Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective :
Robot-assisted laparoscopic prostatectomy (RALP) has recently become so popular as the standard treatment modality for patients with organ-confined prostate cancer (PCa). Superior functional results have been demonstrated in terms of early continence, quality of life (QoL) after RALP, which are at least as important as oncologic results. For preserving the bladder neck and its surrounding anatomy including the internal circular sphincter, some challenging surgical manouvers are of extreme importance.
In view of our limited surgical experience with long-term follow-up on RALP, we evaluated anatomic details for the relationship between the bladder neck and the prostate base. The aim of our study was to describe our novel surgical technique including dissection technique for preserving the bladder neck during RALP resulting with very early continence
Between January 2011 and December 2017, 331 RALPs were performed and evaluated. Demographic, perioperative, and postoperative data were recorded. Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal, and at the first month after RALP. Fatty connective tissue between bladder neck and prostate was introduced, and circular muscle fibers of the internal sphincter were seen in all patients. Complications were classified according to the Clavien-Dindo classification. Statistical analyses were performed.
Mean follow-up was 15.7± 3.2 months; mean age was 62.2±4.2 years. Our novel surgical technique for preserving the bladder neck was performed in 331 patients. Mean duration of the catheter was 7.1±1.3days and all patients were continent after catheter removal. There was a significant difference in QoL before RALP and after catheter removal, however, there was no statistical difference between before and 1 month after RALP (respectively; P < 0.001, P = 0.5). There were no complications related to the bladder neck such as bladder neck stricture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications. In addition, conventional laparoscopy and/or open surgery was not needed in any of the RALP cases.
Our novel technique provided very early continence at the time of catheter removal after RALP within short-term follow-up. This is a promising progress for early recovery and better QoL scores after RALP. Our challenging continence results can really establish the standard for preserving the bladder neck during RALP. This is the best strategy to diminish peroperative amount of bleeding and presents with fascinating early continence results beyond imagination.
Serdar Yalcin– Urologist, Ankara, Ankara, Turkey
Eymen Gazel– Urologist, acibadem, Ankara, Ankara, Turkey
Cagri Guneri– Urologist, Ankara, Ankara, Turkey
Engin Kaya– Urologist, Ankara, Ankara, Turkey
Lutfi Tunc– Urologist, Gazi University School of Medicine Dept. of Urology, Ankara, Ankara, Turkey
Ankara, Ankara, Turkey
Im working İn Acibaem University Ankara hospital as Asist.Prof in Ankara,Turkey