Clinical efficacy of intact retained bladder neck technique in single-site laparoendoscopic radical prostatectomy via extraperitoneal approach

doi:10.3877/cma.j.issn.1674-3253.2025.04.009

Abstract

Abstract:

Objective

To explore the clinical efficacy of complete retained bladder neck technique in single-site laparoendoscopic radical prostatectomy via extraperitoneal approach.

Methods

Patients who underwent extraperitoneal single-site laparoendoscopic radical prostatectomy in our hospital from June 2021 to October 2022 were enrolled in the study, total 74 patients were included. The patients were classified into the control group (n=40) who did not retain the bladder neck and the observation group (n=34) that retained it completely. The perioperative indexes and postoperative urodynamics, such as bladder compliance (BC), post-void residual urine (PVR), maximum detrusor pressure (Pdet_max) and maximum urinary flow rate (Q_max), were compared between the two groups. The patients were followed up for 3 months after operation. The urinary continence of the two groups was compared at 1 month and 3 months after operation. The international index of erectile function (IIEF) score was used to evaluate the erectile function of the patients 3 months after operation. The incidence of postoperative complications was compared between the two groups.

Results

There was no significant difference in intraoperative blood loss and operation time between the two groups (P>0.05). The indwelling time of urinary catheter and pelvic drainage tube, and hospitalization time in the observation group were shorter than those in the control group (P<0.05). The BC, PVR, Pdet_max, Q_max, IIEF of patients in the observation group were better than those in the control group. The urinary continence of the observation group was better than that in the control group at 1 week, 1 month and 3 months after operation (P<0.05). The incidence of postoperative complications in the observation group was (14.71%) lower than that in the control group (35.00%) (P<0.05). Meanwhile, no significant difference of the positive rate of postoperative margin was found between the observation group (17.65%) and the control group (17.50%).

Conclusion

Complete bladder neck method can effectively improve the bladder compliance and the urinary control, and reduce negative impacts on erectile function as well as postoperative complications.

Key words: Extraperitoneal approach, Single-site laparoendoscopic, Radical prostatectomy, Intact bladder neck, Urinary continence, Erectile function

Yong Wei, Kai Li, Baixin Shen, Jianzhong Lin, Luming Shen, Wei Liu, Xin Yang, Haibin Hu, Qingyi Zhu. Clinical efficacy of intact retained bladder neck technique in single-site laparoendoscopic radical prostatectomy via extraperitoneal approach[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(04): 447-453.

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References 27

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组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	既往腹部手术史[例(%)]		Gleason评分[例(%)]			前列腺体积[mL，(±s)]	术前PSA[例(%)]
组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	无	有	6	7	≥8	前列腺体积[mL，(±s)]	<10 ng/mL	≥10 ng/mL
对照组	40	70±7	24.4±2.7	18(45.00)	22(55.00)	4(10.00)	18(45.00)	18(45.00)	32±13	12(30.00)	28(70.00)
观察组	34	73±8	24.3±3.4	19(55.88)	15(44.12)	5(14.70)	15(44.12)	14(41.18)	30±12	10(29.41)	24(70.59)
统计值		t=1.629	t=0.149	χ²=0.807		χ²=0.40			t=0.473	χ²=0.962
P值		0.108	0.882	0.351		0.819			0.558	0.327
组别	临床分期[例(%)]			术前BC[mL/cmH₂O，(±s)]	术前PVR[mL，(±s)]	术前Pdet_max[cmH₂O，(±s)]	术前Q_max[mL，(±s)]	术前IIEF(±s)
组别	T₁	T₂	T₃	术前BC[mL/cmH₂O，(±s)]	术前PVR[mL，(±s)]	术前Pdet_max[cmH₂O，(±s)]	术前Q_max[mL，(±s)]	术前IIEF(±s)
对照组	6(15.00)	18(45.00)	16(40.00)	13±4	149.3±24.5	98±7	7.5±1.3	23.3±1.9
观察组	5(14.70)	14(41.18)	15(44.12)	12±3	148.6±24.2	97±7	7.5±1.2	23.6±1.3
统计值	χ²=0.583			0.107	0.138	0.397	-0.102	-0.779
P值	0.741			0.915	0.891	0.692	0.919	0.439

组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	既往腹部手术史[例(%)]		Gleason评分[例(%)]			前列腺体积[mL，(±s)]	术前PSA[例(%)]
组别	例数	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	无	有	6	7	≥8	前列腺体积[mL，(±s)]	<10 ng/mL	≥10 ng/mL
对照组	40	70±7	24.4±2.7	18(45.00)	22(55.00)	4(10.00)	18(45.00)	18(45.00)	32±13	12(30.00)	28(70.00)
观察组	34	73±8	24.3±3.4	19(55.88)	15(44.12)	5(14.70)	15(44.12)	14(41.18)	30±12	10(29.41)	24(70.59)
统计值		t=1.629	t=0.149	χ²=0.807		χ²=0.40			t=0.473	χ²=0.962
P值		0.108	0.882	0.351		0.819			0.558	0.327
组别	临床分期[例(%)]			术前BC[mL/cmH₂O，(±s)]	术前PVR[mL，(±s)]	术前Pdet_max[cmH₂O，(±s)]	术前Q_max[mL，(±s)]	术前IIEF(±s)
组别	T₁	T₂	T₃	术前BC[mL/cmH₂O，(±s)]	术前PVR[mL，(±s)]	术前Pdet_max[cmH₂O，(±s)]	术前Q_max[mL，(±s)]	术前IIEF(±s)
对照组	6(15.00)	18(45.00)	16(40.00)	13±4	149.3±24.5	98±7	7.5±1.3	23.3±1.9
观察组	5(14.70)	14(41.18)	15(44.12)	12±3	148.6±24.2	97±7	7.5±1.2	23.6±1.3
统计值	χ²=0.583			0.107	0.138	0.397	-0.102	-0.779
P值	0.741			0.915	0.891	0.692	0.919	0.439

组别	例数	手术时间（min）	盆腔引流管留置时间（d）	术中出血量（ml）	尿管留置时间（d）	住院时间（d）
对照组	40	139±24	5.5±0.4	86±60	14.1±1.3	19±5
观察组	34	147±37	5.0±0.3	105±61	12.9±1.5	17±5
t值		-1.202	6.113	1.338	3.660	2.113
P值		0.234	<0.001	0.185	<0.001	0.038

组别	例数	手术时间（min）	盆腔引流管留置时间（d）	术中出血量（ml）	尿管留置时间（d）	住院时间（d）
对照组	40	139±24	5.5±0.4	86±60	14.1±1.3	19±5
观察组	34	147±37	5.0±0.3	105±61	12.9±1.5	17±5
t值		-1.202	6.113	1.338	3.660	2.113
P值		0.234	<0.001	0.185	<0.001	0.038

组别	例数	BC(mL/cmH₂O)	PVR(mL)	Pdet max(cmH₂O)	Q_max(mL)	IIEF
对照组	40	20±3	18±4	72±6	19±4	19.3±1.8
观察组	34	25±3	16±3	65±7	21±3	21.6±2.7
t值		22.905	3.501	5.150	-2.039	-5.208
P值		<0.001	0.001	<0.001	0.045	<0.001

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