The efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis / 中华泌尿外科杂志

ABSTRACT

Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis.Methods From August 2016 to November 2018,31 patients with prostate cancer underwent laparoscopic radical prostatectomy.The patients were 62-85 years old(mean 74.8 years),and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml).The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml.All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis.Surgical procedureAfter resection of the prostate in laparoscopic radical prostatectomy,the bladder neck was sutured at 6 o'lock position to narrow the bladder neck (" tennis racquet" reconstruction).The interval was 1 cm,and 2-3 needles were sutured,the distance between the neck of the bladder and the ureter was extended.The bladder neck mucosa and urethral mucosa eversion were performed.The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline.After the knot was tightened,the posterior wall of the bladder was folded and bladder neck was elevated.The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra.Finally,the bladder and urethra were anastomosed.The postoperative urinary continence recovery and the clinical effect were recorded.Results The operation time of 31 patients ranged from 80 to 210,with an average of 139.7 minutes.Intraoperative bleeding was 50-330 ml,with an average of 144.2 ml.None of the patients switched to open surgery during the operation,and there was no injury to large vessels and rectum,and no anastomotic leakage.Postoperative pathology showed 21 cases of pT2 stage,10 cases of pT3 stage,2 cases of positive margin,including 1 case of basal part and 1 case of apex part,both of which received medical castration therapy postoperatively.The surgical margin was positive in 2 cases (6.45％).31 patients removed the urinary catheter in ten days after surgery.17 cases (54.8％) recovered instantly urinary continence;7 cases (22.6％) urinary continence in 1 month after operation;4 cases (12.9％) urinary continence in 3 months after operation;and 3 cases (9.7％) urinary control in 6 months after operation.One case had urinary retention after removing the urinary catheter,and cathetered for 2 more weeks.After pulling out again,the urinary continence was good.Conclusions Laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis may be helpful for early recovery of urinary continence.