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ROBOTIC RADICAL PROSTATECTOMY WITH PRESERVATION OF THE PENIS DORSAL VEIN COMPLEX AND EARLY RETROGRADED NEUROVASCULAR BUNDLE RELEASE. COMPARATIVE INITIAL CASUITIC WITH TRADITIONAL TECHNIQUE.
Introdução, Material, Método, Resultados, Discussão e Conclusões
introduction - From the studies by Costello and Eichelberg, Menon began to describe the technique of preserving the complex of the dorsal vein of the penis and not opening the endopelvic fascia in 2005, at the Vatikutti Institute. In 2018, Coelho et al described this technique associating the early retrograde release of the neuromuscular bundle, showing very encouraging results.We present our first cases using the technique described by Coelho, comparing with the conventional one by Patel.Materials and methods- After 13 patients operated with the aid of a proctor, we selected 15 patients operated by the same surgeon using the conventional technique (described by Patel -PT) compared to 15 operated using the Coelho technique (CT). Only those who underwent concomitant obturator lymphadenectomy were included and those who were salvage were excluded. Preoperative PSA, prostate volume, surgical time, bleeding estimate, positive margin, and continence and potency were evaluated after 1 month of bladder catheter removal. Results - The mean PSA value was 6.12 x 8.4 ng / ml and prostate volume 46.5 (23-75g) x 45.5 (26-110g) respectively for CT x PT. The estimated bleeding was 356 ml (150-1000 ml) x 346 ml (200-800), operating time 145 (110-195) x 170 min (120-240) respectively for CTxPT and surgical margin was 3 patients for CT x 2 for PT. Urinary continence (up to 1 pad / day) after 1 month of CVD removal was 86% for both cases and the potency rate (SHIM> 17) was 78% x 40% (TC x TP). Discussion-The estimated bleeding was very similar, even without ligature of the plexus, we noticed that the blood loss is not very intense and that it is probably compensated in a shorter surgical time on CT, since we do not need to open the fascia, perform the complex ligature and change instruments. The surgical margin was slightly higher on CT, due to the characteristic of the Coelho technique. Early continence did not prove to be a better CT than TP in our small series, but sexual potency did, showing that the preservation of the anterior prostate nerves may have an impact on sexual function. Conclusions-Both techniques offer very similar bleeding rates, but it seems that the shorter surgical time of CT can have benefits in postoperative recovery. The rate of surgical margin has to be worked on in order to improve the continence indices and especially sexual potency seem very encouraging for CT. A larger sample is necessary to better evaluate the results found.
prostatectomia robotica , continencia urinaria, potencia sexual
Câncer de Próstata Localizado
Hospital de Ipanema - Rio de Janeiro - Brasil
Lessandro Goncalves Curcio, Rafael F Abrahao, Rafael Rosa