Factors Associated With Urinary Continence Following Laparoscopic Radical Prostatectomy

Purpose: Urinary incontinence is one of the common postoperative complications of laparoscopic radical prostatectomy,which affect the quality of life of patients. Surgical techniques, objective clinical characteristics and postoperative treatment may influence urinary continence following laparoscopic radical prostatectomy. The purpose of this issue is to investigate the factors associated with urinary continence following laparoscopic radical prostatectomy.Patients and Methods:A review study of 162 prostate patients data from March 2011 to March 2014 who confirmed prostate cancer and underwent a laparoscopic radical prostatectomy in The First Affiliated Hospital of Fujian Medical University. Close follow-up of Urinary continence was performed. Clinical data of patients was detailed recorded,including age, body mass index(BMI), preoperative PSA, prostate volume, operative time, bleed loss, whether lymph node sweeping operation(PLND), margins, postoperative Gleason score, pathological stage, whether to preservate bladder neck, whether to preservate the neurovascular bundle, whether to preservate maximal urethral length, whether to reconstruct the rear fascia reconstruction. Single factor analysis was performed to screen factors that may affect postoperative urinary continence, logistic regression analysis was performed to analyze influencing factors of postoperative urinary continence and calculate the risk rate.Results: In this study, postoperative immediate urine continence was 8.64%(14/162), 20.37%(33/162)at 1 month,53.09%(86/162) in 3 month and 97.53%(158/162) in 12 month after the surgery. A multivariate analysis showed that,in the 13 factors including age, body mass index(BMI), preoperative PSA, prostate volume, operative time, bleed loss, whether lymph node sweeping operation(PLND), margins, postoperative Gleason score, pathological stage, whether to preservate bladder neck, whether to preservate the neurovascular bundle, whether to preservate maximalurethral length, whether to reconstruct the rear fascia reconstruction, BMI≥28kg/m2(OR=0.189,95%CI:0.047-0.670,P=0.019)reduced the postoperative continence rate, and preservate bladder neck(OR=1.125,95%CI:1.009-9.404, P=0.048)?preservate maximal urethral length(OR=37.582,95%CI: 8.974-157.385,P<0.001)? preservate the neurovascular bundle( OR=13.206,95%CI: 3.812-45.749,P < 0.001)、 and reconstruct the rear fascia reconstruction( OR=14.729,95%CI: 4.048-53.590,P <0.001) significantly improved continence rates in 3 month after the surgery.In 12 month after the surgery BMI ≥ 28kg/m2( OR=0.085,95%CI:0.009-0.841, P=0.035) reduced the postoperative continence rate. And preservate bladder neck(P=0.991)、preservate maximal urethral length(P=0.180)、preservate the neurovascular bundle(P=0.409) and reconstruct the rear fascia reconstruction(P=0.967) did not increase the positive rate of surgical margin.Conclusions: Preservate bladder neck ? preservate maximal urethral length ? preservate the neurovascular bundle and reconstruct the rear fascia reconstruction used in the laparoscopic radical prostatectomy may significantly improved early continence rates. Obesity is not conducive to early and long-term urinary continence following laparoscopic radical prostatectomy. Preservate bladder neck、preservate maximal urethral length、preservate the neurovascular bundle and reconstruct the rear fascia reconstruction did not increase the positive rate of surgical margin.