Study On The Recovery Of Urinary Control Function After Laparoscopic Radical Prostatectomy Combined With Prostate Volume And Preoperative Membranous Urethral Length

Objective: to establish a classification based on preoperative membranous urethral length(MUL)and prostate volume to analyze and predict urine control after laparoscopic radical prostatectomy(LRP).Methods and materials: The clinical data of patients who underwent laparoscopic radical prostatectomy by the same experienced chief physician in the Department of Urology,the First Affiliated Hospital of Fujian Medical University from January 2014 to January 2019 were collected.A total of 170 patients were included after laparoscopic surgery was converted to open surgery,previous prostate surgery,radiotherapy,endocrine therapy,incomplete clinical data,and incomplete prostate MRI image information were excluded.All patients had no symptoms of urinary incontinence and were diagnosed with prostatic adenocarcinoma by prostate biopsy before surgery.All patients underwent MRI before paracentesis and MUL length(mm)and prostate volume(0.52 ×anteroposterior diameter × left and right diameters × supero-inferior diameter cm)were measured.They were grouped according to prostate volume and length of membranous urethra.They were 20 patients in group A(large prostate volume,MUL length),28 patients in group B(large prostate volume,MUL short),54 patients in group C(small prostate volume,MUL long),and 68 patients in group D(small prostate volume,MUL short group).All patients were followed up for 12 months after surgery,and urinary control was assessed and compared at 1,3,6,and 12 months after surgery in each group.In addition,according to various clinical data of patients,such as age,body mass index(BMI),preoperative prostate specific antigen(PSA),operation time,intraoperative blood loss,postoperative Gleason score,and postoperative pathological stage.Enumeration data were expressed as the number and percentage,compared using Fisher’s exact test or χ2 test,and logistic regression was used to analyze the effect of different parameters on postoperative urinary control.P < 0.05 was considered statistically significant.Results: A total of 170 cases were included in this study.In groups A,B,C and D,the postoperative 1-month urinary control rate was 25.0%,21.4%/27.8% and25.0%,respectively,and the difference had no statistical significance(P > 0.05);the 3-month and 6-month urinary control rates were 45.0%,35.7%,48.1%,39.7%and 65.0%,60.7%,/68.5% and 61.8%,respectively,and the differences had statistical significance(P < 0.05).The postoperative 12-month urinary continence rate was 95.0%,89.3%/98.1% and 94.1%,respectively,and the difference had no statistical significance(P > 0.05).There was no significant difference in postoperative urinary control rate between the groups at 1 and 12 months,without statistical significance.There was significant difference at 3 and 6 months after operation.Among them,the urinary continence rate at 3 and 6 months after surgery was higher in group A than in group B(P = 0.003);the urinary continence rate at 3 and 6 months after surgery was higher in group C than in group D(P =0.016).The urinary continence rate at 3 and 6 months after surgery was higher in group C than in group A(P = 0.047);the urinary continence rate at 3 and 6months after surgery was higher in group D than in group B(P = 0.038).There was no significant difference in urinary continence rate at 3 and 6 months after operation in group A and D(P > 0.05).The difference in 3-and 6-month urinary continence rates was most pronounced in group C,with the smallest P value(P =0.001).Logistic regression analysis of the effect of multiple factors on postoperative urinary continence showed that prostate body(OR: 2.491,CI: 0.319– 1.587,P = 0.001)and preoperative MUL length(OR: 1.293,CI: 0.579 – 4.584,P = 0.001 were independent predictors of postoperative urinary continence at 3and 6 months after surgery.Conclusion: preoperative MRI measurement of MUL and prostate volume have a significant effect on early urine control function after laparoscopic radical prostatectomy.Patients with longer MUL and smaller prostate volume recover faster,but patients with larger prostatectomy and longer MUL often lose part of MUL due to surgical tumor control.Therefore,only one preoperative parameter,that is,preoperative MUL,can not accurately predict postoperative UI.Combined with prostate size,there will be a more accurate assessment of urine control in patients after LRP.