机器人治疗良性前列腺增生专家共识

Expert consensus on robotic therapy for benign prostatic hyperplasia

机器人辅助腹腔镜在泌尿外科领域得到越来越广泛地应用,但治疗良性前列腺增生疾病缺乏专家共识和指南指导临床实践。本共识收集中英文数据库中有关机器人治疗良性前列腺增生的文献资料,手术方式主要包括机器人耻骨后单纯前列腺切除术、机器人经膀胱途径单纯前列腺切除术和机器人耻骨后入路保留尿道前列腺切除术三种。前两者不保留前列腺部尿道,后者保留前列腺部尿道。后者在保留患者尿道的完整性,防治逆行射精,保持勃起和性功能方面显示出优异的疗效。机器人治疗良性前列腺增生适合前列腺增生伴有中、重度下尿路症状患者,特别是由于身体条件限制而无法接受经内镜治疗的患者,如尿道下裂或狭窄患者。但由于接受骨盆手术或放射治疗而导致前列腺手术平面封闭的患者,不适合行机器人手术治疗。

Robot-assisted laparoscopy is increasingly used in the field of urology,but there is not sufficient ex⁃pert consensus and guidelines to guide clinical practice in the treatment of benign prostatic hyperplasia.This consensus collected the literatures on robotic treatment of benign prostatic hyperplasia in both Chinese and English databases.The main surgical options include robot-assisted simple retropubic prostatectomy,robot-assisted transvesical ap⁃proach simple prostatectomy and robot-assisted urethra-sparing prostatectomy.The prostatic urethra is not retained in the former two while it is retained in the latter one.The latter has presented excellent efficacy in preserving the integ⁃rity of the patient's urethra preventing retrograde ejaculation and maintaining erection and sexual function.Robotic treatment of benign prostatic hyperplasia is suitable for patients with moderate to severe lower urinary tract symp⁃toms,especially those who cannot receive endoscopic treatment due to physical limitations such as patients with hypo⁃spadias or stenosis.However patients whose surgical plane of the prostate are closed due to pelvic surgery or radiation therapy are not candidates for robotic surgery.