Korean J Urol.  2012 Dec;53(12):836-842. 10.4111/kju.2012.53.12.836.

Preliminary Results for Continence Recovery after Intrafascial Extraperitoneal Laparoscopic Radical Prostatectomy

• Choi YH
• Lee JZ
• Chung MK
• Ha HK

• KMID: 1988728
• DOI: http://doi.org/10.4111/kju.2012.53.12.836

Abstract

PURPOSE
We present our initial experience and surgical outcomes for the most recent refinement of bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy (nsELRP).
MATERIALS AND METHODS
Among 62 patients who underwent laparoscopic radical prostatectomy, 50 patients underwent intrafascial nsELRP by a single surgeon at Pusan National University Hospital from November 2011 to April 2012. As part of the intrafascial technique, the dissection plane is directly on the prostatic capsule to preserve most of the periprostatic fascia containing small vessels and nerves, endopelvic fascia, neurovascular bundle, and puboprostatic ligament. Postoperative continence recovery was established by daily consumption of pads. Follow-up was done at 2 weeks, 6 weeks, and 3 months after surgery.
RESULTS
The patients' mean age was 66.5+/-6.2 years. The mean operation time and mean blood loss were 149.3+/-28.1 minutes and 155.4+/-168.1 ml, respectively. The mean hospitalization time and mean catheterization time were 6.3+/-5.1 days and 5.5+/-4.7 days, respectively. Two weeks after the operation, a total of 14 patients (28.0%) were pad-free but the other incontinent patient group used on average 2.3 pads per day. After 6 weeks, 35 patients (70.0%) achieved pad-free status and 7 patients (14.0%) required more than 2 pads per day. At 3 months after surgery, a total of 31 patients were available for follow-up, and 26 patients (83.9%) were pad-free.
CONCLUSIONS
Compared with conventional laparoscopic prostatectomy, the intrafascial nsELRP procedure enables the preservation of periprostatic structures that are essential to the recovery of surgical structures related to continence. As a result, early postoperative continence can be achieved.

Keyword

Anatomy; Laparoscopy; Prostatectomy

MeSH Terms

Catheterization
Catheters
Fascia
Follow-Up Studies
Hospitalization
Humans
Laparoscopy
Ligaments
Prostatectomy

Figure

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  FIG. 1 Initial approach for intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Incision is made medial to the puboprostatic ligament. PPL, puboprostatic ligament; P, prostate; Bl, bladder; Ef, endopelvic fascia.

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  FIG. 2 Prostatic pedicle dissection and sparing of the neurovascular bundles. Both anterior and posterior neurovascular bundles were preserved by using cold scissors. P, prostate; aNVB, accessory neurovascular bundle; pNVB, predominant neurovascular bundle.

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  FIG. 3 Dissection of the prostate apex and urethra. Urethral dissection was performed proximally very close to the prostate to preserve urethral length. We did not ligate the deep dorsal venous plexus. The endopelvic fascia, which envelops the levator ani muscle, was preserved during surgery and the longer urethra was preserved. Both puboprostatic ligaments and arcuous tendinosus were also preserved. Dv, deep dorsal venous plexus; U, urethra; P, prostate; Ef, endopelvic fascia; PPL, puboprostatic ligament; At, arcuous tendinosus.

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  FIG. 4 Continence rates after intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.

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