Prä-, intra- und postoperative Einflussfaktoren funktioneller Einschränkungen nach radikaler Prostatektomie

Zusammenfassung

Der Erhalt von Kontinenz und Erektionsfähigkeit ist für die Lebensqualität nach radikaler Prostatektomie von entscheidender Bedeutung. Dieser Artikel gibt einen Überblick über präoperative Risikostratifizierung sowie intra- und postoperative Faktoren, die die funktionellen Ergebnisse nach radikaler Prostatektomie maßgeblich beeinflussen.

Alter, präoperativ bestehende Sexualfunktion, Prostatavolumen, Body Mass Index und Komorbiditäten gelten laut Studienlage als valide Prädiktoren der funktionellen Ergebnisse nach einer Prostatektomie. Während die Operationsmethode selbst keinen Einfluss zu haben scheint, wirken sich das intraoperative Vorgehen in Form nervenschonender Techniken und Umfang der Beckenbodenrekonstruktion sowie die Erfahrung des Operateurs signifikant auf die postoperative Potenz und Kontinenz aus. Im Rahmen der Rehabilitationsmaßnahmen werden dem Beckenbodentraining und der PDE-5-Inhibitor-Therapie Schlüsselrollen zur Wiedererlangung der erektilen Funktion und Harnkontrolle zugeschrieben.

Zusammenfassend können zahlreiche Therapiemodifikationen dazu beitragen, funktionelle Ergebnisse und damit auch die Lebensqualität der Patienten nach einer Prostatektomie zu verbessern. Eine sorgfältige präoperative Patientenselektion durch den Urologen sowie der Eingang besserer anatomischer Kenntnisse der nervalen und faszialen periprostatischen Strukturen in das operative Vorgehen sind dabei entscheidende Einflussfaktoren.

Abstract

Maintaining continence and erectile function is crucial for quality of life after radical prostatectomy. This review provides an overview of available evidence concerning preoperative risk stratification as well as intra- and postoperative factors determining functional outcomes after radical prostatectomy.

Current data indicate that patient factors including age, baseline erectile function, prostate size, body-mass index and comorbidity status are valid predictors of functional outcome after prostatectomy. While surgical methods do not seem to have any influence, intraoperative procedures like nerve-sparing techniques, the extent of pelvic floor reconstruction as well as surgeons’ experience have a significant impact on postoperative potency and continence. Rehabilitation consisting of pelvic floor training and use of PDE-5 inhibitors also contributes significantly to the recovery of erectile function and urinary continence.

In summary, numerous adjustments of treatment can help to improve functional results and thus the quality of life after prostatectomy. A careful preoperative selection of suitable patients by urologists and integration of knowledge of periprostatic nerve and fascial structures into the surgical procedure are decisive factors.

Schlüsselwörter

Postprostatektomieinkontinenz - Prostatektomie - Erektile Dysfunktion

Keywords

functional outcome - prostatectomy - incontinence - erectile function

Publikationsverlauf

Artikel online veröffentlicht:
25. Juni 2020

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