Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: Impact on early recovery of urinary continence

Autor:	Yuuki Shimizu, Yukio Usui, Akio Hoshi, Nobuyuki Nakajima, Takeshi Nomoto, Masayoshi Kawakami, Kazuya Hanai, Taro Higure, Masahiro Nitta, Toshiro Terachi
Rok vydání:	2014
Předmět:	Laparoscopic surgery medicine.medical_specialty Pelvic floor Laparoscopic radical prostatectomy Urinary continence business.industry Urology medicine.medical_treatment Urinary system Urinary incontinence Surgery body regions Neck of urinary bladder medicine.anatomical_structure Urethra Medicine medicine.symptom business
Zdroj:	International Journal of Urology. 21:1132-1137
ISSN:	0919-8172
DOI:	10.1111/iju.12539
Popis:	Objectives 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. Methods 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. Results 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
Databáze:	OpenAIRE
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