| Forewords:The incidence of prostate cancer is increasing worldwide,and it has become the sixth most common tumor in the world,accounting for about 30%of the male malignant tumors.Currently,the main surgical procedure for the treatment of early localized prostate cancer is laparoscopic radical prostatectomy(LRP),but urinary incontinence is one of the most common postoperative complications,which seriously affects the quality of life of patients.In order to protect postoperative urinary function,LRP has made many innovations,including preserving the pubic prostatic ligament,retaining the control of the nerve and blood vessels and preserving the proximal external sphincter.At present,the classical method of preserving bladder neck widely used in different centers is to identify the circular muscle fibers of the bladder into the prostate and urethra,and cut them up in the midline and extend them to the sides.In 2013,the bladder neck was retained by sling suspension at the seminal vesicle surface.This study retrospectively analyzed the clinical data of 68 patients who underwent laparoscopic radical prostatectomy with bladder neck preservation from January 2014 to December 2016 in our hospital.The difference between these two methods in improving postoperative urinary continence was compared.Objective To investigate the clinical significance of urinary continence after laparoscopic radical prostatectomy with the technique of preserving bladder neck with sling suspension technique by the seminal vesicle.Methods To retrospectively analyze 68 patients after laparoscopic prostatectomy in theDepartment of Urology in People’s Liberation Army General Hospital,Wuhan,China from January 2014 to December-2016.Grouping:the preservation of the bladder neck sling method group(experimental group)contained 35 patients,11 cases in the Gleason score of 6 or less,15 cases in 7,9 cases more than 8 points;1 cases in T1 period,28 cases of T2 period,6 cases of stage T3a.The classic method of bladder neck preservation group(control group)contained 33 cases,including 9 cases of Gleason below 6 points,14 cases in 7 points,10 cases more than 8 points;2 cases of clinical stage T1,29 cases of stage T2,2 cases of T3a.The average age of the experimental group and the control group of two groups respectively were(64.3 + 4.3)and(62.6 + 3.8)years old(P=0.095);BMI =(22.85 + 1.69)and(22.15 + 1.32)(P=0.062);the volume of the prostate were(45.93 + 9.08)and(44.12 + 6.85 ml(P=0.357));preoperative PSA were(18.76 + 5.43)and(21.18 + 6.55)ng/ml(P=0.101);pathological staging and Gleason score compared by Fisher exact test P ＝0.679 and 0.921.There was no statistical difference in general data(P>0.05).All patients had complete clinical data and follow-up results were collected on time.All patients had no preoperative urinary incontinence and all were dioganized as prostate cancer by the ultrasound guided transrectal prostate biopsy,pathological staging were T1-T3a,CT and MRI showed no seminal vesicle invasion or lymph node metastasis,ECT bone scan showed no distant metastases.The operations were performed by the same surgeon senior director.Exclusion criteria:incomplete or inaccessible imaging before and after surgery,previous TURP and other prostatic surgery,previous endocrine therapy or radiotherapy.The operation time of the two groups,the amount of bleeding,the rate of leakage of urine within 2 weeks after operation,the time of postoperative hospitalization and the positive margin rate were compared.Postoperative urinary incontinence questionnaire(ICIQ-SF)was used to investigate patients’ urinary continence in 1,2,3 and 6 months after operation.Results 68 cases were operated successfully,without conversions to open surgery.The operation times of the experimental group and the control group were respectively(185.14±18.53)min and(193.03±25.432)min(P=0.147),the amount of bleeding were(202.57±24.30)ml and(211.52±22.93)ml(P=0.124),the times of hospital stay were(11.3±2.4)d and(12.3±2.1)d(P= 0.084),the postoperative urinary leakage rate in 2 weeks were 14.29%(5/35)and 21.21%(7/33),bladder neck margin positive cases were 3 cases and 4 cases(P=0.705),there was no significant difference for all.1 month,2 month,3 month and 6 month after operations,the continence rates of the experimental group were 57.1%(20/35),77.1%(27/35),85.7%(30/35),97.14%(34/35),the control group’s continence rates were 36.4%(12/35),54.5%(18/35),75.8%(25/35),93.9%(31/35).At 1 month and 2 month after surgery,there was a statistically significant difference in urinary continence between the two groups(P=0.047and P=0.040),and there was no significant difference in urinary continence between the two groups at 3 and 6 month(P=0.274 and P=0.523).Conclusions Technique of preservation of bladder neck by sling suspension technique at seminal vesicle can improve the recovery of early postoperative urinary continence,and does not increase the rate of positive margin and urinary leakage. |
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