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Seminal vesicle sparing laparoscopic radical prostatectomy using a low-energy source: Better continence and potency.

Shah SJ, Goyal V, Sachar R, Nath AK, Jain N, Kapadia K - Indian J Urol (2009)

Bottom Line: Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II.In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP.Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Civil Hospital, B.J. Medical College and Civil Hospital, Asarwa, Ahmedabad, India.

ABSTRACT

Objectives: Ongoing with the newer developments in laparoscopic radical prostatectomy (LRP), we report our experience in a consecutive series of 42 patients with a mean 18-month follow-up. We also studied the use of a low-energy source, especially in the region of the prostatic apex and the neurovascular bundle and evaluated its outcome on continence and potency.

Materials and methods: Between November 2003 and December 2008, 50 patients aged 50-80 yrs underwent LRP with vesicourethral anastomosis and of these, 42 patients who had a minimum follow-up of 3 months were selected for the study. Of these, the initial 16 patients were operated by the routine method and the 26 patients operated in the later part of our experience were operated upon using a minimal energy source.

Results: The mean follow-up was 18 months (range 3-60). Continence was evaluated at 1, 3, 6, and 12 months. Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II. The difference in continence rates was mainly due to less use of electrocautery and harmonic scalpel at the bladder neck. Of the eight patients who were potent pre-operatively in Group I, four remained potent 3 months after LRP. In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP.

Conclusions: Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

No MeSH data available.


Related in: MedlinePlus

Postoperative photograph of the incision length and port site
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Figure 0002: Postoperative photograph of the incision length and port site

Mentions: We used sharp dissection with scissors in this region and reserving pin point sharp cautery to control any bleeding vessels in this region. Thus, a minimal energy source was used in this dissection. Besides this, a healthy urethra was preserved during apical dissection [Figures 2 and 3].


Seminal vesicle sparing laparoscopic radical prostatectomy using a low-energy source: Better continence and potency.

Shah SJ, Goyal V, Sachar R, Nath AK, Jain N, Kapadia K - Indian J Urol (2009)

Postoperative photograph of the incision length and port site
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2710064&req=5

Figure 0002: Postoperative photograph of the incision length and port site
Mentions: We used sharp dissection with scissors in this region and reserving pin point sharp cautery to control any bleeding vessels in this region. Thus, a minimal energy source was used in this dissection. Besides this, a healthy urethra was preserved during apical dissection [Figures 2 and 3].

Bottom Line: Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II.In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP.Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Civil Hospital, B.J. Medical College and Civil Hospital, Asarwa, Ahmedabad, India.

ABSTRACT

Objectives: Ongoing with the newer developments in laparoscopic radical prostatectomy (LRP), we report our experience in a consecutive series of 42 patients with a mean 18-month follow-up. We also studied the use of a low-energy source, especially in the region of the prostatic apex and the neurovascular bundle and evaluated its outcome on continence and potency.

Materials and methods: Between November 2003 and December 2008, 50 patients aged 50-80 yrs underwent LRP with vesicourethral anastomosis and of these, 42 patients who had a minimum follow-up of 3 months were selected for the study. Of these, the initial 16 patients were operated by the routine method and the 26 patients operated in the later part of our experience were operated upon using a minimal energy source.

Results: The mean follow-up was 18 months (range 3-60). Continence was evaluated at 1, 3, 6, and 12 months. Eleven of the 16 patients in Group I were continent as compared with 21 of 26 patients in Group II. The difference in continence rates was mainly due to less use of electrocautery and harmonic scalpel at the bladder neck. Of the eight patients who were potent pre-operatively in Group I, four remained potent 3 months after LRP. In Group II, 20 of the 26 patients were potent pre-operatively and 16 remained potent 3 months after LRP.

Conclusions: Use of a low-energy source at the bladder neck and neurovascular bundle, sparing of seminal vesicle, and leaving behind a long, healthy stump of the urethra during apical dissection, is associated with better continence and potency without compromising oncological outcome.

No MeSH data available.


Related in: MedlinePlus