Internal urethral sphincter reconstruction with anterior bladder neck tube for robotic and laparoscopic radical prostatectomy: improving early return of continence

被引:0
作者
Xu, Zhibin [1 ]
Zhao, Jie [1 ]
Guan, Zhenghui [1 ]
Guo, Maomao [1 ]
Bian, Hao [1 ]
Li, Zhenchi [1 ]
Zhao, Wenchao [1 ]
Liang, Sudong [1 ]
Liu, Yu [1 ]
Zhang, Siyang [1 ]
Wang, Jiangping [1 ]
机构
[1] Nanjing Med Univ, Affiliated Taizhou Peoples Hosp, Taizhou Sch Clin Med, Dept Urol, 366 Taihu Rd, Taizhou 225300, Peoples R China
关键词
Prostate cancer; radical prostatectomy (RP); urinary continence; anterior bladder neck tube (ABNT); internal urethral sphincter (IUS); PRESERVATION; OUTCOMES; STITCH; LENGTH;
D O I
10.21037/tau-23-583
中图分类号
R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
摘要
Background: In recent years, despite several surgical techniques having been applied, the early incontinence rate after radical prostatectomy (RP) remains high. In this study, we reconstructed an internal urethral sphincter (IUS) with anterior bladder neck tube (ABNT) to improve early return of continence and find a more effective technique for early urinary incontinence after RP. Methods: In this study, 96 previous patients who did not receive an ABNT between October 2018 and May 2020 were compared as historical controls (the control group). A total of 210 consecutive patients underwent robotic or laparoscopic RP with ABNT between May 2020 and February 2023 (the ABNT group). The inclusion criteria included Eastern Cooperative Oncology Group (ECOG) score 0-1 and localized prostate cancer (clinical stages cT1-3, cN0, cM0). The exclusion criteria included patients with diabetes, neurologic diseases, previous pelvic operations, symptoms of urinary incontinence, prior radiation, focal therapy, or androgen deprivation therapy for prostate cancer. ABNT was reconducted with a U-shaped flap from the anterior wall of the bladder neck, and was then anastomosed with the urethra. In the control group, the bladder outlet was directly anastomosed with the urethra. Continence, as defined if 0 pads were used per day and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score <= 6, was assessed at 1, 4, 8, 12, and 24 weeks after catheter removal. At 2 weeks after catheter removal, urethral pressure profilometry (UPP) and upright urethrography were performed to evaluate the function of ABNT in the ABNT group. Results: More patients in the ABNT group were continent than those in the control group at 1 week (85.2% (100% vs. 71.9%, P<0.001), and at 24 weeks (100% vs. 87.5%, P<0.001) after catheter removal. Stricture was presented in 5.2% and 2.1% (P=0.34) in the ABNT group and control group, respectively. UPP showed that a functional IUS was reconstructed with ABNT. Upright urethrography showed that the ABNT was filled with contrast medium in the urination period and with no contrast medium during the storage period and interruption of urination. Conclusions: The ABNT technique significantly improved early return of continence in comparison with the no ABNT technique, especially the immediate continence. The ABNT technique reconstructed the functional IUS with acceptable urethral stricture. The limitations of the present study include that the comparison was conducted retrospectively with a historical cohort and lack of randomization, and the single center setting. A prospective, randomized, and multicenter evaluation is expected.
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页码:994 / 1003
页数:10
相关论文
共 27 条
  • [1] A novel method of bladder neck imbrication to improve early urinary continence following robotic-assisted radical prostatectomy
    Beattie K.
    Symons J.
    Chopra S.
    Yuen C.
    Savdie R.
    Thanigasalam R.
    Haynes A.M.
    Matthews J.
    Brenner P.C.
    Rasiah K.
    Sutherland R.L.
    Stricker P.D.
    [J]. Journal of Robotic Surgery, 2013, 7 (2) : 193 - 199
  • [2] Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy
    Bellangino, Mariangela
    Verrill, Clare
    Leslie, Tom
    Bell, Richard W.
    Hamdy, Freddie C.
    Lamb, Alastair D.
    [J]. CURRENT UROLOGY REPORTS, 2017, 18 (12)
  • [3] Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy
    Choi, Seung-Kwon
    Park, Sejun
    Ahn, Hanjong
    [J]. ASIAN JOURNAL OF ANDROLOGY, 2015, 17 (02) : 304 - 308
  • [4] ANTERIOR BLADDER NECK TUBE RECONSTRUCTION AT RADICAL PROSTATECTOMY PRESERVES FUNCTIONAL URETHRAL LENGTH - A COMPARATIVE URODYNAMIC STUDY
    CONNOLLY, JA
    PRESTI, JC
    CARROLL, PR
    [J]. BRITISH JOURNAL OF UROLOGY, 1995, 75 (06): : 766 - 770
  • [5] Urethral Sphincter Function Before and After Radical Prostatectomy: Systematic Review of the Prognostic Value of Various Assessment Techniques
    Dubbelman, Yvette D.
    Bosch, J. L. H. Ruud
    [J]. NEUROUROLOGY AND URODYNAMICS, 2013, 32 (07) : 957 - 963
  • [6] Urodynamic quantification of decrease in sphincter function after radical prostatectomy: Relation to postoperative continence status and the effect of intensive pelvic floor muscle exercises
    Dubbelman, Yvette D.
    Groen, Jan
    Wildhagen, Mark F.
    Rikken, Berend
    Bosch, J. L. H. Ruud
    [J]. NEUROUROLOGY AND URODYNAMICS, 2012, 31 (05) : 646 - 651
  • [7] Robot-assisted Radical Prostatectomy Using the Novel Urethral Fixation Technique Versus Standard Vesicourethral Anastomosis
    Ficarra, Vincenzo
    Rossanese, Marta
    Crestani, Alessandro
    Alario, Giuseppe
    Mucciardi, Giuseppe
    Isgro, Antonino
    Giannarini, Gianluca
    [J]. EUROPEAN UROLOGY, 2021, 79 (04) : 530 - 536
  • [8] A MODIFICATION OF TECHNIQUE FOR ANASTOMOSING MEMBRANOUS URETHRA AND BLADDER NECK FOLLOWING TOTAL PROSTATECTOMY
    FLOCKS, RH
    CULP, DA
    [J]. JOURNAL OF UROLOGY, 1953, 69 (03) : 411 - 415
  • [9] Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP)
    Gu, Xiao
    Araki, Motoo
    Wong, Carson
    [J]. MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES, 2015, 24 (06) : 364 - 371
  • [10] Early Return of Continence in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy Using Modified Maximal Urethral Length Preservation Technique
    Hamada, Alaa
    Razdan, Shirin
    Etafy, Mohamed H.
    Fagin, Randy
    Razdan, Sanjay
    [J]. JOURNAL OF ENDOUROLOGY, 2014, 28 (08): : 930 - 938