ABSTRACT
Objective@#To investigate the application of a simplified technique for reconstruction of vesicourethral support (RVUS) in laparoscopic radical prostatectomy (LRP).@*METHODS@#From January 2017 to August 2019, 122 patients with localized prostate cancer underwent extraperitoneal LRP, 65 with RVUS (the RVUS group) and 57 without RVUS (the non-RVUS group). We compared the operation time, intraoperative blood loss, rate of pelvic lymph node dissection, neurovascular bundle sparing, incidence of urethrovesical anastomotic urinary leakage (UVAUL), postoperative urinary continence, postoperative hospital stay, intraperitoneal drainage tube removal time, and urethral catheter removal time between the two groups of patients.@*RESULTS@#No statistically significant differences were observed between the two groups in the operation time, intraoperative blood loss, rate of pelvic lymph node dissection, neurovascular bundle sparing, or urethral catheter removal time (P > 0.05). The incidence rate of UVAUL was lower in the non-RVUS than in the RVUS group (8.8% vs 0%, P 0.05) and 12 months after catheter removal (87.7% vs 92.3%, P > 0.05). The postoperative hospital stay was dramatically longer in the non-RVUS than in the RVUS group (［9.1 ± 4.3］ vs ［6.7 ± 1.8］ d, P < 0.01) and so was the intraperitoneal drainage tube removal time (［6.9 ± 4.5］ vs ［4.8 ± 1.5］ d, P < 0.01).@*CONCLUSIONS@#The simplified technique for reconstruction of vesicourethral support in laparoscopic radical prostatectomy improves early urinary continence, especially immediate continence, decreases the incidence rate of urethrovesical anastomotic urinary leakage, and shortens the intraperitoneal drainage tube removal time and postoperative hospital stay.?
Subject(s)
Humans , Male , Laparoscopy , ProstatectomyABSTRACT
Objective To search for method for treatment and prevention of urethrovesical anastomotic leakage (PUAL) follownng laparoscopic radical prostatectomy (LRP). Methods Eight (5. 3%) of the 151 laparoscopic radical prostatectomies performed between Jan. 2006 and Jan. 2011 developed PUAL. Running urethrovesical anastomosis was used for 58 patients and traditional suture was used in 93 during LRP. The mean age of the 8 patients was 66 years (ranging 53 to 78 years), the mean preoperative total prostate specific antigen(T-PSA) was 34. 3 ng/ml (ranging 1. 1 to 165. 0 ng/ml). The preoperative Gleason sum was 7 in 2 patients. The mean preoperative Gleason score was 7 (ranging 5 to 9). Pathological stage was T1c nn 5, T2a in 2, and T2c in 1 patient. The mean operation time was 202 min (ranging 60 to 360 min). Several treatments were used, including prolonged retropubic drainage, bladder catheter traction, drain position adjustment, reduction of fluid intake, delayed bladder catheter removal and enhancing nutrition for patients. Patients underwent reoperation using a laparoscopic approach after failure of the initial management. Results PUAL was not observed in LRP cases with running laparoscopic suture technique, which was significantly better than cases with traditional suture method (0 vs 8. 6% [8/93], P<0. 05). Six patients were cured by conservative treatments, 2 patients required reintervention via a laparoscopic approach. The catheters of all patients were removed after a mean of 33 d (ranging 21-43 d). Urethral stricture was not found during a 39-month follow-up(ranging 22to 60 months). Concision Urethrovesical anastomotic leakage can be effectively avoided by running urethrovesical anastomosis; conservative treatment and laparoscopic repair are effective managements to treat PUAL.