Intrafascial nerve-sparing radical prostatectomy improves patients’ postoperative continence recovery and erectile function

Wang, Xiao; Wu, Yiqi; Guo, Jia; Chen, Hui; Wang, Xiaodong; Liu, Xiuheng

doi:10.1097/md.0000000000011297

Cited by 25 publications

(26 citation statements)

References 44 publications

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“…On the other hand, several studies show that nerve sparing itself has a positive effect on postoperative continence. For example Kim et al showed that continence rates were significantly higher in patients with bilateral than in patients with unilateral or no nerve-sparing 1 year after surgery (28, 29). Even patients with preoperative erectile dysfunction showed better postoperative continence rates when nerve-sparing was performed (30).…”

Section: Discussionmentioning

confidence: 99%

Very Early Continence After Radical Prostatectomy and Its Influencing Factors

et al. 2019

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Introduction and Objectives: Surgical techniques such as preservation of the full functional-length of the urethral sphincter (FFLU) have a positive impact on postoperative continence rates. Thereby, data on very early continence rates after radical prostatectomy (RP) are scarce. The aim of the present study was to analyze very early continence rates in patients undergoing FFLU during RP.Materials and Methods: Very early-continence was assessed by using the PAD-test within 24 h after removal of the transurethral catheter. The PAD-test is a validated test that measures the amount of involuntary urine loss while performing predefined physical activities within 1 h (e.g., coughing, walking, climbing stairs). Full continence was defined as a urine loss below 1 g. Mild, moderate, and severe incontinence was defined as urine loss of 1–10 g, 11–50 g, and >50 g, respectively.Results: 90 patients were prospectively analyzed. Removal of the catheter was performed on the 6th postoperative day. Proportions for no, mild, moderate and severe incontinence were 18.9, 45.5, 20.0, and 15.6%, respectively. In logistic regression younger age was associated with significant better continence (HR 2.52, p = 0.04), while bilateral nerve-sparing (HR 2.56, p = 0.057) and organ-confined tumor (HR 2.22, p = 0.078) showed lower urine loss, although the effect was statistically not significant. In MVA, similar results were recorded.Conclusion: Overall, 64.4% of patients were continent or suffered only from mild incontinence at 24 h after catheter removal. In general, reduced urine loss was recorded in younger patients, patients with organ-confined tumor and in patients with bilateral nerve sparing. Severe incontinence rates were remarkably low with 15.6%.

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Section: Discussionmentioning

confidence: 99%

Very Early Continence After Radical Prostatectomy and Its Influencing Factors

et al. 2019

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“…The better understanding of the anatomical structures surrounding the prostate leads to the re nement of radical prostatectomy especially for clinically localized prostate cancer, that consequently improve the surgical technique, oncological and functional results after surgery [7][8][9][10][11][12][13][14][15][16][17][18]. Recent and well accepted modi cations were the intrafacial nerve-sparing RP technique inlcuding the maximal preservation of NVB, rectourethralis muscle, pubo-prostatic ligament and prostate facisa, that results in good functional results without affection of the oncological results [4][5][6][19][20]. Efforts are still being made, mostly focused on the maximal preservation of the surrounding structures of prostate, to make a perfect functional outcome for localized prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The present follow-up results also demonstrate a good potency recovery rate. In oncological aspect, it is well accepted that intrafasial technique was not a risk factor for positive resection margins for tumor in adequately selected patients undergoing RP, and the positive resection margins rates were reported in pT2 and pT3 tumors of 4.5% to 6.9% and 29.4% to 34%, respectively [4][5][6]20]. Similarly, in the present selected patients undergoing SPP-LRP, the positive resection margins rates (R1) were 6.1% and 16.7% in pT2 and pT3 tumors, which indicated a worthy oncological results.…”

Section: Discussionmentioning

confidence: 99%

“…Then the intrafascial dissection technique [4,5] was performed to mobilize the both bilateral side of the prostate between the prostatic capsule and the prostatic fasica (visceral layer of the pelvic fasica) from the base to the apex. Hemostasis was done only by suture with 3-0 coaed Vicryl plus (Ethicon Inc., Somerville, NJ, USA) and the prostatic fasica was kept intact bilaterally to avoid any injury on NVB.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…A recent prospective and controlled research reported the morbility of incontinence at 12 month after RP was about 20% and that of ED was about 70% [3]. In order to promote the recovery of continence and potency, some modi cations and re nements on the technique of RP were developed and applied by numerous teams mainly based on the maximal preservation of periprostatic structures with the advancing understanding of the surrounding anatomy of prostate such as the neurovascular bundles (NVB),pelvic oor, urethral sphicnter muscle and the prostate fascia [4][5][6]. The cavernous nerves in NVB nally reaching the corpora cavernosa were directly related to potency.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Three-dimensional Camera Systems Assistant the Sheath of Prostate Preservation Laparoscopic Radical Prostatectomy: Technique and Initial Experience

Song¹,

Wang²,

Gao³

et al. 2020

Preprint

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Background: To report our refinement of laparoscopic radical prostatectomy by preservation of the sheath of prostate (SPP-LRP) and 1-year follow-up results.Methods: SPP-LRP was performed in 39 consecutive patients diagnosed as clinically localized prostate cancer from January 2016 to December 2018. The inclusion criteria consisted of Gleason score ≤7, tPSA＜10 ng/ml, positive in no more than 3 in 12 needles by systematical puncture biopsy, less than 50% tumor core involvement, clinical stage T1-2, good potency. The oncological results were identified by postoperative pathology test. Functional outcomes, including continence and potency, were followed postoperatively.Results: The mean operation time was 108.3±35.2 min and the mean estimated blood loss was 129.3±46.4 ml with no transfusion. The catheter was removed 7 days after the surgery. There were no relevant postoperative complications requiring intervention. The histopathological results showed 2 cases (6.1%) in pT2 and 1 case (16.7%) in pT3 presented positive resection margins for tumor (R1). Only 1 case (pT3a,Gleason score 8) suffered pelvic lymph node metastasis. No biochemical relapse was observed after 1-year follow-up. The continence rates were 71.8% and 87.2% after 1 and 3 months, and no patients suffered G2 incontinence after 6 months , and 97.4% recovered continence after 12 months. The potency rates were 61.5% and 82.1% after 1 and 3 months, and that was 92.3% after 12 months. Conclusion:SPP-LRP is a practical and worth-promoting technique for RP. The initial results are preferable and promising in technical, oncological and functional aspects.

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