Clinical application of bilateral anterior urethral suspension combined with intrafascial excision in robot-assisted radical prostatectomy
Objective:To investigate the effect of bilateral anterior urethral suspension combined with intrafas-cial excision on early recovery of urinary continence after robot-assisted radical prostatectomy(RARP).Methods:Fifty patients with prostate cancer were treated with the RARP from June 2022 to June 2023 in Xinhua Hospital Affiliated to Medical College of Shanghai Jiao Tong University.All patients were low-risk or medium-risk cases.Compared with the traditional RARP,the core techniques in our operation are mainly bilateral anterior urethral suspension and intrafascial excision.The anterior urethral suspension is to suspend the puboprostatic ligamental-dorsal vascular complex from the pubic periosteum after suture to improve the stability of the urethra after surgery.The bilateral suspension technique is performed during the operation,which can better maintain urethral stability than unilateral suspension.According to the patient's condition,the technique of intrafascial resection can be divided into unilateral and bilateral neurovascular bundle preservation techniques.Results:All patients were successfully completed the operation.The tPSA reexamination 6 weeks after surgery indicated that all patients had good tumor control.In terms of immediate postoperative urinary continence,52％of patients achieved immediate urinary continence,and 40％and 70％of patients in the unilateral and bilateral neurovascular bundle preservation groups,respectively.In terms of urine continence recovery at 6 weeks after surgery,96％of patients achieved good urine continence,including 95.0％and 96.6％in the group with unilateral and bilateral neurovascular bundle preservation,re-spectively.At 3 months after surgery,all patients achieved good urinary continence.Conclusion:In RARP,bilateral an-terior urethral suspension combined with intrafascial excision can help patients achieve early recovery of urinary conti-nence,and it is worthy of application and promotion for middle and low risk prostate cancer patients.
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