Lou Jiangyong, Jin Baiye, Liu Feng, Zhang Yuelong, Zhang Qi, Zhang Dahong
Department of Urology, The First Affiliated Hospital, Zhangjiang University School of Medicine, Hangzhou 310003, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2013 Nov;42(6):680-4. doi: 10.3785/j.issn.1008-9292.2013.06.016.
To assess the effect of bladder neck preservation (BNP) on postoperative continence during laparoscopic radical prostatectomy.
One hundred and forty-five patients with localized prostate cancer (Tlb-T2c) underwent laparoscopic radical prostatectomy in our center from July 2006 to May 2010, including 59 cases treated with bladder neck preservation (BNP group) and 86 cases with bladder neck resection (non-BNP group). All cases were diagnosed as prostate cancer by transrectal ultrasonography-guided prostate biopsy preoperatively, in which localized tumors were confirmed by CT or MRI and distant metastases were ruled out by ECT bone scan. All patients had no history of incontinence and no radiation therapy preoperatively. All the 145 operations were performed by the same surgeon. The bladder neck preservation was defined as a procedure of direct suturing of the bladder neck on the urethra without repair and reconstruction of the bladder neck. Both procedures of neurovascular bundle preservation and external striated urethral sphincter preservation were carried out on all cases. Urinary continence was evaluated using the International Continence Society questionnaire at 1, 3 and 6 months postoperatively. Positive surgical margins rates were compared between the two groups. Postoperative continence was defined as the absence of need for pads or the use of one pad daily.
At 1, 3 and 6 months, the urinary continence rates were 42.4%, 74.6% and 86.4% in BNP group, respectively, while 25.6%, 58.1% and 80.2% in non-BNP group, respectively. There were statistically significant differences in continence at 1 and 3 months between two groups (P <0.05), while no significant differences were observed at 6 months postoperatively (P=0.331). There were no significant differences in overall rate of positive surgical margins between two groups (10.1% Compared with 10.4% P=0.954) and both groups had one case with positive surgical margins at bladder neck.
Bladder neck preservation during laparoscopic radical prostatectomy is helpful for postoperative continence without increase of positive surgical margins rate.
评估腹腔镜根治性前列腺切除术中保留膀胱颈（BNP）对术后控尿的影响。
2006年7月至2010年5月，145例局限性前列腺癌（Tlb - T2c）患者在本中心接受了腹腔镜根治性前列腺切除术，其中59例行保留膀胱颈手术（BNP组），86例行膀胱颈切除手术（非BNP组）。所有病例术前均经直肠超声引导下前列腺穿刺活检确诊为前列腺癌，其中局限性肿瘤经CT或MRI证实，ECT骨扫描排除远处转移。所有患者术前均无尿失禁病史且未接受过放疗。145例手术均由同一外科医生完成。保留膀胱颈定义为直接将膀胱颈缝合于尿道上，不进行膀胱颈的修复与重建。所有病例均行保留神经血管束及尿道外横纹括约肌手术。术后1、3和6个月采用国际尿失禁学会问卷评估尿控情况。比较两组手术切缘阳性率。术后控尿定义为无需使用尿垫或每日仅使用1片尿垫。
术后1、3和6个月，BNP组尿控率分别为42.4%、74.6%和86.4%，非BNP组分别为25.6%、58.1%和80.2%。两组术后1个月和3个月的控尿情况有统计学差异（P <0.05），术后6个月无显著差异（P =0.331）。两组手术切缘阳性率总体无显著差异（10.1% 与10.4%，P =0.954），两组各有1例膀胱颈手术切缘阳性。
腹腔镜根治性前列腺切除术中保留膀胱颈有助于术后控尿，且不增加手术切缘阳性率。
