Urinary continence and erectile function of laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped ileal neobladder

doi:10.3877/cma.j.issn.1674-3253.2023.01.004

Abstract

Abstract:

Objective

To investigate the clinical effect of laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped orthotopic ileal neobladder.

Methods

Clinical data of 43 patients underwent laparoscopic radical cystectomy with W-shaped ileum orthotopic neobladder from January 2019 to December 2021 were collected. 20 cases were in prostatic apical capsule sparing group (observation group) and 23 cases were in the non prostatic apical capsule sparing group (control group). In the observation group, the prostatic apical capsule was cut at 1.0 cm from the tip of the prostate, the prostate was enucleated, and part of the prostatic apical capsule was reserved for laparoscopic radical cystectomy. The control group underwent conventional laparoscopic radical cystectomy. W-shaped ileal neobladder reconstructions were the same in both groups. The catheters were removed 3 weeks after operation, and the patients were reviewed regularly every 3 months. The clinical data and complete follow-up information of all patients were collected.

Results

All operation were finished successfully. Follow-up of all patients for 6-40 months revealed no tumor recurrence. There were no significant differences between two groups in preoperative demographic data, bladder tumor stage, operation time, intraoperative bleeding, intraoperative complications, 90-day postoperative complication rate and neobladder residual urine volume 6 months after operation (P>0.05). Six months after operation, the urinary function and erectile function (IIEF-5 score) of the observation group were better than that of the control group. Daytime continence were 85.0% and 52.2% respectively (P<0.05), nighetime continence were 65.0% and 34.8% respectively (P<0.05), and the IIEF-5 score were [8(6, 9)] and [3(2, 5)] respectively (P<0.05).

Conclusion

Laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped orthotopic ileal neobladder is conducive to urinary continence and erectile function which would not increase the risk of tumor recurrence. So it is worthy of clinical application.

Key words: Bladder cancer, Ileal neobladder, Prostate-capsule sparing

Sheng Xue, Qingwen Li, Jianmin Liu, Sheng Wang, Chengyong Wang, Beibei Liu, Wenyong Li, Xiaole Zhang, Changyuan Dai. Urinary continence and erectile function of laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped ileal neobladder[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(01): 16-21.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2023.01.004

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2023/V17/I01/16

Figures/Tables 3

References 20

[1]	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(1): 7-30.
[2]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[3]	Witjes JA, Compérat E, Cowan NC, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines[J]. Eur Urol, 2014, 65(4): 778-792．
[4]	黄健, 董文. 微创时代根治性膀胱切除术后尿流改道的选择[J]. 中华泌尿外科杂志, 2018, 39(7): 489-492.
[5]	田家乐, 张古田, 张威, 等. 机器人辅助全腹腔镜下"紫砂壶型"原位回肠新膀胱的临床疗效分析[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14 (6): 420-424.
[6]	王成勇, 李庆文, 陈志军, 等. 腹腔镜下根治性全膀胱切除术+回肠新膀胱术6例临床分析[J]. 安徽医学, 2017, 38(2): 208-211.
[7]	Groeben C, Koch R, Baunacke M, et al. Urinary Diversion After Radical Cystectomy for Bladder Cancer: Comparing Trends in the US and Germany from 2006 to 2014[J]. Ann Surg Oncol, 2018, 25: 3502-3509.
[8]	Bachour K, Faiena I, Salmasi A, et al. Trends in urinary diversion after radical cystectomy for urothelial carcinoma[J]. World J Urol, 2018, 36: 409-416.
[9]	易贤林, 程继文. 膀胱癌尿流改道手术的应用现状[J]. 山东医药, 2017, 57(04): 108-110.
[10]	Miyake H, Furukawa J, Takenaka A, et al. Long-term functional outcomes in patients with various types of orthotopic intestinal neobladder[J]. Int J Urol, 2008, 15(7): 612-615．
[11]	Petrelli F, Coinu A, Cabiddu M, et al. Correlation of pathologic complete response with survival after neoadjuvant chemotherapy in bladder cancer treated with cystectomy: A Meta-analysis[J]. Eur Urol, 2014, 65(2): 350-357．
[12]	Almassi N, Bochner BH. Ileal conduit or orthotopic neobladder: selection and contemporary patterns of use[J]. Curr Opin Urol. 2020, 30(3): 415-420.
[13]	张涛, 于德新, 方露, 等. 保留神经的腹腔镜根治性膀胱切除原位新膀胱术对性功能和尿控的影响[J]. 现代泌尿生殖肿瘤杂志, 2020, 12(02): 81-85.
[14]	Jian H, Fan X, Wen D. Current status of laparoscopic and robot-assisted nerve-sparing radical cystectomy in male patients[J]. Asian Journal of Urology, 2016, 3(3):150-155.
[15]	Muto G, Collura D, Rosso R, et al. Seminal-sparing cystectomy: technical evolution and results over a 20-year period. Urology[J]. 2014, 83(4): 856-861.
[16]	Mertens LS, Meijer RP, de Vries RR, et al. Prostate sparing cystectomy for bladder cancer: 20-year single center experience[J]. J Urol. 2014, 191(5): 1250-1255
[17]	Rivas JG, Gregorio SA, Gómez áT, et al. Laparoscopic radical cystectomy with prostate capsule sparing. Initial experience[J]. Cent European J Urol, 2016, 69(1): 25-31.
[18]	Nyame YA , Zargar H, Ramirez D, et al. Robotic-assisted Laparoscopic Bilateral Nerve Sparing and Apex Preserving Cystoprostatectomy in Young Men With Bladder Cancer[J]. Urology, 2016, 94: 259-264.
[19]	林光正, 毕良宽, 王进有, 等. 三孔三层面法保留前列腺包膜的腹腔镜膀胱根治性切除+Studer膀胱术的初步探讨[J]. 中国临床保健杂志, 2021, 24(05): 702-705.
[20]	薛胜, 李庆文, 张家俊, 等. 原位回肠新膀胱与乙状结肠新膀胱早期贮尿囊功能的比较[J]. 蚌埠医学院学报, 2011, 36(12): 1303-1305.

