S.A. Vozianov, S.N. Shamrayev, A.M. Leonenko

The modification of laparoscopic and endovideoscopic extraperitoneal radical prostatectomy

The aim of the study is to improve the technique of formation of vesico-urethral anastamosis (VUA) in the performance of endoscopic radical prostatectomy (ERPE) and evaluate its immediate results.

Material and methods. In this study, there are estimated the immediate results of various methods for the formation of VUA in patients with localized prostate cancer (n=101) who were undergone a radical surgical intervention in one center of the third level of medical care for 2015-2016 years. The patients were divided into three groups. Group I included 24 (23,8%) patients who had undergone a modified ERPE. Group II involved 49 (48,5%) patients who had undergone the formation of VUA by the method of R.F. Van Velthoven. Group III inserted 28 (27,7%) patients, in which the formation of VUA were occurred in the way of J.-U. Stolzenburg. More than 75 parameters (clinical, biochemical, pathological, results of instrumental research, etc.) were analyzed for each patient. Complications were divided: by the number; by severity according to the scale P.A. Clavien et al. (2009); by type for G. Novara et al. (2010); by prognostic group formed by P.M. Pierorazio et al. (2013). The data are processed using parametric and nonparametric statistics (Shapiro-Wilk test, Mann-Whitey test, chi-squared test, Fisher’s exact test).

Results. The median time of catheterization of the bladder in the group of the new method of VUA was 7 (7; 10) days and was 41,7% less than the similar indicator in the group of single-row running suture of VUA - 12 (10; 14,5) days (p<0,001) and 26,3% less than in the group of single-row interrupted VUA - 9,5 (7; 15,5) days (p<0,05). The investigated method of EPRE illustrates less blood loss than ERPE with the formation of VUA by the method of Van Velthoven: 200 (150; 300) vs 400 (200; 600) ml (p<0,01), the corresponding volume of blood loss in a group of patients operated using the method of J.-U. Stolzenburg was 225 (150; 300) ml (p>0,05). The number of genitourinary complications in the ERPE with the implementation of the proposed method for the formation of VUA was 33,3±9,6% and was statistically significantly lower than that in group with the running suture VUA: 65,3 ± 6,8% (p=0,013) mainly due to the occasional occurrence of leakage of VUA (p=0,047) and decrease in the frequency of postoperative urinary incontinence (p=0,041). Despite a greater number of genitourinary complications in the group of single-row interrupted suture - 57,1±9,4%, statistically, the group of single-row and two-row interrupted sutures of VUA did not differ (p=0,102). In all groups of patients, the “small” complications of P.A. Clavien predominate, so for group I, this figure was 37,5%, for group II - 75,5% and 64,3% for the group III. In patients of all studied groups as a concomitant disease, the diseases of the cardiovascular system were dominated.

Conclusions. The data, which were obtained from this study on the reduction of the number of postoperative complications during the implementation of a new method for the formation of VUA in the ERPE, indicate the prospect of further study of this problem in terms of minimizing of the complications of ERPE and improving the quality of life of patients with prostate cancer.