Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press39810.17650/1726-9776-2014-10-4-62-69PROSTATE CANCERРАК ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫUrethra-sparing prostatectomy: indications, surgical technique, functional and oncologic resultsУретросберегающая простатэктомия: показания, хирургическая техника, функциональные и онкологические резу льтатыKostyukI. P.КостюкИ. П.
Russian Federation
dr.igor.kostyuk@gmail.comVasilyevL. A.ВасильевЛ. А.
Russian Federation
KrestyaninovS. S.КрестьяниновС. С.
Russian Federation
KrasikovD. N.КрасиковД. Н.
Russian Federation
S.M. Kirov Military Medical AcademyВоенно-медицинская академия им. С.М. Кирова6, Ac. Lebedev Street, St. Petersburg, 194044, RussiaРоссия, 194044 Санкт-Петербург, ул. Академика Лебедева, 63012201410462690112201401122014https://oncourology.abvpress.ru/oncur/article/view/398

Objective. To evaluate the effect of preserving proximal and distal segments of the prostatic urethra on functional and oncological outcomes retropubic prostatectomy.

Patients and methods. 97 men who underwent radical prostatectomy were divided into two groups. The first group (n = 49) included patients with complete retention of the bladder neck and prostatic urethra segments followed urethro- urethral anastomosis. The control group (n = 48) included patients who have not been saved the bladder neck. Continence control produced by the method of monitoring the daily amount of urine in the pad.Social aspects and quality of life was assessed using conventional questionnaire. Radical surgery was evaluated by «negative surgical margin».

Results. Within 1, 3, 6 and 12 months after surgery the average loss of urine control patients with respect to patients of the study group was 741.3 g vs. 218.3 g, 56.9 g and 16.5 g, 48.7 g, against 8.5 g and 35.6 g from 3.3 g, respectively (for each comparison, p < 0.05). The indicator of the quality of life of the patients of the first group on all end points was significantly higher than those of the second group. There were no significant differences betweenthe frequency of «positive margins» in patients in the control group and the group with a fully preserved bladder neck (5.8 % vs. 5.4 %, p = 0.65).

Conclusions. Preservation of the bladder neck and proximal and distal segments of the prostatic urethra during radical prostatectomy significantly improved urinary function, and can achieve full satisfaction of quality of life in these patients compared with patients in the control group, subject to the necessary oncologic outcomes.

Цель исследования – оценка эффекта сохранения дистального и проксимального сегментов простатического отдела уретры на функциональные и онкологические результаты позадилонной простатэктомии.

Материалы и методы. В исследование были включены 97 мужчин, перенесших радикальную простатэктомию. В основную группу (n = 49) включены пациенты с полным сохранением шейки мочевого пузыря (ШМП) и сегментов простатического отдела уретры с последующим прямым уретро-уретральным анастомозом. В контрольную группу (n = 48) вошли пациенты, которым ШМП сохранить не удалось. Контроль удержания мочи проводили с помощью метода суточного мониторинга количества выделенной мочи в прокладки. Социальные аспекты и качество жизни пациентов оценивали с помощью общепринятого опросника. Радикальность операции оценивали по характеру хирургического края.

Результаты. В течение 1, 3, 6 и 12‑го месяцев после операции средняя потеря мочи у пациентов контрольной группы в сравнении с таковой у пациентов с сохраненными сегментами простатического отдела уретры составила 741,3 г против 218,3 г, 56,9 г против 16,5 г, 48,7 г против 8,5 г и 35,6 г против 3,3 г соответственно (для каждого сравнения р < 0,05). Показатель качества жизни пациентов основной группы на всех контрольных точках был статистически значимо выше, чем у пациентов контрольной группы. Не выявлено существенного различия между частотой положительного хирургического края у пациентов контрольной группы и группы с полностью сохраненной ШМП (5,8 % против 5,4 %; р = 0,65).

Выводы. Сохранение ШМП, а также дистального и проксимального сегментов простатического отдела уретры при радикальной простатэктомии достоверно улучшает функцию удержания мочи и позволяет достичь полного удовлетворения качеством жизни у данных пациентов в сравнении с пациентами, которым ШМП сохранить не удалось, при условии соблюдения необходимых онкологических результатов.

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