The Study Of Bladder Neck Preservation In Robot-assisted Laparoscopic Radical Prostatectomy For Early Postoperative Urinary Control Recovery

Objective:Prostate cancer(PCa)is one of the most frequent cancers of the urogenital system.With the advancement of prostate specific antigen(PSA)screening in China,prostate cancer ranks ninth among the top ten common malignant tumors in China.Most patients have early disease discovery and are early localized prostate cancer,so surgical treatment is a more preferred treatment.Radical retropubic prostatectomy(RRP)was first performed in the 19 th century.With the gradual maturity of the technology,It has become the golden standard for the treatment of localised prostate cancer.With the development of minimal invasive techniques,laparoscopic radical prostatectomy(LRP)and robot-assisted laparoscopic prostatectomy(RALP)have been gradually adopted by surgeons.Urinary leakage after RP is one of the common complications,which is related to many factors such as postoperative surgical techniques,surgical experience and urinary tract reconstruction techniques.Bladder neck preservation(BNP)has developed particularly rapidly.The bladder neck is a circular contraction structure,which is connected to the base of the prostate.Some scholars have reported that retaining the bladder neck during RP can effectively improve the postoperative urinary control function and reduce the postoperative anastomotic stenosis rate,but there are still few studies on this technique.The purpose of this paper is to explore the effectiveness of bladder neck preservation technique in RALP for early postoperative urinary control recovery.Methods:A retrospective analysis of 53 cases of robot-assisted radical prostatectomy in China-Japan Union Hospital of Jilin University from May 2020 to August 2022.All patients were diagnosed with prostate cancer by transrectal prostate biopsy before operation,supplemented by MRI or PSMA-PET / CT.After excluding urinary incontinence,history of external radiotherapy and other diseases that may affect urinary incontinence,they were divided into two groups according to the different surgical methods: 31 cases in the experimental group underwent RALP + BNP;the control group underwent standard RALP in 22 cases.Preoperative data of patients were collected: age,BMI,prostate volume,preoperative PSA,Gleason score,T stage,risk group;surgery-related data:operation time,intraoperative blood loss,positive margin rate;postoperative data: postoperative drainage tube removal time,exhaust time,postoperative catheter indwelling time,postoperative pathological stage,Gleason score,postoperative complications,postoperative catheter removal and 1,2,3,6 months of patients with urinary pad usage.Results:There was no obvious difference between the preoperative data of the experimental and control groups(P>0.05).The operative times were 161.16±3.83 min and 154.18±5.21 min for the experimental and control groups respectively(p<0.05).The drainage tube indwelling time was 7.29±0.23 d and7.64±0.26 d,respectively(P < 0.05).The differences were statistically significant.Intraoperative blood loss was160.65±14.71 ml and 155.68±17.49 ml,respectively(P>0.05).The postoperative recovery time of gastrointestinal function was 22.94±1.79 h and 22.68±2.02 h,respectively(P>0.05).The difference was not statistically significant;there was no significant difference in postoperative complications between the two groups(P>0.05).By non-parametric rank sum test,there was a statistically significant difference in the use of pads between the experimental and control groups in the immediate postoperative period,1 month postoperative,2 months postoperative and 3 months postoperative(P<0.05);there was no significant difference in urine control between the two groups at 6 months postoperative.Conclusion:This study confirmed that in robot-assisted radical prostatectomy,bladder neck preservation technology can effectively improve the patient ’s immediate urinary control and early urinary control,and can effectively improve the patient ’s postoperative quality of life,and there is no significant difference in perioperative efficacy and tumor control rate.However,due to the limited number of samples,it is necessary to further expand the sample size to explore the clinical application value of this technology.