Modified apical dissection of the prostate improves early continence in laparoscopic radical prostatectomy: technique and initial results

Abstract

In this preliminary study, the technique of simplified apical dissection of the prostate in LRP appears to be an easy and feasible technique in early recovery of urinary continence. Further long-term and larger sample studies are necessary to elucidate the modified technique in LRP on early restoration of urinary continence.

Laparoscopic Radical Prostatectomy Plus Extended Lymph Node Dissection in Combination With Immediate Androgen Deprivation Therapy for Cases of pT3-4N0-1M0 Prostate Cancer: A Multimodal Study of 8 Years' Follow-up

“…However, some studies showed that RPbecame one of the modalities for advanced non-bonemetastatic PCa with remarkable cancer-specific survivalwhich is higher than endocrine ablation and as highas radiotherapy [4]. Also, a report by Casey et al [20]showed that there was a comparable continencerate between pT3 and localized PCa patientstreated by robot-assisted LRP.More studies have also demonstratedLRP may benefit locally advanced PCa and lead to a better functional control compared with open radical prostatectomy [5,8].In our study, LRP plus ePLND for non-extra node metastatic PCa resulted in 17.7 %of positive surgical margin, which was consistent with previouslypublished range (14 to 61 %) for pT3 PCatreated by robot-assisted laparoscopic prostatectomy(RALP) [21,22].We reported a higher continence rate of 94.8 % at 1 yearpostoperatively which was attributable tothemodifiedprostate apex dissection in our operation [11].Furthermore, as the surgical equipment and operation skills improved, the incidence of treatment-related complications decreased year by year [19,20]. In our study, the mean intra-operative bleedingwas 105 ml, andof 232 patients,4 cases were observed to have adjacent organinjury (3 rectal and 1 ureter), which also demonstratedthat it can be safe for pathologically advanced PCatreated by LRP.…”

“…Before extra-fascia LRP, ePLND was performedthrough transperitoneal approach.The dissected lymphnode clusters included external iliac artery, common iliac artery, obturator fossa,internal iliac, and presacral lymph nodes. Each lymph node wasdissected en bloc for histopathological analysisto evaluate the metastaticstatus.Following the ePLND, LRP comprises the following steps in turn: 1)bladder and anterior mobilization; 2) ligation of thedorsal venous complex; 3) dissection of the anterior andposterior bladder neck; 4) detachment of the seminal vesicles; 5) mobilization of prostate; 6)vesicourethral anastomosis [11,12]. Rectal injury andpositive surgicalmargin (PSM)should be avoided during the operation [13].…”

Single‐port transvesical laparoscopic radical prostatectomy for organ‐confined prostate cancer: technique and outcomes

“…Continence and potency were evaluated using the ICS questionnaire and IIEF diaries, respectively. Continence was defined as achieving 0-pad use or a liner used for security reasons only [2]. The requirement for 2-3 pads daily by patients with normal physical activity was considered 'mild incontinence' , and >3 pads daily was considered 'incontinence' .…”

“…Laparoscopic radical prostatectomy (LRP) has become the standard approach to the treatment of organ-confined prostate cancer; however, outcomes can include incontinence and loss of sexual function, which can have significant adverse effects on quality of life. Although some modifications, including preservation of the bladder neck [1], sparing neurovascular bundles and apical modified dissection [2], have been implemented to improve outcomes with regard to postoperative continence and sexual function, achieving the rapid recovery of continence and sexual function remains a huge challenge. early by PSA testing, radical prostatectomy (RP) did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up.…”

Pelvic Floor Reconstruction After Radical Prostatectomy: A Systematic Review and Meta-analysis of Different Surgical Techniques

“…Urinary incontinence is often perceived as more bothersome than erectile dysfunction 4 . Several methods of pelvic floor reconstruction have been introduced to reduce the risk of urinary incontinence.…”