Radikal prostatektomi operasyonunda rabdoid sfinkterden geçilen sütürün inkontinans üzerine olan etkisi / The effect of suture which crossed the rhabdoid sphicter during radical prostatectomy on the patient's continency
AdvisorProf. Dr. Şinasi Yavuz ÖNOL
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Objective: The success of radical retropubic prostatectomy (RRP) depends on effective control of the deep venous complex, preservation of neurovascular bundles when necessary and water-tight and wide urethrovesical anastomosis. Including rhabdosphincter in the vesicourethral anastomosis, where striated sphincter is fixed to the bladder neck, not only prevents caudal retraction of the urethra but also provides more anatomically position. The aim of this study was to define the continence status in patients where rhabdosphincter was included in the vesicourethral anastomosis.Materials and Methods: Between November 2004 and September 2010, 90 cases who underwent RRP by the same surgeon in our clinic were taken into the study. The mean age of patients was 64.3 years (range 51-78). In all cases, during RRP vesicourethral anastomosis was performed include the rhabdosphincter. The anastomosis was performed with mean 2,9 (0-7) interrupted no.2-0 vicryl sutures, depending on the angulation of symphisis pubis and pelvic cavity. All patients preoperatively had total prostatic specific antigen level (tPSA), prostate biopsy accompanied by transrectal ultrasound (TRUS-Bx) and bone scintigraphy. Intraoperative and postoperative parameters were considered blood loss, operation time, hospitalization,time to drain removal and pathological examination. Pad test was performed to all patients at 1, 3, 6 and 12 months postoperatively. We defined patients as `continent? when they no need pad, as `mild incontinence? when they use only one pad daily, as `moderate incontinence? when they use two or three pads daily and as `severe incontinence? when they use more than three pads daily.Results: Preoperative total PSA value was 12,2 ng/ml ( range: 2,7- 84 ng/ml ). Preoperative TRUS-Bx results were found that Gleason scores were 5, 6, 7 and 8 in 7, 53, 21, 9 patients, respectively. Intraoperative mean blood loss was 780 ml. (150-3500). Mean operation time was 103 minutes (60-200). Mean hospital stay was 4,6 days(2-20) and mean urethral catheter removal time was 14,6 days (9-28). Postoperative pathology results were found that Gleason scores were 5, 6, 7 and 8 in 5, 43, 32, 10 patients, respectively. According to results of postoperative pad tests, 38, 48, 55 and 75 patients were defined as continent in first, third, sixth and twelfth months, respectively.Conclusion: We think that, our novel technique of vesicourethral anastomosis in standard RRP provides more optimal urethral position during fixation of pelvic floor and urethra, protect caudal retraction, preserve functional urethral lenght. Also strong fullthickness stitch on urethra provides better urinary continence by hanging urethra in our patients. Although our early continence rate is better, our long term continence rate is similar to literature.