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  • Cancer de la Prostate
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Prostatectomie radicale rétropubienne avec préservation nerveuse. Technique et résultats à propos de 200 cas

Nerve-sparing radical retropubic prostatectomy: technique and results of the first 200 cases

Andrologie volume 13, pages 232–241 (2003)Cite this article

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Introduction

La préservation des nerfs érecteurs dans la prostatectomie radicale rétropubienne expose au risque de marges d’exérèses postérolatérales positives. Nous décrivons des modifications de la technique de préservation nerveuse en analysant l’incidence des marges d’exérèses positives et le taux de reprise des rapports sexuels.

Méthode

entre 1990 et 2000, 605 patients ont été opérés d’une prostatectomie radicale rétropubienne; parmi eux, 200 patients consécutifs ont été sélectionnés pour une préservation nerveuse: bilatérale (87%), unilatérale (13%). L’âge moyen était de 61,7 ans, le P.S.A. moyen 10,48, le stade clinique T1 (41%) ou T2 (59%), le score de Gleason de 2 à 6 pour 81% et de 7 à 8 pour 19%.

Les pièces de prostatectomies ont été totalement encrées avant d’être fixées et analysées histologiquement selon le protocole de Stanford.

La fonction érectile a été systématiquement évaluée avant l’intervention, puis régulièrement tous les trois mois pendant deux ans en post-opératoire. Seuls les patients ayant une reprise des rapports sexuels avec pénétration vaginale sans assistance pharmacologique ont été considérés puissants.

Résultats

Des marges d’exérèses positives ont été retrouvées chez 35 (17%) patients et identifiés en postéro-latéral sur le site de la préservation nerveuse chez 8 (4%) patients.

Au total, sur les 157 patients évaluables avec un recul minimum de 2 ans, 70% ont une reprise des rapports sexuels sans aide pharmacologique. En analyse multivariée, les seuls facteurs pronostiques significatifs affectant la reprise post-opératoire des rapports sexuels ont été la qualité de la fonction érectile pré-opératoire et le degré de préservation, bilatéral versus unilatéral; l’âge n’a pas été identifié comme facteur pronostique significatif.

Conclusion

Les améliorations techniques de la préservation nerveuse apportent un risque extrêmement limité de marges d’exérèses postéro-latérales positives, en maintenant des résultats très favorables sur la reprise de la fonction érectile.

Abstract

Objectives

Nerve-sparing radical retropublic prostatectomy carries a risk of leaving positive posterolateral margins with controversial potency recovery rates. We analyses the potency recovery rate and the incidence of positive surgical margins observed with the nerve-sparing procedure in 200 cases.

Methods

Between 1990 and 2000, 605 patients underwent radical retropubic prostatectomy; 200 consecutive potent patients were selected for nerve-sparing: bilateral (87%), unilateral (13%). Mean age was 61.7, mean PSA was 10.48, clinical stage: T1 (41%) T2 (59%), Gleason score: 2 to 6 (81%) 7 to 8 (19%).

Specimens were step-sectioned for histological examination, according to the Stanford protocol.

Erectile function was evaluated before surgery and postoperatively every 3 months for 2 years. Only patients who achieved unassisted intercourse were considered to be potent.

Results

Positive surgical margins were found in 35 (17%) patients and identified at the nerve-sparing site in 8 (4%) patients. Overall, 157 patients were followed for two years and recovery of potency was observed in 70% of them. On multivariate analysis, the most significant factors affecting postoperative potency were preoperative erectile function and extent of nerve sparing, bilateral versus unilateral; age was not significant.

Conclusions

Nerve-sparing techniques in radical retropubic prostatectomy carry a very low incidence of positive posterolateral margins and yield favorable results in terms of potency recovery.

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Authors and Affiliations

  1. Service d’Urologie, Clinique Jules Verne, Nantes

    Philippe Chauveau, Christian Barre, Philippe Pocholle & Philippe Colls

  2. Laboratoire de Statistiques Médicales, Paris

    Hervé Picard

  3. Institut d’Histo-Pathologie, Nantes

    Geneviève Aillet

Authors
  1. Philippe Chauveau
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  2. Christian Barre
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  3. Hervé Picard
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  6. Geneviève Aillet
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Correspondence to Philippe Chauveau.

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Chauveau, P., Barre, C., Picard, H. et al. Prostatectomie radicale rétropubienne avec préservation nerveuse. Technique et résultats à propos de 200 cas. Androl. 13, 232–241 (2003). https://doi.org/10.1007/BF03034877

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Basic and Clinical Andrology

ISSN: 2051-4190