Improving early urinary continence recovery after radical prostatectomy by applying a sutureless technique for maximal preservation of the intrapelvic urethra: A 17-year single-surgeon experience

Abstract

Background: There is a growing concern about postsurgical outcomes of radical prostatectomy, especially in the younger population and patients with earlier tumor stages. Here, we present our 17 years’ experience of sutureless vesico-urethral alignment after radical prostatectomy with a focus on postoperative functional urinary outcomes. Methods: Data of 784 patients who underwent radical prostatectomy during 2001–2017 were evaluated retrospectively. Before surgery, patients’ demographic information, pathologic stage, margin of surgery, prostate-specific antigen, and Gleason score were obtained. Then, serum prostate-specific antigen level, urinary continence, potency, and other functional outcomes of surgery were recorded after each postoperative visit. Results: The mean age (±standard deviation) of patients was 61.3 (±6.30) years. The median (IQ25–75) duration of follow-up was 30 (12–72) months. Full continence was achieved in 90% and 95.9% of patients at 3 and 6 months post surgery and 96.4% of the patients were continent at the last follow-up visit. Bladder neck stricture occurred in 167 patients (21.3%). During the follow-up period, none of the patients complained of total incontinence and at the last visit, 36.6% of patients reported potency. The frequency of grade 2 continence was significantly higher in patients with high-stage tumors (T3/T4), high Gleason score (⩾8), high preoperative serum prostate-specific antigen (>20 ng/dL), and positive margin of surgery. Potency had a significant relationship with age, stage of the disease, and preoperative prostate-specific antigen. Conclusion: Maximal sparing of intrapelvic urethral length through sutureless vesico-urethral alignment technique results in excellent early urinary continence recovery after radical prostatectomy. A more advanced tumor stage (T1/T2), a higher Gleason score, high preoperative prostate-specific antigen, as well as positive surgical margin are risk factors of postoperative incontinence in patients who undergo radical prostatectomy.

Benign prostatic hyperplasia: Who will benefit from surgical intervention? A single center experience

“…Some of these changes include tissue remodeling of the prostate, alteration in the autonomous nerve system and sex hormone metabolism, and also changes in the interactions of epithelial/stromal cell, cytokines, and infiltrating lymphocytes with aging. [6][7][8]15,16 These findings support the hypothesis that irreversible age-related changes can affect the outcome of surgery and result in less improvement of symptoms in older patients. However, many studies have opposed this hypothesis.…”

Comparison of histopathological features, survival, and oncological outcome between patients under and above 55-year-old with prostate cancer who underwent radical prostatectomy

“…All patients underwent scheduled follow-ups at 1, 3, and 6 months post-surgery and every other 6 months thereafter (as mentioned in previous studies). 18,19 Post-operative data including stage of pathology, surgical margin, post-operative PSA, recurrence rate, and metastasis was recorded. Biochemical failure was defined as two consecutive post-operative PSA >0.2 ng/dl.…”

Technical advances in nerve-sparing and continence preservation

“…The retroapical approach [44] and collar technique [45] were described to attain optimal visualization and MUL whereas decreasing PSM rates. As MUL is one of the major determinants of UC, techniques like the sutureless vesico-urethral anastomosis [46], urethral dissection up to the colliculus seminalis [47] and preservation of intraprostatic urethra [48] have been explored, reporting positive functional outcomes. Another key step during apical dissection is the dorsal venous complex (DVC) division.…”