项目	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	勃起功能评分[M(Q₁，Q₃)]	新辅助化疗[例(%)]	肿瘤分期[例(%)]
项目	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	勃起功能评分[M(Q₁，Q₃)]	新辅助化疗[例(%)]	T₁	T₂	T₃
观察组	20	67±11	22.5±1.9	3(15.0)	8(40.0)	12(10，14)	1(5.0)	8(40.0)	11(55.0)	1(5.0)
对照组	23	65±9	21.6±2.2	5(21.7)	7(30.4)	13(10，14)	1(4.3)	8(34.8)	13(56.5)	2(8.7)
统计值		0.482	1.425	0.030	0.431	-0.922	0.010	0.297
P值		0.632	0.162	0.862	0.512	0.357	0.919	0.862

项目	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	勃起功能评分[M(Q₁，Q₃)]	新辅助化疗[例(%)]	肿瘤分期[例(%)]
项目	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	勃起功能评分[M(Q₁，Q₃)]	新辅助化疗[例(%)]	T₁	T₂	T₃
观察组	20	67±11	22.5±1.9	3(15.0)	8(40.0)	12(10，14)	1(5.0)	8(40.0)	11(55.0)	1(5.0)
对照组	23	65±9	21.6±2.2	5(21.7)	7(30.4)	13(10，14)	1(4.3)	8(34.8)	13(56.5)	2(8.7)
统计值		0.482	1.425	0.030	0.431	-0.922	0.010	0.297
P值		0.632	0.162	0.862	0.512	0.357	0.919	0.862

组别	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	日间控尿[例(%)]	夜间控尿[例(%)]	残余尿量[ml，M(Q₁，Q₃)]	勃起功能评分[M(Q₁，Q₃)]	术后90 d并发症[例(%)]
组别	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	日间控尿[例(%)]	夜间控尿[例(%)]	残余尿量[ml，M(Q₁，Q₃)]	勃起功能评分[M(Q₁，Q₃)]	肠梗阻	尿路感染	尿漏	输尿管积水	尿潴留
观察组	20	341±50	283±114	17(85.0)	13(65.0)	5(0，14)	8(6，9)	3(15.0)	14(70.0)	1(5.0)	2(20.0)	1(5.0)
对照组	23	326±41	236±104	12(52.2)	8(34.8)	6(0，10)	3(2，5)	4(17.4)	15(65.2)	1(4.3)	3(13.0)	0(0)
统计值		1.083	1.418	5.250	3.909	-0.025	-5.071	1.675
P值		0.285	0.164	0.022	0.048	0.980	<0.001	0.795

组别	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	日间控尿[例(%)]	夜间控尿[例(%)]	残余尿量[ml，M(Q₁，Q₃)]	勃起功能评分[M(Q₁，Q₃)]	术后90 d并发症[例(%)]
组别	例数	手术时间[min，(±s)]	术中出血量[ml，(±s)]	日间控尿[例(%)]	夜间控尿[例(%)]	残余尿量[ml，M(Q₁，Q₃)]	勃起功能评分[M(Q₁，Q₃)]	肠梗阻	尿路感染	尿漏	输尿管积水	尿潴留
观察组	20	341±50	283±114	17(85.0)	13(65.0)	5(0，14)	8(6，9)	3(15.0)	14(70.0)	1(5.0)	2(20.0)	1(5.0)
对照组	23	326±41	236±104	12(52.2)	8(34.8)	6(0，10)	3(2，5)	4(17.4)	15(65.2)	1(4.3)	3(13.0)	0(0)
统计值		1.083	1.418	5.250	3.909	-0.025	-5.071	1.675
P值		0.285	0.164	0.022	0.048	0.980	<0.001	0.795

Please choose a citation manager

Content to export