Reconstrução do colo vesical em prostatectomia radical: estudo randomizado sobre o papel da eversão mucosa vesical
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Data
2003
Autores
Paranhos, Mario Luiz da Silva [UNIFESP]
Orientadores
Srougi, Miguel [UNIFESP]
Tipo
Tese de doutorado
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O presente estudo, prospectivo, randomizado e controlado, comparando dois grupos de pacientes submetidos a prostatectomia radical por cancer de, prostata foi efetuado comi o objetivo de estudar o valor da reconstrucao do colo vesical com e sem a eversao da mucosa. Foram analisados os indices de esclerose de colo e continencia urinaria, no decorrer dos seis meses subsequentes. Foi estudada tambem a frequencia de extravasamento de urina ao nivel da reconstrucao do colo vesical. Foram incluidos no estudo 100 casos de cancer de prostata com estagio Tlc - T2c, submetidos a prostatectomia radical retropubica pelo mesmo cirurgiao, e o tipo de reconstrucao de colo vesical foi escolhido, por sorteio, durante a cirurgia. No final analisaram-se 95 dos 100 pacientes recrutados, tendo sido excluidos cinco pacientes quer tiveram seu pos-operatorio prejudicada por perda de seguimento ou por nao terem feito a cistografia. Os pacientes foram alocados em dois grupos, submetidos respectivamente a anastomose vesico-uretral com e sem eversao da mucosa vesical Foi realizada uretrocistografia retrograda no quarto dia de pos-operatorio, para verificar a presenca de colecoes ou extravasamento perivesical de urina. Incontinencia urinaria foi definida como a necessidade de uso de mais que um absorvente ao dia, apos a retirada da sonda vesical Avaliacoes clinicas, analisando a ocorrencia de esclerose de colo ou dei incontinencia urinaria, foram feitas 48 horas apos a retirada da sonda vesical , 2 meses e 6 meses apos a intervencao. Dentre os 95 pacientes estudados, 48 e 47 respectivamente, foram incluidos nos grupos com e sem eversao da mucosa vesical. Extravasamento de urina ao nivel da anastomose foi mais frequente no grupo com eversao(33,33 por cento), em comparacao ao grupo sem eversao (21,27 por cento), sendo, contudo, esta diferenca nao significativa. A esclerose de colo foi observada em apenas um caso (1,05 por cento), nao estando relacionada estatisticamente com o tipo de reconstrucao do colo vesical. As taxas de incontinencia urinaria foram as mesmas em ambos os grupos, apos 48 horas de retirada a sonda, dois e seis meses apos a cirurgia. Verificou-se um aumento significativo na proporcao de pacientes aos 2 e 6 meses, comparados a avaliacao inicial. Concluimos que a eversao da mucosa vesical, no momento da anastomose vesico-uretral durante a prostatectomia radical retropudica nao modifica a frequencia de esclerose de colo ou de incontinencia urinaria
The present study evaluated the role of blader neck (BN) mucosa evertion during retropubic radical prostatectomy (RRP) on the rate of BN sclerosis and postoperatory urinary incontinence. The hypothesis was that BN mucosa evertion was not essential to improve the patient's clinical outcome following RRP. One hundred patients with stage T1c-T2c prostate cancer underwent RRP by the same surgeon and were randomized in two groups, vesicourethral anastomosis performed with or without BN mucosa evertion. Retrograde cistourethrography was performed at 4th postoperative day in order to evaluate the presence of urinary leak. The clinical outcome concerning the ocurrence of BN sclerosis and the rate of urinary incontinence (more than 1 pad/day) was accessed by double blinded interview at 2 days, 2 months and 6 months after catheter removal. Forty eight and forty seven patients were evaluable, respectively, in the mucosa evertion and non-evertion groups. Urinary leak at vesicourethral anastomosis was seen with the same rate in both groups. BN sclerosis ocurred in only one patient in the mucosa non-evertion group. The rate of urinary incontinence was similar at 2 days, 2 months and 6 months after surgery in both groups. In conclusions, BN mucosa evertion before vesicourethral anastomosis during retropubic radical prostatectomy is not essential to reduce the frequency of BN sclerosis or urinary incontinence.
The present study evaluated the role of blader neck (BN) mucosa evertion during retropubic radical prostatectomy (RRP) on the rate of BN sclerosis and postoperatory urinary incontinence. The hypothesis was that BN mucosa evertion was not essential to improve the patient's clinical outcome following RRP. One hundred patients with stage T1c-T2c prostate cancer underwent RRP by the same surgeon and were randomized in two groups, vesicourethral anastomosis performed with or without BN mucosa evertion. Retrograde cistourethrography was performed at 4th postoperative day in order to evaluate the presence of urinary leak. The clinical outcome concerning the ocurrence of BN sclerosis and the rate of urinary incontinence (more than 1 pad/day) was accessed by double blinded interview at 2 days, 2 months and 6 months after catheter removal. Forty eight and forty seven patients were evaluable, respectively, in the mucosa evertion and non-evertion groups. Urinary leak at vesicourethral anastomosis was seen with the same rate in both groups. BN sclerosis ocurred in only one patient in the mucosa non-evertion group. The rate of urinary incontinence was similar at 2 days, 2 months and 6 months after surgery in both groups. In conclusions, BN mucosa evertion before vesicourethral anastomosis during retropubic radical prostatectomy is not essential to reduce the frequency of BN sclerosis or urinary incontinence.
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Citação
PARANHOS, Mario Luiz da Silva. Reconstrução do colo vesical em prostatectomia radical: estudo randomizado sobre o papel da eversão mucosa vesical. Tese (Doutorado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2003.