Preservation and reconstruction of vesicourethral support during laparoscopic radical prostatectomy accelerates early recovery of urinary continence: a retrospective cohort study.

OBJECTIVE

To compare the efficacy and safety of preservation and reconstruction of vesicourethral supportive structures during laparoscopic radical prostatectomy (PRVUS-LRP) to the conventional LRP (Conv-LRP).

METHODS

This retrospective study analyzed 106 patients with clinically localized prostate cancer (PCa) (cT1-2N0M0) who underwent LRP between August 2020 and June 2023. The patients were stratified into a PRVUS-LRP group (n = 52) and a Conv-LRP group (n = 54). The modified technique preserves the pelvic floor fascia, bladder neck, puboprostatic ligament, and functional urethral length via intrafascial excision, non-ligation of the dorsal vascular complex, modified posterior pelvic floor reconstruction, and anterior pelvic floor reconstruction.

RESULTS

The operative times of the PRVUS-LRP and Conv-LRP groups were comparable (P > 0.05) but the former group experienced significantly greater estimated blood loss (160.6 ± 115.3 vs. 89.4 ± 55.3 mL; P < 0.001). The urinary continence (UC) rates at the 1-, 3-, and 6-month follow-ups were 50.0, 94.2, and 98.1% in the PRVUS-LRP group vs. 24.1, 77.8, and 92.6% in the Conv-LRP group. Significant intergroup differences that favored PRVUS-LRP were observed at 1 (P = 0.006) and 3 (P = 0.031) months, but the 6-month outcomes did not differ significantly (P = 0.383). No significant between-group differences were detected in terms of the positive surgical margin rate or biochemical recurrence. The cumulative summation curve started to decrease after 19 operations.

CONCLUSION

PRVUS-LRP is a safe and effective modification that significantly enhances early UC recovery, without compromising oncological outcomes.