Preventive intraoperative methods for restoring urine function after laparoscopic and open radical prostatectomy

Abstract

Purpose of the study. To evaluate the effectiveness of preserving the anatomical structures surrounding the prostate gland for prophylactic intraoperative restoration of urinary retention functions in the postoperative period.

Materials and methods. A study was carried out in 86 patients with prostate cancer after performing radical prostatectomy from 2013 to 2021. Men were divided into 4 groups:

Group 1 – LRP with preservation of the puboprostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis.

Group 2 – LRP with complete preservation of the anatomical structures of the small pelvis without preserving the neurovascular bundles of the penis.

Group 3 – ORP with preservation of the puboprostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis.

Group 4 – RRP with complete preservation of the anatomical structures of the small pelvis without preserving the neurovascular bundles of the penis.

In group 1, in which LRP was performed, 58 patients with prostate cancer T1N0M0 and T2N0M0.

In group 2 LRP 12 patients with prostate cancer T1N0M0 and T2N0M0.

There were 12 patients with prostate cancer T1N0M0 and T2N0M0 in group 3 with RRP.

There are 4 patients with prostate cancer T1N0M0 and T2N0M0 in group 4 with RRP.

He diagnosis of prostate cancer in all patients was established on the basis of a histological examination of preparations obtained by performing a transrectal multifaceted biopsy of the prostate gland. The basis for performing a biopsy was an increase in the level of prostate-specific antigen (PSA) in the blood above 4 ng/ml, the presence of pathological nodes according to MRI of the pelvic organs with contrast, as well as suspicious areas of the prostate gland during digital rectal examination. A study was carried out in 86 patients with prostate cancer after performing radical prostatectomy from 2013 to 2021.

Research results and their discussion. 12 patients of group 3 underwent open surgery-radical prostatectomy. RRP (12 people) with preservation of the pubo-prostatic ligaments, pubo-perineal muscle, pelvic fascia and neurovascular bundles of the penis.

In 4 patients of group 4, RRP with complete preservation of the anatomical structures of the small pelvis without preservation of the neurovascular bundles of the penis.

We do not dwell on the method of performing the operation, it is known, all 16 patients underwent lymphadenectomy.

The average operation time in the groups LRP 1 group, LRP 2 group did not differ significantly, and amounted to 147,16. And in a comparative analysis in group 3 RR, Group 4 RR there was a difference of 89,29, open operations were performed much faster.

In our study, the criterion for urinary retention was the absence of the patient's need to use safety pads. This definition is adhered to by many specialists involved in the surgical treatment of prostate cancer. The use of at least 1 safety pad was equivalent to urinary incontinence. And it was considered a complication after the operations performed. Inourstudy, themeantimetorestoration of the full urinary continence function was the longest where the standard surgical procedure was performed, and the shortest was in the groups where the maximum preservation of the anatomical structures of the periprostatic anatomical zone was performed.

Conclusions. 1. The main mechanism for the rapid restoration of urinary retention in patients after radical prostatectomy with prostate cancer is the maximum preservation of the pubo-prostatic ligaments and the pubo-perineal muscle, which makes it possible to fully restore the function of urinary retention within a month. 2. Preservation, only of the neurovascular bundle of the penis, is not enough to restore the function of early urinary retention after surgery.