Correlation Between Residual Functional Urethra And Early Urinary Control Recovery After Laparoscopic Radical Prostatectomy For Prostate Cancer

Objective:To explore and analyze the correlation between the functional urethral length measured by preoperative urodynamics and the shape of the prostate tip measured by magnetic resonance imaging and other relevant imaging data of patients undergoing 3D laparoscopic radical prostatectomy(LRP)and the early postoperative incontinence recovery of patients.To analyze the effects of laparoscopy in tumor control and postoperative incontinence recovery.Methods:Collected clinical data of 66 patients who accepted laparoscopic radical prostatectomy from August 2017 to December 2018,including patients with preoperative general data,urine flow dynamic data,magnetic resonance imaging measurement data,including age,body mass index(BMI),maximum urethral closure pressure(Pclomax),functional urethral length(FUL),prostatic apex of morphology,membrane of urethra length(the MUL),prostatic urethra length,etc.,and defines the remaining functional urethral length(RFUL)as the functional urethral length and the prostatic urethra length difference.3D laparoscopic system was used in all patients during the operation and the whole process of video recording was performed.Meanwhile,the postoperative pathology of the patients was tracked.Patients with urinary incontinence were followed up continuously 24 hours,1 week,1 month and 3 months after surgery by mail,We Chat and telephone.Incontinence was assessed using a widely used pad test,defined as the use of no more than one pad per day.SPSS 20.0 computer statistical software was used for statistical analysis of the data.Spearman correlation coefficient describes the correlation between the two variables,and the chi-square test was used to compare the counting data.Logistic regression was used to analyze the relationship between relevant parameters and urinary control rate.P < 0.05 was considered as significant difference.Result:All the 66 patients who met the enrollment criteria received the operation successfully and were followed up for at least 3 months after the operation.The length of the membranous urethra(P=0.002,P=0.003,P=0.001),the maximum urethral closure pressure(P=0.012,P=0.002,P=0.010),and the length of the residual functional urethra(P=0.014,P=0.035,P=0.040)were the relevant predictors of urinary control function recovery within 24 hours,1 week,and 1 month after the removal of the catheter.The presence or absence of prostate apex tissue in the membranous urethra was a predictor of urinary control recovery 3 months after the removal of the catheter(P=0.025).Age(P=0.004)is correlated with the urinary control rate 24 hours after the removal of the catheter was also significantly.In this study,the overall urinary control rates of patients receiving 3D laparoscopic radical prostatectomy at 24 hours,1 week,1 month and 3 months were 54.5%,63.6%,75.8% and 89.6%,respectively.The positive rate of cutting edge was 12.1%,of which the positive rate of cutting edge at the tip was 9.1%.Conclusion:Preoperative residual functional urethral length,maximum urethral closure pressure,and membranous urethral length are important predictors of early urinary control after radical prostatectomy.3D laparoscopy is helpful for early postoperative urinary control recovery under the principle of tumor clearance.