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08.04.2019 | Urology - Original article

Morphologic changes after bladder neck intussusception in laparoscopic radical prostatectomy contribute to early postoperative continence

Zeitschrift:
International Urology and Nephrology
Autoren:
Lin Yao, Yuke Chen, He Wang, Wei Yu, Yu Fan, Yang Yang, Yunxiang Xiao, Jihong Duan, Qian Zhang, Zhisong He, Shiliang Wu
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11255-019-02118-0) contains supplementary material, which is available to authorized users.
Lin Yao, Yuke Chen, and He Wang contributed equally to this manuscript.

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Abstract

Purpose

To explore the mechanism and efficacy of the modified bladder neck intussusception in laparoscopic radical prostatectomy (LSRP) on postoperative early continence.

Methods

We prospectively collected clinical information of prostate cancer patients who underwent LSRP with modified bladder neck intussusception (n = 10) and non-intussusception (n = 10). At postoperative 1 month, the prostate-specific antigen (PSA), pad test, real-time magnetic resonance imaging (rt-MRI), and flow rate were performed. At postoperative 3 months, the PSA, pad test, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), incontinence questionnaire short form (ICI-Q-SF), and quality of life (Qol) were recorded.

Results

The intussusception and non-intussusception patients had similar baseline characteristics. At postoperative 3 months, intussusception patients had lower OABSS than non-intussusception patients (P = 0.038). The non-intussusception patients suffered from more severe incontinence (P = 0.026). The continence rate of intussusception patients was significantly higher (90% vs. 20%, P = 0.005). And intussusception patients had significantly lower Qol scores (P = 0.038). According to the morphologic analysis by rt-MRI, there were 7/10 non-intussusception patients and 2/10 intussusception patients having funnel-shaped bladder necks at Valsalva movement. The intussusception patients had larger angle between anterior and posterior wall at bladder neck (P = 0.029) and longer length of functional posterior urethra (P = 0.029). During micturition, the intussusception bladder neck was found to move less dynamically on X-axis and Y-axis, but the difference did not reach significance.

Conclusions

The modified technique of bladder neck intussusception in laparoscopic radical prostatectomy prolongs the length of functional posterior urethra and is effective to improve postoperative early continence.

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Zusatzmaterial
Supplementary figure 1. The postoperative morphologic changes of the bladder neck a: the funnel-shaped bladder neck at valsalva movement; b: the non-funnel-shaped bladder neck at valsalva movement. (TIF 14151 KB)
11255_2019_2118_MOESM1_ESM.tif
Supplementary figure 2. Demonstrative examples of the morphologic indexes measurement. a: the angle between anterior wall and posterior wall at the vesical neck (AAP) equals to the degree of angle AOP; b: the angle between the right wall and the left wall at the vesical neck (ARL) equals to the degree of angle ROL; c: OQ (the dashed line) is the distance from vesical neck to the horizontal line across the lower margin of pubic symphysis, which is assigned to evaluate the relative length of posterior urethra (rLPU); the actual urethral length between the dot O and the horizontal line across the urogenital diaphragm is defined as the length of functional posterior urethra (LFPU); d: the line NO is the axis of the balder neck, the line OU is the axis of the posterior urethral, and the angle between bladder neck and posterior urethral (ANU) equals to the degree of angle (NOU). (TIF 11380 KB)
11255_2019_2118_MOESM2_ESM.tif
Supplementary material 3 (MP4 8061 KB)
11255_2019_2118_MOESM3_ESM.mp4
Literatur
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