Clinical significance of preservation of bladder neck by sling suspension technique at seminal vesicle for urinary continence in laparoscopic radical prostatectomy / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the clinical significance of urinary continence after laparoscopic radical prostatectomy with the technique of preserving bladder neck with sling suspension technique by the seminal vesicle.Methods Sixty-eight patients' clinical data from January 2014 to December 2016 in our hospital who underwent laparoscopic radical prostatectomy were retrospectively analyzed.35 cases with sling suspension (experimental group).Preoperative Gleason score ≤ 6,11 cases;Gleason score 7,15 cases;Gleason score ≥8,9 cases.Stage T1 1 cases,stage T2 28 cases,and T3a 6 cases.The traditional method of bladder neck group(control group) contained 33 cases.Preoperative Gleason score ≤6,9 cases;Gleason score 7,14 cases;Gleason score ≥8,10 cases.Stage T1 2 cases,stage T2 29 cases,and T3a 2 cases.The mean ages [(64.3 ± 4.3) years old and (62.6 ± 3.8) years old],BMI [(22.85 ±1.69) kg/m2 and (22.15 ± 1.32) kg/m2],prostate volume [(45.93 ± 9.08) ml and (44.12 ± 6.85) ml],preoperative PSA[(18.76 ± 5.43) ng/ml and (21.18 ± 6.55) ng/ml],preoperative Gleason of the two groups were not statistically different (both P ＞ 0.05).All patients had no urinary incontinence.All the surgery was done by the same senior surgeon.The continence status was assessed at 1 month,2 month,3 month,and 6 month after operation.The operation time,bleeding volume,urinary leakage rate,the length of hospital stay,and positive margin between the two groups were compared.Urinary continence was assessed by daily urinary pad volume0-1 /d for urinary continence was normal,2-3/d for mild urinary incontinence,and ＞ 3/d for severe urinary incontinence.Results 68 cases were operated successfully.There was no conversions to open surgery.1 month,2 month,3 month and 6 month after operations,the continence rates of the experimental group were 57.1％ (20/35),77.1％ (27/35),85.7％ (30/35),97.14％ (34/35),respectively.The control group's continence rates were 36.4％ (12/35),54.5％ (18/35),75.8％ (25/35),93.9％ (31/35),respectively.At 1 month and 2 month after surgery,there was a statistically significant difference in urinary continence between the two groups (P =0.047 and P =0.040),and there was no significant difference in urinary continence between the two groups at 3 and 6 month (P =0.274 and P =0.523).There were 3 cases and 4 cases of positive margins in the experimental group and the control group,with no statistical significance (P =0.705).Conclusions Technique of preservation of bladder neck by sling suspension technique at seminal vesicle may improve the recovery of early postoperative urinary continence,and does not increase the rate of positive margin.