Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function

Abstract

To assess the impact of laparoscopic radical prostatectomy on vesicourethral function and compare it to that of open radical prostatectomy. Sixty-three patients undergoing laparoscopic radical prostatectomy for localized prostate cancer were included in this retrospective analysis. Urodynamic parameters, including maximum urethral closing pressure (MUCP), functional profile length (FPL), bladder compliance, maximum cystometric capacity (MCC) and detrusor overactivity, were considered. Continence status and changes in urodynamic findings before and after surgery were evaluated. In addition, postoperative urodynamic findings were compared with those in 58 patients undergoing open radical prostatectomy. After laparoscopic radical prostatectomy, MUCP and FPL showed a significant postoperative decrease. Continence rates after surgery were 82% in the laparoscopic and 78% in the open group. Comparison of postoperative data between continent and incontinent patients in both surgical groups showed significantly lower MUCP, shorter FPL, lower bladder compliance and higher incidence of detrusor overactivity in incontinent patients. Although there was no significant difference in postoperative MUCP and FPL between the two groups, bladder compliance was significantly lower and incidence of detrusor overactivity was significantly higher in the open prostatectomy group. Laparoscopic radical prostatectomy has a negative impact on storage function by impairing function of the urethral sphincter and decreasing bladder compliance. There is no difference in postoperative urethral function between open and laparoscopic radical prostatectomy. Laparoscopic surgery might be associated with less impairment of bladder function than open surgery.