ABSTRACT
Radical prostatectomy (RP) is the standard treatment for patients with early-stage of prostate cancer,but often causes urinary incontinence and other complications, which harm patients’ quality of life. The protection and reconstruction of urinary continence-related structures during the operation are significant approaches to reduce the incidence of urinary incontinence and restore urinary continence. This article reviewed the surgical approaches of radical prostatectomy, anatomy of urinary continence-related structures (bladder neck, functional urethra, supporting structures, nerves and vessels) and the protective skills,hoping to provide reference for the treatment of early-stage prostate cancer.
ABSTRACT
【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.
ABSTRACT
Objective To evaluate the variation of functional urethra length on urine control,explore a new method to prevent urinary incontinence and seek urodynamic evidence after radical prostatectomy. Methods Sixteen male dogs,matched in body weight,were randomly divided into two groups. Group A were used to test the different rest urethral pressure profile after resection of prostate,resection of distant prostate plus posterior urethra in length of 1.5 cm and 2.0 cm respectively; Group B to test the different rest urethral pressure profile on pedicle myotube in length of 2.0 cm and 1.0 cm using anterior bladder flap respectively after resection of prostate and posterior urethra in length of 2.0 cm. Results The urodynamic indexes fell off while the functional urethra length decurtated gradually in group A,but they went up in group B. The two groups showed significant difference before and after the resection of prostate and distant urethra in length of 2. 0 cm. Conclusion There was a direct ratio between the functional urethra length and the capability of urethral urine control. Reconstruction of functional urethra using anterior bladder flap pedicle myotube is a good choice to treat urinary incontinence after radical prostatectomy.