Retention of urethral mesangium during laparoscopic radical prostatectomy for recovery of urinary control in prostate cancer

doi:10.3877/cma.j.issn.1674-3253.2024.01.004

Abstract

Abstract:

Objective

To investigate the safety and efficacy of immediate and early recovery of postoperative urinary continence by retaining the urethral mesentery during laparoscopic radical prostatectomy (LRP) in patients with moderate and high-risk prostate cancer (PCa).

Methods

The clinical data of 18 LRP patients who underwent the same operation from July 2021 to November 2021 were retrospectively analyzed. All patients retained the urethral mesentery. The mean age was (69±7) years, the mean prostate volume was (45±16) ml, ther were 13 cases of preoperative prostate specific antigen (PSA) ≥10 ng/ml, and body mass index (BMI) was (24.1±2.5) kg/m².

Results

18 patients were completed the operation successfully, the median operation time was 299(267, 397) minutes and the median intraoperative blood loss was 50(50, 100) ml. Postoperative pathology was all prostate adenocarcinoma, Gleason score was 9 in 4 cases, 8 in 2 cases, 7 in 8 cases, and 6 in 4 cases. Postoperative TNM stage was T_2a-T₄. Surgical margins were positive in 4 patients (22%). The average indwelling time of catheter was (11±5) days. Postoperative complications occurred in 4 patients. Among them 2 cases were Clavien-Dindo class Ⅱ, including 1 urinary tract infection and 1 wound infection. 2 cases were Clavien-Dindo grade Ⅲ, including 1 urinary retention after extubation and 1 anastomotic leakage. PSA re-examination 3 months after the operation showed no biochemical recurrence. The continence rate was 61%, 72%, 77% and 83% immediately, 1 week, 1 month and 3 months after extubation.

Conclusion

Retaining the urethral mesentery improves early recovery of urinary continence after LRP in middle and high risk PCa patients.

Key words: Urethral mesentery, Radical prostatectomy, Urinary control, Prostate cancer, Anatomy

Juntao Li, Tianyou Zhang, Lei Ye, Qiang Guo, Jianjian Wu, Bing Yao, Dejuan Wang, Jianguang Qiu. Retention of urethral mesangium during laparoscopic radical prostatectomy for recovery of urinary control in prostate cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(01): 19-24.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2024.01.004

