Curative effects of anatomic reconstruction of periurethral structure in robotic assisted laparoscopic radical prostatectomy

Abstract

Objective To investigate the outcome of patients underwent anatomic periurethral reconstruction during robotic assisted laparoscopic radical prostatectomy (RARP). Methods During August 2016 to May 2018, anatomic periurethral reconstruction was performed during RARP in 58 consecutive patients. The control group consists of another 50 patients had no anatomic periurethral reconstruction procedure during RARP.Perioperative data of these patients were collected retrospectively, including operation time, anastomosis timeintraoperative blood loss, duration of indwelling catheter, length of hospital stay, complications, postoperative pathology, and continence outcome at 1, 3, 6, 12 months after surgery. Results All cases were successfully performed without conversion to open or laparoscopic surgery. There were no major intraoperative or postoperative complications. Operative time and anastomosis time was (145.3±12.3)mins and (31.6±8.2)mins in reconstruction group comparing to (122.4±11.4)mins and (21.2±4.4) in control group (both P 0.05). Postoperative pathology confirmed 53 T2a-T2b diseases and 5 pT2c diseases in reconstruction group, in comparison with 46 T2a-T2b and 4 pT2c diseases in non-reconstruction group (P>0.05). There were 19 and 15 cases with a final Gleason score of 6, 30 and 27 cases with Gleason 7, 9 and 10 cases with Gleason 8, in reconstruction group and non-reconstruction group respectively(all P>0.05). There was no significant difference between the two groups regarding incidence of positive surgical margins (3 in reconstruction group and 2 in control group, P>0.05). The percentage of patients maintain continence in reconstruction group and non-reconstruction group: at 1 month [84.5%(49/58)and 70.0%(35/50)], at 3 months [89.7%(52/58)and 78.0%(39/50)], at 6 months [91.3%(53/58)and 86.0%(43/50)] and 1 year after surgery [100.0%(58/58)and 96.0%(48/50)]. Reconstruction group showed better continence outcome at 1 and 3 month (P 0.05). Conclusion Anatomic reconstruction of periurethral structure during RARP is safe and feasible with reduced duration of indwelling catheter and better continence outcome. Key words: Robotic assisted laparoscopic surgery; Radical prostatectomy; Incontinence; Enhanced recovery after surgery