Hoshi Akio, Nitta Masahiro, Shimizu Yuuki, Higure Taro, Kawakami Masayoshi, Nakajima Nobuyuki, Hanai Kazuya, Nomoto Takeshi, Usui Yukio, Terachi Toshiro
Department of Urology, Tokai University School of Medicine, Isehara, Japan.
Int J Urol. 2014 Nov;21(11):1132-7. doi: 10.1111/iju.12539. Epub 2014 Jun 26.
To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes.
A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction.
There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P < 0.05). The mean interval to achieve continence was significantly shorter in the total pelvic floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003).
The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical reinforcement of the pelvic floor. Therefore, this technique is likely to improve urinary continence outcomes after laparoscopic radical prostatectomy.
在非保留神经的腹腔镜根治性前列腺切除术中开发一种改良的“全盆底重建”技术，并确定其对术后排尿结果的影响。
共评估了128例行非保留神经腹腔镜根治性前列腺切除术的患者，其中81例行全盆底重建，47例行非全盆底重建。排除保留神经的病例。在腹腔镜根治性前列腺切除术后1、3、6和12个月，通过自我管理问卷（扩展前列腺癌指数综合问卷）评估排尿结果。全盆底重建技术包括涉及前后重建的两个概念。在后侧重建中，通过滑结将Denonvilliers筋膜与膀胱颈和正中背侧缝接近似。在前侧重建中，将膀胱颈的前表面与逼尿肌前围裙和耻骨前列腺韧带环接近似。
两组患者的特征、围手术期和肿瘤学结果无显著差异。在全盆底重建组中，腹腔镜根治性前列腺切除术后3、6和12个月的控尿率分别为45.7%、71.4%和84.6%。在非全盆底重建组中，控尿率分别为26.1%、46.8%和60.9%。全盆底重建技术在腹腔镜根治性前列腺切除术后3、6和12个月分别导致显著更高的控尿率（所有P < 0.05）。全盆底重建组实现控尿的平均间隔时间显著短于非全盆底重建组（平均7.7个月对9.8个月；P = 0.0003）。
全盆底重建技术可保留尿道血供并对盆底进行物理加固。因此，该技术可能改善腹腔镜根治性前列腺切除术后的尿控结果。
