A Comparative Study Of The Effect Of Anterior Reconstruction On Urinary Control In Laparoscopic Extrafascial Radical Prostatectomy

Objective : To investigate the safety,efficacy and advantages of anterior reconstruction in laparoscopic extrafascial radical prostatectomy,and to analyze the factors that may affect the recovery of urinary control after surgery.Methods:A total of 166 patients who underwent LERP and were followed up in the Department of Urology,the First Affiliated Hospital of Kunming Medical University from October 2016 to June 2021 were evaluated,including 58 cases in the total anterior reconstruction group,58 cases in the partial anterior reconstruction group,and 50 cases in the non-reconstruction group.In the anterior reconstruction group,periurethral suspension stitch,anterior detrusor apron reconstruction,and arcus tendineus fasciae pelvis reconstruction were performed.In the partial anterior reconstruction group,periurethral suspension stitch was performed.Combined with outpatient data,hospitalization data and telephone follow-up data,relevant data were collected.The general date(age,BMI,PSA level at first diagnosis,prostate volume,tumor Gleason score,ASA score,IPSS score,clinical stage and preoperative treatment history),perioperative data(operation time,estimated intraoperative blood loss,intraoperative reconstruction method,blood transfusion volume,blood transfusion rate,length of hospital stay,duration of urinary catheter indwelling,and postoperative complications),oncological data(postoperative GS,postoperative tumor pathological stage,positive surgical margin,and biochemical recurrence rate),urinary continence recovery data(urinary leakage frequency,urinary continence recovery time,continence control,number of pads used per day,and postoperative complications)of the three groups were compared.At 24 hours,2weeks,1,3,6 and 12 months after catheter removal,the Expanded prostate cancer index composite-26 was used to evaluate the postoperative urinary outcomes.SPSS22.0 data analysis software was used to analyze the above data,P< 0.05 was considered statistically significant.Results : All the 166 patients in the study were successfully operated without conversion to open surgery.1.There was no significant difference in general data,perioperative data and oncologic outcome data between the anterior reconstruction group and the non-reconstruction group.The results of urinary control in the anterior reconstruction group were better than those in the non-reconstruction group at 2 weeks,1 month,3months,6 months and 12 months after catheter removal,and the difference was statistically significant.2.The average time of urinary continence recovery after catheter removal in the total anterior reconstruction group(3.51 months)was significantly shorter than that in the partial anterior reconstruction group(10.28 months).The total anterior reconstruction technique was significantly correlated with the urinary control results at 1,3,and 6 months after catheter removal,and the urinary control results in the total anterior reconstruction group was better than those in the partial anterior reconstruction group.The total anterior reconstruction group was significantly better than the partial anterior reconstruction group in terms of operation time,catheter indwelling time and hospital stay,and the difference was statistically significant.There were no significant differences in general date and oncological outcomes between the two groups.There were no statistically significant differences in estimated blood loss and transfusion rate during operation.3.The results showed that in the anterior reconstruction group,different body mass index,different preoperative prostate volume,different preoperative and intraoperative blood transfusion history,different operation duration,and different indwelling duration of urinary catheter may affect urinary control,and the difference was statistically significant.In the non-reconstruction group,different body mass index and different preoperative prostate volume had statistically significant effects on urinary continence.4.Multivariate analysis showed that BMI and prostate volume were important risk factors for urinary continence recovery after extrafascial laparoscopic radical prostatectomy.In the anterior reconstruction group,intraoperative and postoperative blood transfusion history was also an independent risk factor for postoperative urinary control recovery.Conclusion:1.Anterior reconstruction in laparoscopic extrafascial radical prostatectomy can promote early urinary control recovery and improve the quality of life of patients.2.BMI and prostate volume were risk factors for urinary incontinence after laparoscopic extrafascial radical prostatectomy.3.Total anterior reconstruction is significantly better than partial anterior reconstruction in terms of early urinary continence recovery.4.Total anterior reconstruction is a safe and feasible technique with excellent clinical results,which is suitable for the current practice of RP.