Effect of modified Retzius-sparing robot-assisted radical prostatectomy and

Dong CHEN; Feiya YANG; Mingshuai WANG; Sujun HAN; Shihao ZHANG; Boda GUO; Zhannan SI; Xiongjun YE; Yong ZHANG; Nianzeng XING

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Effect of modified Retzius-sparing robot-assisted radical prostatectomy and " Sandwich" technique of total urethral reconstruction on the early postoperative urinary continence

VernacularTitle:改良RS-RARP＋"三明治"法尿道重建技术对术后早期尿控的影响
Author: Dong CHEN ¹ ; Feiya YANG ¹ ; Mingshuai WANG ¹ ; Sujun HAN ¹ ; Shihao ZHANG ¹ ; Boda GUO ¹ ; Zhannan SI ¹ ; Xiongjun YE ¹ ; Yong ZHANG ¹ ; Nianzeng XING ¹
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1. 国家癌症中心　国家肿瘤临床医学研究中心　中国医学科学院北京协和医学院肿瘤医院泌尿外科，北京　100021
Publication Type:Journal Article
Keywords: Prostatic neoplasms; Carcinoma; Radical prostatectomy; Robot; Early urinary continence; Retzius-sparing
From: Chinese Journal of Urology 2024;45(11):821-824
CountryChina
Language:Chinese
Abstract: Objective:To investigate the effect of modified Retzius-sparing robot-assisted radical prostatectomy(RS-RARP) and " Sandwich" technique of total urethral reconstruction on the early postoperative urinary continence.Methods:The clinical data of 70 consecutive patients who underwent RS-RARP by the same operator at the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2021 to November 2023 were retrospectively analyzed. The age was (65.1±8.0) years old, the body mass index (BMI) was (25.6±3.1) kg/m 2, the prostate volume was (31.9±18.1)ml and the preoperative prostate specific antigen(PSA) was (16.3±16.1)ng/ml. Four patients treated with neoadjuvant hormonal therapy before radical prostatectomy. Eleven patients underwent radical prostatectomy without prostate biopsy, while the remaining 59 patients underwent prostate biopsy. There were 10, 23, 14, 10 and 2 patients with Gleason scores of 6, 7, 8, 9 and 10 respectively.There were 48 patients with clinical stage cT 2 and 22 with cT 3. The surgical method was RS-RARP and "Sandwich" technique of total urethral reconstruction. The operation time, intraoperative blood loss, postoperative drain tube preservation time, postoperative hospitalization time, pathological staging and positive margin rate, and recovery of urinary continence immediately after postoperative catheter removal were recorded. Results:In this study, all 70 surgeries were successfully completed, with no cases converted to anterior approach radical surgery or open surgery, and no serious intraoperative complications such as post-shamus hemorrhage or ureteric/rectal injury. The median postoperative follow-up was 14(3, 28) months, and there were no cases of readmission for surgical complications. The duration of surgery was (89.8±19.5) min, and the blood loss volume was (53.7±25.2)ml. The duration of drainage tube after surgery was (6.7±1.8)d, the duration of hospitalization after surgery was (7.1±1.9)d, and the duration of urinary catheter was (8.9±3.0)d. Immediate urinary continence was achieved in 50 cases when the catheter was removed, and the rate of immediate urinary continence was 71.4%(50/70). Postoperative urinary continence rate was 81.4% (57/70) at 1 month after surgery, and 90.0% (63/70) at 3 months after surgery.At 1 month postoperatively, 94.3% (66/70) of patients had a PSA <0.2 ng/ml. At 3 months postoperatively, 98.5% (69/70) of patients had a PSA <0.2 ng/ml.Conclusions:The RS-RARP and "Sandwich" technique of total urethral reconstruction is technically feasible for patients with localized prostate cancer.The short-term follow-up effect of tumor control and urinary continence are satisfactory.