Objective: To preliminarily examine the feasibility and outcome of single-port laparoscopic radical prostatectomy with full-length urethral preservation (FLUP-SPRP). Method: This study was a prospective case series study. A total of 25 patients with prostate cancer who met the enrollment criteria and agreed to this surgical procedure from March 2022 to December 2022 were collected at the Department of Urology, the Second Affiliated Hospital of Nanjing Medical University. The age of the patients was (67.2±7.6) years (range: 61 to 76 years). This novel procedure was performed by an experienced surgeon who performed single hole radical prostatectomy skillfully. Patient urinary control, tumor control, and related surgical complications after surgery were regularly monitored. Postoperative urinary control was evaluated using the daily amount of urine pad, 0 to 1 piece of urine pad was to restore urinary control, and 0 to 1 piece of pad within 24 hours after catheter removal was immediate urinary control. Result: All prodecures were successfully completed without transit to open surgery. The surgical time was (128.4±22.4) minutes (range: 100 to 145 minutes), the intraoperative blood loss was (68.2±13.7) ml (range: 50 to 120 ml). The urethral injury occurred in 4 cases during surgery and was repaired by sutures. The urinary control recovery rates within 24 hours, 1 week, 4 weeks, and 7 weeks after surgery were 80.0%, 84.0%, 92.0% and 100%, respectively. Postoperative large section pathology revealed 1 case with a positive basal margin of the prostate and negative margins of all prostate glands around the urethra. Postoperative complications included urinary tract infection in 3 cases, urodynia in 2 cases, and acute urinary retention in 1 case. MRI follow-up 3 months after surgery showed normal anatomy of the bladder and urethra. The follow-up values of prostate specific antigen at 3 and 6 months after surgery were less than 0.1 μg/L. Conclusions: The preliminary results of this study indicate that the FLUP-SPRP procedure is safe and feasible. The early results of postoperative urinary control and oncology are as expected.
目的： 初步探讨连续性全尿道保留技术在单孔腹腔镜根治性前列腺切除术中的可行性和效果。 方法： 本研究为前瞻性病例系列研究。前瞻性收集2022年3—12月南京医科大学第二附属医院收治的符合入组条件（病理学分期≤pT2c期，Gleason评分≤7分，前列腺特异性抗原<20 μg/L，MRI检查结果提示尿道和前壁无肿瘤侵犯，既往无尿道严重外伤史），术前充分沟通后明确接受此术式的25例前列腺癌患者的资料。患者年龄（67.2±7.6）岁（范围：61~76岁）。手术由熟练开展单孔根治性前列腺切除术的医师实施。术后定期随访患者的尿控、肿瘤控制和手术并发症等；日尿垫用量0~1片为恢复尿控，拔除导尿管后24 h内尿垫用量0~1片为即刻尿控。 结果： 所有病例顺利完成手术，无中转开放手术。手术时间（128.4±22.4）min（范围：100~145 min），术中出血量（68.2±13.7）ml（范围：50~120 ml），4例发生尿道损伤并进行缝合修补。术后24 h、1周、4周和7周尿控恢复率分别为80.0%、84.0%、92.0%和100%。术后大切片病理学检查结果提示1例前列腺基底部切缘阳性，所有患者尿道周围腺体切缘阴性。术后并发症包括泌尿系感染3例、尿痛2例、急性尿潴留1例。术后3个月MRI随访结果提示膀胱和尿道形态基本正常。术后3个月和6个月前列腺特异性抗原值均<0.1 μg/L。 结论： 连续性全尿道保留技术在单孔腹腔镜根治性前列腺切除术中可行，患者术后早期尿控和肿瘤学效果达到预期。.