Influence of urethral preservation combined with posterior urethral reconstruction on postoperative urinary control in patients undergoing radical resection of prostate cancer

Background: To explore the influence of retrourethral fascia reconstruction technique on postoperative urine control and therapeutic effectiveness in prostate cancer patients undergoing radical prostatectomy. Methods: In this retrospective study, we included 80 patients with prostate cancer admitted between January 2019 and December 2023. All patients were randomly divided into control group (41 cases) and observation group (39 cases). All participants gave their consent and had full knowledge of the research protocol. The control group received laparoscopic radical prostate cancer resection, while the observation group underwent retrourethral sphincter fascia reconstruction. The study compared surgical parameters, postoperative pathological findings, urinary tract control after surgery, and evaluations of quality of life between the two groups. Results: Intraoperative blood loss and Operation time were not significantly different between the two groups (p > 0.05). There were no significant differences in Postoperative Gleason score, Postoperative pathological stage and Positive margin between the two groups (p > 0.05). There were no significant differences in catheter removal time, postoperative hospitalization time and postoperative feeding time between the two groups (p > 0.05). The recovery rates of urine control were 53.66% (22/41) and 70.73% (29/41) at 3 months and 6 months, respectively, in the control group, and 79.49% (31/39) and 94.87% (37/39) at 3 months and 6 months, respectively, which were significantly higher than those of the control group (p < 0.05). At 3 months and 6 months after surgery, International Incontinence Advisory Committee Urinary Incontinence Questionnaire (ICIQ-SF) score of observation group was significantly lower than that of control group, Extended Prostate Cancer Composite Index (EPIC-UIN) score was significantly higher than that of control group (p < 0.05). Conclusions: The retrourethral fascia rebuilding approach in radical prostatectomy is very safe and feasible, and it promotes better recovery of postoperative urine control based on the patient’s condition.

Prostate cancer; Laparoscopic radical; Retrourethral sphincter fascia reconstruction

[1] Sekhoacha M, Riet K, Motloung P, Gumenku L, Adegoke A, Mashele S. Prostate cancer review: genetics, diagnosis, treatment options, and alternative approaches. Molecules. 2022; 27: 5730.

[2] Wasim S, Lee SY, Kim J. Complexities of prostate cancer. International Journal of Molecular Sciences. 2022; 23: 14257.

[3] Mizuno K, Beltran H. Future directions for precision oncology in prostate cancer. The Prostate. 2022; 82: S86–S96.

[4] Papachristodoulou A, Abate-Shen C. Precision intervention for prostate cancer: re-evaluating who is at risk. Cancer Letters. 2022; 538: 215709.

[5] Yu K, Bu F, Jian T, Liu Z, Hu R, Chen S, et al. Urinary incontinence rehabilitation of after radical prostatectomy: a systematic review and network meta-analysis. Frontiers in Oncology. 2024; 13: 1307434.

[6] Wrona-Lis M, Wrona M, Madej A, Jakóbczyk B, Różanski W, Lipiński M. A comparative evaluation of radical prostatectomy using laparoscopic and open method in view of surgical margins. Central European Journal of Urology. 2023; 76: 300–304.

[7] Bhatt NR, Ippoliti S, Nambiar A, Ilie C, Doherty R, Smith L. Outcome of post-prostatectomy stress urinary incontinence surgery in men with preoperative idiopathic detrusor overactivity. BJUI Compass. 2024; 5: 1001–1010.

[8] Chen M, Chen H, He L, He L, Zhang L, Li Q, et al. Impact of fast-track surgery-oriented care pathways on perioperative rehabilitation indices in patients undergoing radical prostatectomy for prostate cancer. American Journal of Translational Research. 2024; 16: 1620–1629.

[9] Rocco B, Luciani LG, Collins J, Sanchez-Salas R, Adding C, Mattevi D, et al. Posterior reconstruction during robotic-assisted radical cystectomy with intracorporeal orthotopic ileal neobladder: description and outcomes of a simple step. Journal of Robotic Surgery. 2021; 15: 355–361.

[10] Takahara K, Motonaga T, Nakamura W, Saruta M, Nukaya T, Takenaka M, et al. Robot-assisted radical prostatectomy with the Hugo™ robot-assisted surgery system: a single-center initial experience in Japan. Asian Journal of Endoscopic Surgery. 2024; 17: e13342.

[11] Shao IH, Chen SY, Chen HY, Sheng TW, Chang YH, Liu CY, et al. Integrating clinical and image-based parameters for prediction of early post-prostatectomy incontinence recovery: simplified nomogram approach. BMC Cancer. 2024; 24: 1344.

[12] Lenart S, Holub M, Gutjahr G, Berger I, Ponholzer A. Prolonged indwelling catheter time after RARP does not lead to follow-up surgery. World Journal of Urology. 2024; 42: 379.

[13] Liu L, Zhou S, Song D, Li Z, Yang S, Wu Y, et al. The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China. World Journal of Surgical Oncology. 2024; 22: 150.

[14] Koliakos N, Mottrie A, Buffi N, De Naeyer G, Willemsen P, Fonteyne E. Posterior and anterior fixation of the urethra during robotic prostatectomy improves early continence rates. Scandinavian Journal of Urology and Nephrology. 2010; 44: 5–10.

[15] Vis AN, van der Poel HG, Ruiter AEC, Hu JC, Tewari AK, Rocco B, et al. Posterior, anterior, and periurethral surgical reconstruction of urinary continence mechanisms in robot-assisted radical prostatectomy: a description and video compilation of commonly performed surgical techniques. European Urology. 2019; 76: 814–822.

[16] Leslie S, Jackson S, Broe M, van Diepen DC, Stanislaus C, Steffens D, et al. Improved early and late continence following robot-assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling). BJUI Compass. 2023; 4: 597–604.

[17] Rosenberg JE, Jung JH, Edgerton Z, Lee H, Lee S, Bakker CJ, et al. Retzius-sparing versus standard robot-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer. BJU International. 2021; 128: 12–20.

[18] Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Translational Andrology and Urology. 2020; 9: 3036–3048.

[19] Hurtes X, Rouprêt M, Vaessen C, Pereira H, Faivre d’Arcier B, Cormier L, 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 International. 2012; 110: 875–883.