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Morphologic changes after bladder neck intussusception in laparoscopic radical prostatectomy contribute to early postoperative continence

  • Urology - Original Paper
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Abstract

Purpose

To explore the mechanism and efficacy of the modified bladder neck intussusception in laparoscopic radical prostatectomy (LSRP) on postoperative early continence.

Methods

We prospectively collected clinical information of prostate cancer patients who underwent LSRP with modified bladder neck intussusception (n = 10) and non-intussusception (n = 10). At postoperative 1 month, the prostate-specific antigen (PSA), pad test, real-time magnetic resonance imaging (rt-MRI), and flow rate were performed. At postoperative 3 months, the PSA, pad test, international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), incontinence questionnaire short form (ICI-Q-SF), and quality of life (Qol) were recorded.

Results

The intussusception and non-intussusception patients had similar baseline characteristics. At postoperative 3 months, intussusception patients had lower OABSS than non-intussusception patients (P = 0.038). The non-intussusception patients suffered from more severe incontinence (P = 0.026). The continence rate of intussusception patients was significantly higher (90% vs. 20%, P = 0.005). And intussusception patients had significantly lower Qol scores (P = 0.038). According to the morphologic analysis by rt-MRI, there were 7/10 non-intussusception patients and 2/10 intussusception patients having funnel-shaped bladder necks at Valsalva movement. The intussusception patients had larger angle between anterior and posterior wall at bladder neck (P = 0.029) and longer length of functional posterior urethra (P = 0.029). During micturition, the intussusception bladder neck was found to move less dynamically on X-axis and Y-axis, but the difference did not reach significance.

Conclusions

The modified technique of bladder neck intussusception in laparoscopic radical prostatectomy prolongs the length of functional posterior urethra and is effective to improve postoperative early continence.

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Abbreviations

LSRP:

Laparoscopic radical prostatectomy

PSA:

Prostate-specific antigen

IPSS:

International prostate symptom score

OABSS:

Overactive bladder symptom score

ICI-Q-SF:

Incontinence questionnaire short form

Qol:

Quality of life

rt-MRI:

Real-time magnetic resonance imaging

FIESTA:

Fast imaging employing steady-state acquisition

AAP:

Anterior and posterior wall

ALR:

Angle between left and right wall

ANU:

Angle between bladder neck and posterior urethral

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Acknowledgements

This work was supported by Grants from the National Key R&D Program of China to Shiliang Wu (Grant number 2018YFC2002200).

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Author notes

  1. Lin Yao, Yuke Chen, and He Wang contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China

    Lin Yao, Yuke Chen, Wei Yu, Yu Fan, Yang Yang, Yunxiang Xiao, Jihong Duan, Qian Zhang, Zhisong He & Shiliang Wu

  2. Institute of Urology, National Urological Cancer Center, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China

    Lin Yao, Yuke Chen, Wei Yu, Yu Fan, Yang Yang, Yunxiang Xiao, Jihong Duan, Qian Zhang, Zhisong He & Shiliang Wu

  3. Department of Radiology, Peking University First Hospital, Beijing, China

    He Wang

  4. Institute of Urology, National Urological Cancer Center, Peking University First Hospital, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China

    Zhisong He & Shiliang Wu

Authors
  1. Lin Yao
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Contributions

Study Concepts: Zhisong He and Shiliang Wu. Study Design: Wei Yu, Zhisong He, and ShiliangWu. Data Acquisition: Lin Yao, Yuke Chen, and He Wang. Quality Control of Data and Algorithms: Yuke Chen and Yu Fan. Data Analysis and Interpretation: Yuke Chen and Yu Fan. Statistical Analysis: Yuke Chen and Yu Fan. Manuscript Preparation: Yang Yang, Jihong Duan, Yunxiang Xiao, and Yu Fan. Manuscript Editing: Yuke Chen. Manuscript Review: Qian Zhang, Wei Yu, and Shiliang Wu.

Corresponding authors

Correspondence to Zhisong He or Shiliang Wu.

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11255_2019_2118_MOESM1_ESM.tif

Supplementary figure 1. The postoperative morphologic changes of the bladder neck a: the funnel-shaped bladder neck at valsalva movement; b: the non-funnel-shaped bladder neck at valsalva movement. (TIF 14151 KB)

11255_2019_2118_MOESM2_ESM.tif

Supplementary figure 2. Demonstrative examples of the morphologic indexes measurement. a: the angle between anterior wall and posterior wall at the vesical neck (AAP) equals to the degree of angle AOP; b: the angle between the right wall and the left wall at the vesical neck (ARL) equals to the degree of angle ROL; c: OQ (the dashed line) is the distance from vesical neck to the horizontal line across the lower margin of pubic symphysis, which is assigned to evaluate the relative length of posterior urethra (rLPU); the actual urethral length between the dot O and the horizontal line across the urogenital diaphragm is defined as the length of functional posterior urethra (LFPU); d: the line NO is the axis of the balder neck, the line OU is the axis of the posterior urethral, and the angle between bladder neck and posterior urethral (ANU) equals to the degree of angle (NOU). (TIF 11380 KB)

Supplementary material 3 (MP4 8061 KB)

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Yao, L., Chen, Y., Wang, H. et al. Morphologic changes after bladder neck intussusception in laparoscopic radical prostatectomy contribute to early postoperative continence. Int Urol Nephrol 51, 1157–1165 (2019). https://doi.org/10.1007/s11255-019-02118-0

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  • DOI: https://doi.org/10.1007/s11255-019-02118-0

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