Abstract
ABSTRACTPurpose:To demonstrate the effect of total reconstruction technique on postoperative urinary continence after laparoscopic radical prostatectomy (LRP).Material and Methods:LRP was performed using a standard urethrovesical anastomosis in 79 consecutive patients (Group-A) from June 2011 to October 2012, and a total reconstruction procedure in 82 consecutive patients (Group-B) from June 2012 to June 2013. The primary outcome measurement was urinary continence assessed at 1, 2, 4, 12, 24 and 52 weeks after catheter removal. Other data recorded were patient age, body mass index, International Prostate Symptoms Score, prostate volume, preoperative PSA, Gleason score, neurovascular bundle preservation, operation time, estimated blood loss, complications and pathology results.Results:In Group-A, the continence rates at 1, 2, 4, 12, 24 and 52 weeks were 7.59%, 20.25%, 37.97%, 58.22%, 81.01% and 89.87% respectively. In Group-B, the continence rates were 13.41%, 32.92%, 65.85%, 81.71%, 90.24% and 95.12% respectively. Group––B had significantly higher continence rates at 4 and 12 weeks after surgery (P<0.001 and P=0.001). There were no significant differences between the groups with respect to patient's age, body mass index, prostate-specific antigen level, prostate volume, IPSS, estimated blood loss, number of nerve-sparing procedures and postoperative complications.Conclusions:Total reconstruction technique in the procedure of urethrovesical anastomosis during LRP improved early recovery of continence.
Highlights
Radical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer [1]
Several surgical technical modifications have been proposed to minimize the incidence of urinary incontinence, including nerve sparing [4], bladder ibju | “Total reconstruction” of the urethrovesical anastomosis and continence in laparoscopic radical prostatectomy neck preservation [5], sparing or reconstruction of the puboprostatic ligament [6,7,8], posterior reconstruction of the rhabdomyosphincter [9, 10], and anterior retropubic suspension [11, 12]
The two groups had no significant differences in their pathologic stage, positive surgical margin (PSM), or Gleason score of the surgical specimen (Table-2)
Summary
Radical prostatectomy (RP) is the standard surgical treatment for localized prostate cancer [1]. Several surgical technical modifications have been proposed to minimize the incidence of urinary incontinence, including nerve sparing [4], bladder ibju | “Total reconstruction” of the urethrovesical anastomosis and continence in laparoscopic radical prostatectomy neck preservation [5], sparing or reconstruction of the puboprostatic ligament [6,7,8], posterior reconstruction of the rhabdomyosphincter [9, 10], and anterior retropubic suspension [11, 12] These techniques are associated with different improvement on early continence. We compared the perioperative and urinary continence outcomes of LRP with and without total reconstruction technique
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