Laparoscopic Radical Prostatectomy with a Bladder Neck and Urethra Preservation Modified Posterior Approach: Short-term Oncological and Functional Results of the First 108 Patients

Abstract

Objective:Short-term oncological and functional results of patients who underwent laparoscopic radical prostatectomy (LRRP) with a bladder neck and urethra preservation modified posterior approach (Demirtaş Erciyes Modification) are presented.Materials and Methods:The data of 140 patients who were operated between July 2015 and March 2020 for localized prostate cancer were analyzed retrospectively. A total of 32 patients were excluded from evaluation because a history of transurethral prostate resection or bladder neck preservation could not be applied due to the median lobe protruding into the bladder. Preoperative prostate-specific antigen (PSA), prostate biopsies, preoperative erectile function status, operation time, transfusion rate, complications, pathology results of LRRP, postoperative erectile function, and continence status were evaluated.Results:The mean age of 108 patients was 64±4.47 years, with median PSA of 9.65 ng/mL. The mean operation time was 186.96±54.1 min, and the median catheter removal time was 10 days. The median hospital stay was 4 days. The median follow-up time was 17.5 months. The prostatectomy pathology of 95% of patients was at pT2 stage. The complication rate of Clavien 3 and above was 4.6%. The surgical margin positivity rate was 10.2%. Continence rates were 88% and 92.6% at 6 and 12 months, respectively. The rate of erection with spontaneous or oral medications was 43.5%. Among 58 patients with at least 2 years follow-up, PSA recurrence was detected only in two patients.Conclusion:Laparoscopic radical prostatectomy with a bladder neck and urethra protective modified posterior approach may be an option in the selected patient group in terms of short-term oncological and functional results.

Keywords

• prostate cancer
• laparoscopy
• radical prostatectomy