Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

医学 解剖(医学) 前列腺切除术 尿失禁 尿道 外科 尿道括约肌 腹腔镜前列腺根治术 泌尿科 筋膜 前列腺 癌症 内科学
作者
Oscar Laucirica,E Cantos Gómez,Ramin Hajianfar,Joan C. Vilanova,María Jesús Muniesa
出处
期刊:International Journal of Urology [Wiley]
卷期号:27 (6): 525-536 被引量:5
标识
DOI:10.1111/iju.14228
摘要

Objectives To describe our surgical technique of “muscle‐sparing” laparoscopic radical prostatectomy and to review relevant anatomical landmarks during the procedure. Methods This was a prospective non‐controlled case series of 120 consecutive patients who underwent laparoscopic radical prostatectomy, always carried out by the same surgeon (OL). The median follow‐up period was 33 months. Dissection of the puboperinealis and puborectalis muscle consists of the precise dissection of the puborectalis and puboperinealis muscles from the periprostatic fascia. Rhabdomyo‐dissection consists of an approach that spares the external urethral sphincter from the ventral surface of the prostate and membranous urethra. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications and outcomes of urinary continence were assessed. A descriptive statistical analysis was carried out. Results Continence rates were 70.8%, 83.3% and 92.5%, at 0–2, 3–4 and 5–8 weeks after removal of the urethral catheter, respectively; 96.6% and 98.3% at 6 and 12 months after surgery. The positive surgical margin rate associated with rhabdomyo‐dissection was 8.3%. Conclusions Laparoscopic radical prostatectomy with dissection of the puboperinealis and puborectalis muscle, and rhabdomyo‐dissection is an oncologically safe procedure, associated with very early recovery urinary continence in most patients. It is a technique that can be applied in most cases, as long as there is no invasion of the ventral side of the prostate.
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