Improvement of continence with preservation of pelvic stabilized structure in patients undergoing robot-assisted laparoscopic radical prostatectomy

Abstract

Objective To investigate the effect of pelvic floor stabilized structure preservation (PPSS) during robot-assisted laparoscopic radical prostatectomy (RARP) on postoperative continence recovery. Methods From October 2017 to April 2018, 86 patients with prostatic cancer who underwent traditional RARP and RARP plus PPSS were included. There were 31 patients in non-PPSS group and 55 patients in PPSS group. In non-PPSS group, patients age was (68.48±7.79) years old, BMI was (24.79±3.05) kg/m2, median prostate volume was 63.54 (53.00-99.36)cm3, clinic T-stage T1-T2, T3, T4 accounted for 49.39%, 22.58%, 6.45% and ISUP grade 1, 2, 3, 4, 5 accounted for 22.58%, 22.81%, 12.90%, 12.90%, 19.35% respectively. In PPSS group, patients age was (69.53±6.81) years old, BMI was (23.95±3.03) kg/m2, median prostate volume was 73.39 (54.88-94.23)cm3, clinic T-stage T1-T2, T3, T4 accounted for 72.73%, 7.27%, 3.64% and ISUP grade 1, 2, 3, 4, 5 accounted for 21.82%, 18.18%, 23.64%, 18.18%, 10.91% respectively. The preoperative PSA, BMI, clinical T-stage, ISUP grade, and postoperative hospital days had no significant differences(P>0.05) between the two groups.Both groups were operated via transperitoneal approach. In the non PPSS group, endo-pelvic fascia and pubic prostate ligament was cut, and dorsal vessel complex was ligated. In PPSS group, the partial endo-pelvic fascia was bluntly pushed to the pelvic wall to preserve tendon arch, and pubic prostate ligament also was preserved without suturing and ligating dorsal vascular complex. The catheter was removed 7 d after RARP. The continence recovery were compared between the two groups, including pad number on the day of 1, 7, 14, 30, 90 and ICI-Q-SF scores on the day of 30 and 90 after catheter removal. Results There was no significant difference in pad numbers used between the two groups on the day of 1, 7, 14, 30 after catheter removal. On the 90th day, the proportions of using pad ≥4 in PPSS group were significantly lower than those in non-PPSS group (1.89% vs. 20.69%, P=0.004). No significant difference was found in ICI-Q-SF scores on the 30th and 90th day between the two groups. Univariate analysis showed that PPSS group used less pads than non-PPSS group on the 90th day [OR=0.07(95%CI 0.01-0.65), P=0.019]; T3 patients used more pads than T1-T2 patients [OR=9.19(95%CI 1.32-63.87), P=0.025]. After adjusting for age, ISUP grading, T staging, and PSA, multivariate regression analysis showed that the risk of using pad ≥4 in PPSS group compared with non-PPSS group was 0.46, 0.34, 0.27, 0.25, and 0.03 on the day of 1 , 7, 14 , 30 and 90 after catheter removal, respectively. The PPSS approach didn′t increase the risk of positive surgical margin. Conclusions Preservation of pelvic stabilized structure in RARP is very efficient in term of continence rate after RARP, and it does not increase the risk of positive surgical margin. Key words: Prostatic neoplasms; Robotic assisted laparoscopic radical prostatectomy; Pelvic stabilized structure; Continence