To evaluate the feasibility of three bladder neck reconstruction (BNR) techniques in laparoscopic radical prostatectomy (laparoscopic RP) and their effects on urinary continence.
We retrospectively analyzed 121 patients with organ-confined prostate cancer who underwent laparoscopic RP in our center from March to December 2018. Three BNR techniques-zero o'clock reconstruction (ZOR), six o'clock reconstruction (SOR), and three/nine o'clock reconstruction (T/NOR)-applied in patients with large bladder opening after prostate resection were described comprehensively. Demographic and peri-operative data were collected and analyzed using Pearson's chi-square and one-way Anova test. Multivariate analysis was performed to explore predictors that affected continence recovery in 24 h, 1 month, 3 months, and 6 months after catheter removal.
laparoscopic RP was performed successfully in all patients, wherein 37, 35, 34, and 15 patients underwent bladder neck preservation (BNP), ZOR, SOR, and T/NOR techniques, respectively. There were more high-risk patients and larger mean prostate volume in groups with BNR techniques. Perioperatively, patients with reconstruction techniques had longer operation and anastomosis time, more estimated blood loss, and more positive margin status. Nevertheless, there was no significant difference among four groups regarding continence recovery in 24 h, 1 month, 3 months, and 6 months after catheter removal. On multivariable analysis, positive apical margin and long anastomosis time were independent adverse predictors of continence recovery in 24 h. Large prostate volume and positive apical margin were adverse factors of continence recovery at 1, 3, and 6 months.
Three different kinds of BNR techniques were safe and feasible in laparoscopic RP and had no different impact on continence recovery. Positive apical margin, large prostate volume, and long anastomosis time were independent adverse predictors of continence.
Journal of endourology. 2020 Mar 31 [Epub ahead of print]
Shaobo Zhang, Chao Liang, Jian Qian, Yiyang Liu, Qiang Lv, Jie Li, Pu Li, Pengfei Shao, Zengjun Wang
The First Affiliated Hospital of Nanjing Medical University, Department of Urology, Nanjing, Jiangsu, China; ., The first Affiliated Hospital of Nanjing Medical University, Department of Urology, Nanjing, Jiangsu, China; ., First Affiliated Hospital of Nanjing Medical University, Department of Urology, 300 Guangzhou Road, Nanjing, Jiangsu, China, 210029; ., The First Affiliated Hospital of Nanjing Medical University, Urology, Nanjing, Jiangsu, China; ., The first Affiliated Hospital of Nanjing Medical University, Department of Urology, Nanjing, Jiangsu, China; ., The First Affiliated Hospital of Nanjing Medical University, Department of Urology, Nanjing, Jiangsu, China; ., The first Affiliated Hospital of Nanjing Medical University, Department of Urology, 300 Guangzhou Road, Nanjing, Nanjing, Jiangsu, China, 210029; ., The First Affiliated Hospital of Nanjing Medical University, Urology, 300 Guangzhou Road, Gulou District, Nanjing, China, Nanjing, Jiangsu, China, 210029; ., The first Affiliated Hospital of Nanjing Medical University, Department of Urology, nanjing, Jiangsu, China; .