Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Number 600, Tianhe Road, 510630, Guangzhou, Guangdong, China.
J Cancer Res Clin Oncol. 2010 Apr;136(4):511-6. doi: 10.1007/s00432-009-0683-4. Epub 2009 Sep 23.
Incontinence after radical retropubic prostatectomy (RRP) is one of the greatest worries for all patients. One of the possible reasons for this urinary incontinence is a postoperative deficiency of the external striated urethral sphincter (EUS) complex and continence nerves. This study evaluated the application of a modified simple technique to dissection of the apical prostate in laparoscopic radical prostatectomy (LRP) and assessed the rate of urinary continence.
A total of 104 patients were randomly selected using envelopes and enrolled in this study. A standard LRP was performed in 52 patients (standard LRP group) and a modified technique for simple dissection of the apical prostate in LRP was performed in another 52 patients (modified LRP group). The urethra was dissected and transected at the apex of the prostate, proximal to the nerve-distributing rhabdosphincter using sharp scissors to avoid damage to the EUS complex and continence nerves. In all patients, a pad test was performed on 3, 30 and 90 days postoperatively and correlated with urinary continence. Continence was defined as zero pads or a liner used for security reasons only.
After catheter removal, the continence rates were regained in 66, 85 and 96% of patients in the modified LRP group compared with 28, 55 and 91% of the patients in the standard LRP group at 3, 30 and 90 days, respectively. A statistically significant difference was present at 3 and 30 days (p < 0.01, respectively). At 90 days, the difference, although still present, was not statistically significant (p > 0.05).
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.
根治性耻骨后前列腺切除术（RRP）后尿失禁是所有患者最担心的问题之一。这种尿失禁的一个可能原因是术后外横纹尿道括约肌（EUS）复合体和控尿神经的缺陷。本研究评估了改良的简单技术在腹腔镜根治性前列腺切除术（LRP）中对前列腺尖部解剖的应用，并评估了控尿率。
采用信封法随机选择 104 例患者纳入本研究。52 例患者行标准 LRP（标准 LRP 组），另 52 例患者行改良 LRP 简单前列腺尖部解剖术（改良 LRP 组）。在靠近神经分布的横纹肌处，用锐利的剪刀锐性解剖和切断尿道，避免损伤 EUS 复合体和控尿神经。所有患者均在术后 3、30 和 90 天进行垫试验，并与控尿情况相关联。控尿定义为零垫或仅出于安全原因使用衬垫。
拔除导尿管后，改良 LRP 组患者的控尿率分别在 3、30 和 90 天恢复至 66%、85%和 96%，而标准 LRP 组患者的控尿率分别为 28%、55%和 91%。3 天和 30 天差异有统计学意义（p < 0.01）。90 天时，差异虽然仍然存在，但无统计学意义（p > 0.05）。
在这项初步研究中，LRP 中简化前列腺尖部解剖的技术似乎是一种简单可行的技术，可以早期恢复尿控。需要进一步的长期和更大样本的研究来阐明 LRP 中改良技术对早期恢复尿控的作用。
