Abstract：Objective： To investigate the safety and efficacy of urethra reconstruction via the “modified sandwich” technique of laparoscopic radical prostatectomy （LRP）. Methods： We retrospectively analyzed the clinical data of LRP from January 2017 to December 2018, in the Department of Urology, Weifang People’s Hospital. The patients undergoing the “modified sandwich” technique served as experimental group, and those receiving the original technique served as control group. Both groups were treated by extrafascial pathway. The demographic, perioperative and follow-up data were used for comparison. Specifically, the perioperative data included prostate specific antigen （PSA）, volume of prostate, Gleason score, surgical duration, bleeding amount, pathology （invasion of vascular, nerve, seminal vesicle, capsule and urethra） and the rate of positive surgical margin （PSM）. We followed up the postoperative urinary continence at 1st week, 2nd week, 4th week, 12th week and then monthly after extubation. Results： There were no statistical differences in demographic and perioperative data. The recovery of the urinary continence was significantly better in the experimental group than in the control group since extubation at 4th week and 12th week （P = 0.012, P = 0.011）. Conclusion： The “modified sandwich” technique of LRP is safe and feasible in urethral reconstruction, which could significantly improve the urinary continence during the early period of postoperation.
[1] TUNC L, GUMUSTAS H, AKIN Y, et al.A novel surgical technique for preserving bladder neckduring robotic-assisted laparoscopic radical prostatectomy; preliminary results. J Endourol, 2015,29(2):186-191.
[2] TASCI AI, SIMSEK A, TORER BD, et al.Fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis: point of technique. Arch Esp Urol, 2014,67(9):731-739.
[3] KIM M, PARK M, PAK S, et al.Integrity of the urethral sphincter complex, nerve-sparing, and long-term continence status after robotic-assisted radical prostatectomy. Eur Urol Focus, 2019,5(5):823-830.
[4] HURTES X, ROUPRÊT M, VAESSEN C, et al. Anterior suspension combined with posterior reconstruction during robot-assisted laparoscopic prostatectomy improves early return of urinary continence: a prospective randomized multicentre trial. BJU Int, 2012,110(6):875-883.
[5] DAL MORO F, CRESTANI A, VALOTTO C, et al.CORPUS--novel complete reconstruction of the posterior urethral support after robotic radical prostatectomy: preliminary data of very early continence recovery. Urology, 2014,83(3):641-647.
[7] SIEGEL R, NAISHADHAM D, JEMAL A.Cancer statistics, 2013. CA Cancer J Clin, 2013,63(1):11-30.
[8] SIEGEL RL, MILLER KD, JEMAL A.Cancer statistics, 2016. CA Cancer J Clin, 2016,66(1):7-30.
[9] HEIDENREICH A, BASTIAN PJ, BELLMUNT JA, et al.EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative Intent-Update 2013. Eur Urol, 2014,65(1):124-137.
[10] RANASINGHE W, DE SILVA D, BANDARAGODA T, et al. Robotic-assisted vs. open radical prostatectomy: a machine learning framework for intelligent analysis of patient-reported outcomes from online cancer support groups. Urol Oncole, 2018,36(529):529.e1-529.e9.
[11] TEWARI A, JHAVERI J, RAO S, et al.Total reconstruction of the vesico-urethral junction. BJU Int,2008,101(7):871-877.
[12] 廖晓星,邢念增,乔鹏,等.“三明治”法尿道重建技术改善腹腔镜下根治性前列腺切除术后早期尿控的效果.北京大学学报(医学版),2015,47(4):601-604.
[13] COELHO RF, CHAUHAN S, ORVIETO MA, et al.Influence of modified posterior Reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol, 2011,59(1):72-80.
