Comparative Effectiveness Of Intrafascial And Extrafascial Laparoscopic Radical Prostatectomy

Research background:With the improvement of medical diagnosis,more and more patients with early localized prostate cancer have been diagnosed.This part of the patients require a higher quality of life in the case of a radical cure.A series of surgical procedures were presented to improve patients’ urinary continence and erectile function.Intrafascial radical prostatectomy is the main representative among these procedures.In this paper,the effect of intrafascial and extrafascial radical prostatectomy on urinary continence and erectile function of patients after surgery was studied to determine what type of surgery is more profitable for patients.Objective:To compare the efficacy of intrafascial and extrafascial laparoscopic extraperitoneal radical prostatectomy for the treatment of localized prostate cancer in patients under 70 years of age.Methods:The clinical data of 48 patients with extraperitoneal radical prostatectomy under intrafascial and extrafascial laparoscopy from January 2016 to August 2017 in our hospital was analyzed retrospectively.The follow-up time was 6 months.Among them,the clinical data of patients included:age of patients,preoperative prostate-specific antigen(PSA),Gleason score,clinical and pathological stage,time of retropubic drainage tube removal and urinary catheter removal,positive surgical margin rate;postoperative follow-up included urinary control recovery immediately,at 3 and 6 months after catheter removal,,erectile function recovery at 1,3 and 6 months after surgery,PSA index at 3 and 6 months after surgery.All patients were divided into two groups according to the operation method:including 19 cases treated with intrafascial radical prostatectomy(group A),and 29 cases treated with extrafascial radical prostatectomy(group B).SPSS 19.0 was used for data statistics,and U test was used for continuous variable comparison.Chi-square test was used for counting variables and other data.P<0.05 was statistically significant.Results:All surgeries went successfully.There was no significant difference in age,PSA,Gleason score,clinical and pathological stage between the two groups.There was no significant difference in the removal time of retropubic drainage tube and urinary catheter,and positive surgical margin rate between the twa groups.The urinary continence function of the patients in group A recovered faster than that in group B(p<0.05),but there was no significant difference in the urinary continence function recovery between the two groups at 6 months after operation(p>0.05).The erectile function of patients in group A was better than that in group B at 1,3 and 6 months after operation(p<0.05).The survival rate of patients with no biochemical progression was similar between the two groups according to PSA level at 3 and 6 months(p>0.05).Conclusion:The urinary continence function of patients in group A recovered faster than that in group B,but it was similar at 6 months.The erectile function of patients in group A was significantly better than that in group B,and the positive surgical margin rate and postoperative biochemical recurrence rate were similar.Therefore,intrafascial extraperitoneal laparoscopic radical prostatectomy was recommended for patients with localized prostate cancer under 70 years of agewith clinical stage cT1-cT2b,PSA ≤ 20 ng/ml and normal preoperative erectile function.