Background: Cold dissection (CD) during nerve-sparing robot-assisted radical prostatectomy (nsRARP) in patients with prostate cancer has been proposed to improve functional outcomes by reducing the thermal damage to neurovascular bundles (NVBs). This study compares the impact of CD versus thermal dissection (TD) on postoperative early continence and erectile function recovery.Methods: A prospective comparative analysis was conducted on patients undergoing nsRARP, comparing CD and TD techniques. Continence was assessed at 15, 30, and 90 days, while erectile function was evaluated at 30, 90, and 180 days using IIEF-5 scores. Logistic and linear regression analyses were performed to identify predictors of functional recovery.Results: CD significantly improved early continence at 15 and 30 days (p< 0.05), although the difference diminished by 90 days. Erectile function recovery was consistently higher in the CD group at all time points (p< 0.01). Age negatively impacted continence and erectile function recovery, while preoperative IIEF-5 scores were strong predictors of erectile function. Prostate volume, BMI, and metabolic syndrome showed no significant influence on outcomes.Conclusions: CD enhances early continence and erectile function recovery following nsRARP by preserving NVBs and minimizing thermal damage. This technique offers a valuable approach to improving patient functional outcomes. Further studies are required to validate its long-term benefits.
背景：在前列腺癌患者接受保留神经的机器人辅助根治性前列腺切除术（nsRARP）过程中，采用冷分离（CD）技术被认为可通过减少对神经血管束（NVBs）的热损伤来改善功能预后。本研究比较了CD与热分离（TD）技术对术后早期尿控功能和勃起功能恢复的影响。 方法：对接受nsRARP的患者进行前瞻性比较分析，对比CD与TD技术。分别在术后15天、30天和90天评估尿控功能，并在术后30天、90天和180天使用国际勃起功能指数-5（IIEF-5）评分评估勃起功能。采用逻辑回归和线性回归分析确定功能恢复的预测因素。 结果：CD组在术后15天和30天的早期尿控功能显著改善（p<0.05），但至90天时差异减小。在所有时间点，CD组的勃起功能恢复率均显著更高（p<0.01）。年龄对尿控和勃起功能恢复有负面影响，而术前IIEF-5评分是勃起功能恢复的重要预测因素。前列腺体积、体重指数（BMI）及代谢综合征对预后无显著影响。 结论：CD技术通过保护神经血管束并最小化热损伤，可促进nsRARP术后早期尿控功能和勃起功能的恢复。该技术为改善患者功能预后提供了有效方法，其长期效益尚需进一步研究验证。
肿瘤(癌症)患者之家