla grup 1 ve 2’de ortalama hasta yaşı 68.3± 5.9 ve 63.3±6.8 yıl p=0.00; ortalama konsol süresi 144.3±37.1 ve 124.6±24.0 dakika, p=0.02; mesane boynu rekonstrüksiyon gereksinim oranı %31.6 ve %16.7, p=0.02; ortalama transüretral kateter kalış süresi 11.3±5.1 ve 8.6±2.7 gün, p=0.00 saptanmıştır. Sırasıyla grup 1 ve 2’de, pozitif cerrahi sınır, grup 1’de %26.3, grup 2’de %27.3, p=0.897 ve erektil fonksiyon oranları (IIEF≥17) (postoperatif 12. ay grup 1’de %60, grup 2’de %67, p=0.644) benzer saptanmıştır. Erken dönemde (3. ay) kontinans oranları grup 1 ve grup 2 de sırasıyla %52.6 ve %72 olarak bulunmuştur (p=0.035). 12. ay sonunda kontinans oranları açısından iki grupta %94.7 ve %97.3 olarak birbirine benzer sonuçlar elde edilmiştir (p=0.562). Sonuç: TUR-P sonrası RYRP ameliyatı yapılması, TUR-P geçirmeyen hastalara göre benzer onkolojik sonuçları olan, daha uzun ameliyat süresi olan, postoperatif erken kontinans kazanılması oranları daha az olan ve daha uzun süre idrar sondası takılması gerektiren bir ameliyattır.

Anahtar Kelimeler:

Prostat kanseri, Robotik prostatektomi, TUR-P

How does previous transurethral resection of the prostate affect the results of robotic radical prostatectomy?

Objective: We investigated the impact of transurethral resection of the prostate (TUR-P) on perioperative outcomes in patients who underwent robot assisted radical prostatectomy (RARP).Material and Methods: A total of 752 cases performed by 3 surgeons between February 2009 and December 2017 were reviewed retrospectively. First 100 cases of each surgeon were not included to exclude the learning curve effect. All patients (n = 452) were divided into two groups according to having a previous TUR-P history as Group 1 = patients with TUR-P history (n = 38), Group 2 = patients without TUR-P history (n = 414).Results: Mean patient age was 68.3± 5.9 versus 63.3±6.8 years p=0.00; mean console time was 144.3±37.1 versus 124.6±24.0 minutes, p=0.02; bladder neck reconstruction was 31.6% versus 16.7%, p=0.02; transurethral catheter removal time was 11.3±5.1 versus 8.6±2.7 days, p=0.00; for groups 1 and 2, respectively. Positive surgical margin rates were 26.3% versus 27.3%, p=0.897; erectile function (IIEF≥17) rates on postoperative 12th-month were 60% versus 67%, p=0.644 for groups 1 and 2, respectively. First 3 months continence rates were 52.6% versus 72%, p=0.035 for groups 1 and group 2, respectively. Postoperative 12. month continence rates were similar for group 1 and 2(94.7% vs 97.3% ; p=0.562).Conclusion: RARP after TUR-P has similar oncological outcomes, longer operative time, worse postoperative early continence acquisition rates and longer urethral catheter removal time.

Keywords:

Robotic prostatectomy, Prostate cancer, TUR-P,

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