Frontiers in surgery · 2025
Study on the impact of the reserved length of the membranous urethra during laparoscopic radical prostatectomy on the recovery of urinary control function in patients.
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Li Chuanbo, Lin Rui, Bai Qiulei, Guo Huaiyuan
Аннотация
BACKGROUND: Prostate cancer is a common malignant tumor in the male urogenital system, and laparoscopic radical prostatectomy (LRP) is the standard surgical procedure for early-stage patients. However, postoperative urinary incontinence remains a major complication. The membranous urethra and its surrounding sphincters play a critical role in urinary continence, but the impact of their preserved length on postoperative recovery of urinary continence function remains unclear.
OBJECTIVE: To investigate the effect of the preserved length of the membranous urethra during LRP on early and long-term recovery of urinary continence function in patients.
METHODS: A retrospective analysis was conducted on 160 patients who underwent LRP from March 2023 to June 2024. The patients were divided into a long-segment group (preserved length ≥15 mm, 90 cases) and a short-segment group (preserved length <15 mm, 70 cases) based on the preserved length of the membranous urethra. The International Continence Society criteria were used to evaluate the urinary continence recovery rate (≤1 pad/day) at 1, 3, 12, and 24 months postoperatively, and differences between the two groups were compared.
RESULTS: Baseline characteristics were comparable between long-segment (≥15 mm, n = 90) and short-segment (<15 mm, n = 70) groups (P > 0.05). The long-segment group demonstrated significantly superior urinary continence recovery at all time points (P < 0.05): At 1 month, pad-based recovery (38.9% vs. 25.7%) and PGI-I improvement (41.1% vs. 28.6%); at 3 months (61.1% vs. 42.9%; 65.6% vs. 47.1%); at 12 months (77.8% vs. 64.3%; 80.0% vs. 67.1%); and at 24 months (88.9% vs. 78.6%; 91.1% vs. 81.4%). Notably, patients receiving bilateral nerve-sparing with long urethral preservation achieved optimal outcomes (94.3% pad-based recovery; 96.2% PGI-I improvement), significantly surpassing other nerve-sparing approaches (P < 0.05).
CONCLUSION: Preserving the length of the membranous urethra ≥15 mm during LRP can significantly promote the recovery of early and long-term urinary continence function, providing a basis for precise surgical operations in clinical practice. Future studies with larger sample sizes and longer follow-up periods are needed for validation.
OBJECTIVE: To investigate the effect of the preserved length of the membranous urethra during LRP on early and long-term recovery of urinary continence function in patients.
METHODS: A retrospective analysis was conducted on 160 patients who underwent LRP from March 2023 to June 2024. The patients were divided into a long-segment group (preserved length ≥15 mm, 90 cases) and a short-segment group (preserved length <15 mm, 70 cases) based on the preserved length of the membranous urethra. The International Continence Society criteria were used to evaluate the urinary continence recovery rate (≤1 pad/day) at 1, 3, 12, and 24 months postoperatively, and differences between the two groups were compared.
RESULTS: Baseline characteristics were comparable between long-segment (≥15 mm, n = 90) and short-segment (<15 mm, n = 70) groups (P > 0.05). The long-segment group demonstrated significantly superior urinary continence recovery at all time points (P < 0.05): At 1 month, pad-based recovery (38.9% vs. 25.7%) and PGI-I improvement (41.1% vs. 28.6%); at 3 months (61.1% vs. 42.9%; 65.6% vs. 47.1%); at 12 months (77.8% vs. 64.3%; 80.0% vs. 67.1%); and at 24 months (88.9% vs. 78.6%; 91.1% vs. 81.4%). Notably, patients receiving bilateral nerve-sparing with long urethral preservation achieved optimal outcomes (94.3% pad-based recovery; 96.2% PGI-I improvement), significantly surpassing other nerve-sparing approaches (P < 0.05).
CONCLUSION: Preserving the length of the membranous urethra ≥15 mm during LRP can significantly promote the recovery of early and long-term urinary continence function, providing a basis for precise surgical operations in clinical practice. Future studies with larger sample sizes and longer follow-up periods are needed for validation.