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2024/V18/I01/19

Figures/Tables 3

References 25

[1]	中国抗癌协会泌尿男生殖系统肿瘤专业委员会前列腺癌学组, 戴波, 叶定伟, 等. 前列腺癌筛查中国专家共识(2021年版)[J].中国癌症杂志. 2021, 31(5): 6.
[2]	Abdollah F, Sood A, Sammon JD, et al. Long-term cancer control outcomes in patients with clinically high-risk prostate cancer treated with robot-assisted radical prostatectomy: results from a multi-institutional study of 1100 patients[J]. Eur Urol, 2015, 68(3): 497-505.
[3]	Wang Z, Ni Y, Chen J, et al. The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis[J].World J Surg Oncol, 2020, 18(1):1-13.
[4]	Moris L, Cumberbatch MG, Van den Broeck T, et al. Benefits and risks of primary treatments for high-risk localized and locally advanced prostate cancer: an international multidisciplinary systematic review[J]. Eur Urol, 2020,77(5): 614-627.
[5]	Nyarangi-Dix JN, Radtke JP, Hadaschik B, et al. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial[J]. J Urol, 2013, 189(3): 891-898.
[6]	Patel VR, Coelho RF, Palmer KJ, et al. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes[J]. Eur Urol, 2009, 56(3): 472-478.
[7]	Qiu X, Li Y, Chen M, et al. Retzius-sparing robot-assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single-blind trial with a 1-year follow-up[J].BJU Int, 2020, 126(5): 633-640.
[8]	Rosenberg JE, Jung JH, Lee H, et al. Posterior musculofascial reconstruction in robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer[J].The Cochrane Database Syst Rev, 2021, 8(8): Cd013677.
[9]	Ficarra V, Novara G, Rosen RC, 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.
[10]	张旭. 前列腺根治性切除术尿控之关键外科因素解析——从解剖基础到临床应用[J]. 现代泌尿生殖肿瘤杂志, 2022, 14(6): 321-324.
[11]	Vis AN, van der Poel HG, Ruiter AE, et al. Posterior, anterior, and periurethral surgical reconstruction of urinary continence mechanisms in robot-assisted radical prostatectomy: a description and video compilation of commonly performed surgical techniques[J]. Eur Urol, 2019, 76(6): 814-822.
[12]	Ficarra V, Rossanese M, Crestani A, et al. Robot-assisted radical prostatectomy using the novel urethral fixation technique versus standard vesicourethral anastomosis[J]. Eur Urol, 2021,79(4): 530-536.
[13]	Barakat B, Othman H, Gauger U, et al. Retzius sparing radical prostatectomy versus robot-assisted radical prostatectomy: which technique is more beneficial for prostate cancer patients (MASTER Study)? A systematic review and meta-analysis[J]. Eur Urol Focus, 2022, 8(4): 1060-1071.
[14]	Pansadoro V, Brassetti A. Extrafascial robot-assisted laparoscopic radical prostatectomy in locally advanced prostate cancer[J]. Minerva Chir, 2018, 74(1): 78-87.
[15]	Shin TY, Lee YS. Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes[J]. Sci Rep, 2020, 10(1): 1-8.
[16]	Zhao Z, Zhu H, Yu H, et al. Comparison of intrafascial and non-intrafascial radical prostatectomy for low risk localized prostate cancer[J]. Sci Rep, 2017, 7(1): 1-11.
[17]	Wagaskar VG, 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.
[18]	Egan J, Marhamati S, Carvalho FLF, et al. Retzius-sparing robot-assisted radical prostatectomy leads to durable improvement in urinary function and quality of life versus standard robot-assisted radical prostatectomy without compromise on oncologic efficacy: single-surgeon series and step-by-step guide[J]. Eur Urol, 2021, 79(6): 839-857.
[19]	Pavlovich C, Rocco B, Druskin S, et al. Urinary continence recovery after radical prostatectomy - anatomical/reconstructive and nerve-sparing techniques to improve outcomes[J]. BJU Int, 2017, 120(2): 185-196.
[20]	Nunez Bragayrac LA, Hussein AA, Attwood K, et al. Feasibility and continence outcomes of extended prostatic urethral preservation during robot-assisted radical prostatectomy[J]. Prostate cancer prostatic Dis, 2020, 23(2): 286-294.
[21]	Ferreira A, Duarte Cruz C. The urethra in continence and sensation: Neural aspects of urethral function[J]. Neurourol Urodyn, 2021, 40(3): 744-752.
[22]	Walz J, Epstein JI, Ganzer R, et al. A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update[J]. Eur Urol, 2016, 70(2): 301-311.
[23]	Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes[J]. Eur Urol, 2009, 56(6): 972-980.
[24]	Zaorsky NG, Calais J, Fanti S, et al. Salvage therapy for prostate cancer after radical prostatectomy[J]. Nat Rev Urol, 2021, 18(11): 643-668.
[25]	Panebianco V, Villeirs G, Weinreb JC, et al. Prostate magnetic resonance imaging for local recurrence reporting (PI-RR): international consensus -based Guidelines on multiparametric magnetic resonance imaging for prostate cancer recurrence after radiation therapy and radical prostatectomy[J]. Eur Urol Oncol, 2021, 4(6): 868-876.

年龄(岁)	BMI(kg/m²)	前列腺体积(ml)	tPSA[ng/ml，(例)]		临床分期(例)					穿刺Gleason评分(例)
69±7	24.1±2.5	45±16	PSA<10	PSA≥10	T_1c	T_2b	T_2c	T_3b	T₄	6	7	8	9
69±7	24.1±2.5	45±16	5	13	2	3	5	3	1	3	4	4	3

年龄(岁)	BMI(kg/m²)	前列腺体积(ml)	tPSA[ng/ml，(例)]		临床分期(例)					穿刺Gleason评分(例)
69±7	24.1±2.5	45±16	PSA<10	PSA≥10	T_1c	T_2b	T_2c	T_3b	T₄	6	7	8	9
69±7	24.1±2.5	45±16	5	13	2	3	5	3	1	3	4	4	3

手术时间(min)	失血量(ml)	神经保留(例)		盆腔淋巴结清扫(例)		术后病理分期(例)			术后Gleason评分(例)				病理切缘阳性(例)	拔除尿管时间(d)
299(267，397)	50(50，100)	无	有	无	标准	T_2a～2c	T_3a～3c	T₄	6分	7分	8分	9分	4	11±5
299(267，397)	50(50，100)	18	0	0	18	10	6	2	4	8	2	4	4	11±5

手术时间(min)	失血量(ml)	神经保留(例)		盆腔淋巴结清扫(例)		术后病理分期(例)			术后Gleason评分(例)				病理切缘阳性(例)	拔除尿管时间(d)
299(267，397)	50(50，100)	无	有	无	标准	T_2a～2c	T_3a～3c	T₄	6分	7分	8分	9分	4	11±5
299(267，397)	50(50，100)	18	0	0	18	10	6	2	4	8	2	4	4	11±5

Please choose a citation manager

Content to export