Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Institute of Urology, National Urological Cancer Center, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Int Urol Nephrol. 2019 Jul;51(7):1157-1165. doi: 10.1007/s11255-019-02118-0. Epub 2019 Apr 8.
To explore the mechanism and efficacy of the modified bladder neck intussusception in laparoscopic radical prostatectomy (LSRP) on postoperative early continence.
We prospectively collected clinical information of prostate cancer patients who underwent LSRP with modified bladder neck intussusception (n = 10) and non-intussusception (n = 10). At postoperative 1 month, the prostate-specific antigen (PSA), pad test, real-time magnetic resonance imaging (rt-MRI), and flow rate were performed. At postoperative 3 months, the PSA, pad test, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), incontinence questionnaire short form (ICI-Q-SF), and quality of life (Qol) were recorded.
The intussusception and non-intussusception patients had similar baseline characteristics. At postoperative 3 months, intussusception patients had lower OABSS than non-intussusception patients (P = 0.038). The non-intussusception patients suffered from more severe incontinence (P = 0.026). The continence rate of intussusception patients was significantly higher (90% vs. 20%, P = 0.005). And intussusception patients had significantly lower Qol scores (P = 0.038). According to the morphologic analysis by rt-MRI, there were 7/10 non-intussusception patients and 2/10 intussusception patients having funnel-shaped bladder necks at Valsalva movement. The intussusception patients had larger angle between anterior and posterior wall at bladder neck (P = 0.029) and longer length of functional posterior urethra (P = 0.029). During micturition, the intussusception bladder neck was found to move less dynamically on X-axis and Y-axis, but the difference did not reach significance.
The modified technique of bladder neck intussusception in laparoscopic radical prostatectomy prolongs the length of functional posterior urethra and is effective to improve postoperative early continence.
探讨腹腔镜前列腺癌根治术中改良膀胱颈内陷术对术后早期控尿的机制和疗效。
前瞻性收集行改良膀胱颈内陷术（n=10）和非内陷术（n=10）腹腔镜前列腺癌根治术患者的临床资料。术后 1 个月行前列腺特异抗原（PSA）、尿垫试验、实时磁共振成像（rt-MRI）、尿流率检查；术后 3 个月行 PSA、尿垫试验、国际前列腺症状评分（IPSS）、膀胱过度活动症状评分（OABSS）、尿失禁问卷短表（ICI-Q-SF）、生活质量（Qol）评分。
内陷组和非内陷组患者的基线特征相似。术后 3 个月，内陷组 OABSS 评分低于非内陷组（P=0.038）。非内陷组患者失禁症状更严重（P=0.026）。内陷组的控尿率明显更高（90%比 20%，P=0.005），且 Qol 评分明显更低（P=0.038）。根据 rt-MRI 形态学分析，非内陷组中有 7/10 例患者和内陷组中有 2/10 例患者在 Valsalva 运动时出现漏斗形膀胱颈，内陷组膀胱颈前壁和后壁之间的角度更大（P=0.029），功能性后尿道长度更长（P=0.029）。在排尿过程中，内陷膀胱颈在 X 轴和 Y 轴上的运动幅度较小，但差异无统计学意义。
腹腔镜前列腺癌根治术中改良膀胱颈内陷术延长了功能性后尿道的长度，有助于改善术后早期控尿。
