The effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy

doi:10.3969/j.issn.1006-7795.2021.06.012

Abstract

Abstract: Objective To explore the effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy. Methods The patients who were diagnosed with prostate cancer in the Department of Urology of Beijing Chaoyang Hospital from September 2020 to December 2020 were selected as the study subjects. Among them, total 10 patients underwent laparoscopic radical prostatectomy with modified apical dissection and periurethral structure preservation by the same surgical team. The perioperative and follow-up data were collected for analyzing the perioperative complication and immediate continence rate. Results The mean age was 68±9, the median Eastern Cooperative Oncology Group (ECOG) score was 1, the median maximum prostate specific antigen (PSA) was 15.05(7.05,31.00)ng/mL. There were 8 cases for cT2, 1 case for cT3, and 1 case for cT4. The mean operative time was (123±26) min and the mean established blood loss was (63±28) mL. The median day of catheter removal was 5 (5, 7) days and 9 patients obtained complete urinary continence at the day of catheter removal. One case suffered Clavien I complication postoperatively. Totally 2 cases were diagnosed as pT2a, 5 cases as pT2c, 1 case as pT3b and 2 case as pT4. Gleason score of 2 cases was 3+3, 5 cases 4+3, and 3 cases 4+5/5+4. Four patients had positive apical surgical margin. Conclusion The primary study indicated that the technique of modified apical dissection and periurethral structure preservation could improve the immediate continence rate after laparoscopic radical prostatectomy without compromising complication. However, the apical positive surgical margin was higher. The technique requires further development, and high-quality clinical study was required to confirm the efficacy.

Key words: prostate cancer, radical prostatectomy, urethra, continence

CLC Number:

R737.25

Wang Mingshuai, Xiong Tianyu, Jiang Mingxin, Qian Xiaosong, Wang Sihao, Cui Yun, Niu Yinong. The effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy[J]. Journal of Capital Medical University, 2021, 42(6): 973-977.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2021.06.012

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2021/V42/I6/973

References

[1] Ficarra V, Novara G, Rosen R C, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy[J]. Eur Urol,2012,62(3):405-417.
[2] Nyberg M, Hugosson J, Wiklund P, et al. Functional and oncologic outcomes between open and robotic radical prostatectomy at 24-month follow-up in the Swedish LAPPRO trial[J]. Eur Urol Oncol, 2018,1(5):353-360.
[3] Wagaskar V G, Mittal A, Sobotka S, et al. Hood technique for robotic radical prostatectomy-preserving periurethral anatomical structures in the space of retzius and sparing the pouch of douglas, enabling early return of continence without compromising surgical margin rates[J]. Eur Urol,2021,80(2):213-221.
[4] Menon M, Shrivastava A, Kaul S, et al. Vattikuti institute prostatectomy: contemporary technique and analysis of results[J]. Eur Urol,2007,51(3):648-658.
[5] Liu Y, Zhao Q X, Yang F Y, et al. “Sandwich” technique of total urethral reconstruction in the laparoscopic radical prostatectomy: a prospective study[J]. Cancer Manag Res, 2021,13:2341-2347.
[6] Zhou X C, Fu B, Zhang C, et al. Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes[J]. BJU Int,2020,126(2):300-308.
[7] Lee J, Kim H Y, Goh H J, et al. Retzius sparing robot-assisted radical prostatectomy conveys early regain of continence over conventional robot-assisted radical prostatectomy: a propensity score matched analysis of 1 863 patients[J]. J Urol,2020,203(1):137-144.
[8] 乔鹏,邢念增. 经腹膜外腹腔镜前列腺癌根治术(附9例报告)[J]. 中华腔镜泌尿外科杂志:电子版,2009,3(1):25-29.
[9] Dindo D, Demartines N, Clavien P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey[J]. Ann Surg, 2004,240(2):205-213.
[10] Lee J, Kim H Y, Goh H J, et al. Retzius sparing robot-assisted radical prostatectomy conveys early regain of continence over conventional robot-assisted radical prostatectomy: a propensity score matched analysis of 1 863 patients[J]. J Urol,2020,203(1):137-144.
[11] Dalela D, Jeong W, Prasad M A, et al. A pragmatic randomized controlled trial examining the impact of the retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy[J]. Eur Urol,2017,72(5):677-685.
[12] Galfano A, Di Trapani D, Sozzi F, et al. Beyond the learning curve of the retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥1 year of follow-up.[J]. Eur Urol,2013,64(6):974-980.
[13] Covas Moschovas M, Bhat S, Onol F F, et al. Modified apical dissection and lateral prostatic fascia preservation improves early postoperative functional recovery in robotic-assisted laparoscopic radical prostatectomy: results from a propensity score-matched analysis[J]. Eur Urol,2020,78(6):875-884.
[14] Rozet F, Jaffe J, Braud G, et al. A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience[J]. J Urol, 2007,178(2):478-482.
[15] Carlsson S, Nilsson A E, Schumacher M C, et al. Surgery-related complications in 1 253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden.[J]. Urology,2010,75(5):1092-1097.