神経保存的前立腺全摘術の術後尿コンチネンスに関する検討

Abstract

神経保存的前立腺全摘術20例と従来の術式による前立腺全摘術13例とで術後の排尿コントロールおよび尿道機能につき比較検討した.1)術後continentであった症例は, 神経保存群で14例, 従来群で6例であり, 尿失禁のある場合も, 神経保存群ではその程度が軽い.2)術後1ヵ月目の平均最高尿道内圧は, 神経保存群31.5±5.4 cmH2O, 従来群23.2±5.7 cmH2Oであり, 機能的尿道長では両群の間に有意差はみられなかった.3)前立腺全摘術において神経血管束を保存することは, 術後の勃起機能の保持の面からではなく, 排尿コントロールに対して重要な意味を持つ

Recently, the morbidity of radical prostatectomy has been reduced by improvements in surgical techniques and greater understanding of pelvic anatomy. The nerve sparing technique has been considered to be a major contribution to this advance. In our study, urinary control was compared in 33 consecutive patients undergoing a radical retropubic prostatectomy. In 13 patients, a conventional radical prostatectomy was performed and in 20 subsequent patients, a nerve sparing operation was performed. The staff surgeons were the same throughout the study. The age of the patients and pathological stage of the tumor were not significantly different between the groups. The operative time was shorter and intraoperative blood loss was less both significantly in the nerve sparing group. In the conventional operated group, there was one patient with total incontinence and two with significant incontinence requiring absorbable pads. In the nerve sparing group, there were no patients having total incontinence and one had stress incontinence requiring absorbable pads. Urethral pressure profile was measured postoperatively in 17 in the nerve sparing group and in 7 in the conventional group. The maximum urethral pressure in the nerve sparing group was 31.5 cm H2O (SD = 5.4) and in the conventional group 23.2 cm H2O (SD = 5.7) with a significant difference between groups (p less than 0.01). The functional urethral length of the nerve sparing group was 16.7 mm (SD = 5.2) and in the conventional group 13.3 mm (SD = 3.7) with no significant difference between the groups. These results suggest that preservation of neurovascular bundles from the pelvic plexus during radical prostatectomy has no important role in postoperative urinary continence.