Correlative Analysis Of Factors Of Urinary Continence Recovery After Laparoscopic Radical Prostatectomy

Objective:Through the collection of clinical data related to laparoscopic radical prostatectomy in the Department of Urology of Jiujiang First People’s Hospital,we analyzed the factors related to the recovery of urinary continence,and provided a rationale for postoperative urinary continence evaluation.Materials and Methods:We collected the case data of 76 patients who underwent laparoscopic radical prostatectomy in the Urology Department of Jiujiang First People’s Hospital from January 2018 to December 2020,and we retrospectively analyzed the urinary continence at 1,3,6 and 12 months after laparoscopic radical prostatectomy.Preoperative and postoperative related clinical indicators and data were recorded,including the general condition of the patient: age,body mass index(BMI),preoperative PSA,Gleason score,pathological stage,positive surgical margins;preoperative anatomy: prostate volume,membranous urethral length(MUL);intraoperative related factors: such as operation time,intraoperative blood loss,whether to preserve the bladder neck,neurovascular bundle(NVB)and posterior fascia reconstruction.The above data were analyzed by statistical methods to evaluate the relationship between its various data and postoperative urinary continence recovery.Results:A total of 76 patients were included in the study.The number of urinary continence patients at 1,3,6 and 12 months after operation were 17(22.36%),39(51.31%),63(82.89%)and 68(89.47%)cases,respectively.Age,operation time,intraoperative blood loss,pathological stage,and positive surgical margin were not significantly associated with postoperative urinary continence recovery.At 1 month after laparoscopic radical prostatectomy,MUL,Gleason score,bladder neck preservation,NVB preservation,and posterior fascial reconstruction were statistically significant in univariate analysis.We further included MUL,Gleason score,bladder neck preservation and posterior fascia reconstruction into logistic multivariate analysis and showed that Gleason score,MUL,bladder neck preservation,and posterior fascial reconstruction were independent risk factors for the recovery of urinary continence.At 3 months after laparoscopic radical prostatectomy,prostate volume,MUL,bladder neck preservation,NVB preservation,and posterior fascial reconstruction were statistically significant in univariate analysis.We further included prostate volume,MUL,bladder neck preservation,NVB preservation and posterior fascia reconstruction into logistic multivariate analysis and showed that MUL,bladder neck preservation,posterior fascial reconstruction,and prostate volume were independent risk factors for the recovery of urinary continence.At 6 months after laparoscopic radical prostatectomy,BMI and prostate volume were statistically significant in univariate analysis.We further included BMI and prostate volume in logistic multivariate analysis and showed that BMI and prostate volume were independent risk factors for the recovery of urinary continence.At 12 months after laparoscopic radical prostatectomy,BMI,prostate volume and preoperative PSA were statistically significant in univariate analysis.We further included BMI,prostate volume and preoperative PSA into logistic multivariate analysis and showed that BMI and prostate volume were independent risk factors for the recovery of urinary continence.Conclusion:(1)MUL,bladder neck preservation and posterior fascia reconstruction are independent risk factors for early postoperative urinary continence recovery,and MUL≥14mm,bladder neck preservation and posterior fascia reconstruction are beneficial to early postoperative urinary continence recovery.Gleason score was an independent risk factor for continence recovery at 1 month after surgery.(2)Prostate volume is an independent risk factor for continence recovery during and after 3 months of laparoscopic radical prostatectomy.Prostate volume greater than 50 ml does not promote the recovery of urinary continence.(3)BMI is an independent risk factor for long-term(after 6 months)urinary continence recovery after laparoscopic radical prostatectomy,and obesity does not promote long-term urinary continence recovery.