Effect of Precise Dissection and Reconstruction of the Prostate Apex and Bladder Neck in Radical Prostatectomy on Urinary Control Improvement

Objective To investigate the impact of the precise dissection and reconstruction of the prostate apex and bladder neck urethra during radical prostatectomy on the improvement in postoperative urinary control in patients with prostate cancer.

Methods A retrospective study was conducted. A total of 131 prostate cancer patients who underwent robot-assisted radical prostatectomy at our institution between January 1, 2023 and December 31, 2023 were enrolled. The subjects were divided into two groups, with 64 in the experimental group and 67 in the control group. Patients in the experimental group underwent radical prostatectomy in a modified approach, while those in the control group underwent conventional radical prostatectomy. Propensity score matching was employed to match the two groups at a 1-to-1 ratio based on age, body mass index (BMI), preoperative prostate specific antigen (PSA), prostate volume, Prostate Imaging Reporting and Data System (PI-RADS) scores, biopsy Gleason score, and preoperative urinary control status. After matching, we compared the preoperative baseline data, surgical margin positivity rates, and urinary control status at 3 months post operation between the two groups. Urinary control was assessed before and after surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) scale.

Results  A total of 56 pairs of patients were successfully matched between the experimental group and the control group through 1-to-1 propensity score matching. At 3 months after surgery, the median score for ICIQ-SF scale of the experimental group was 7.0 points, while that of the control group was 9.5 points, with the difference being statistical significant (P<0.05). There was no significant difference in the positive rate of incision margins between the experimental group and the control group. Multiple linear regression analysis showed that both the prostate volume and the Gleason score in the experimental group were positively correlated with the ICIQ-UI SF scores 3 months after surgery (P<0.05), while the age of patients in the control group was positively correlated with ICIQ-UI SF score 3 months after surgery (P<0.05).

Conclusion  Precise dissection and reconstruction of the prostate apex and bladder neck urethra during radical prostatectomy significantly improve the postoperative urinary control of patients at 3 months after surgery.