Role of sparing of puboprostatic ligaments on continence recovery after radical prostatectomy: a randomized controlled trial

Abstract

Objective

Sparing of puboprostatic ligaments (PPLs) during radical prostatectomy was introduced as a technique to improve urinary continence. This study aims to study the effect of sparing of PPLs during laparoscopic radical prostatectomy in terms of continence during the first 3 months.

Methods

A total of 74 patients, diagnosed with clinically localized prostate cancer, were randomly assigned to two equal groups; PPLs division and sparing during LRP. Based on the number of daily used pads, both groups completed 3 months follow-up to assess continence recovery. The effects of age, preoperative total prostate-specific antigen (PSA) and clinical tumor stage on continence recovery were also studied. The study was registered and approved by the Ethics Committee of Alexandria University-Faculty of Medicine (Protocol No. 0201074).

Results

Seventy-four patients were enrolled, with a mean age of 63.8 years. Baseline characteristics were comparable, except significantly higher mean PSA in the division group. Sixty patients were continent (0–1 pad/day) at 3 months follow-up. Continence was significantly better in the sparing than division group at 1 week after catheter removal (67.6% vs 40.5%, p = 0.01), at 1 month (73% vs 45.9%, p = 0.009) and 2 months (89.2% vs 51.4%, p = 0.0001). At 3 months follow-up, there was no significant difference between both groups (83.3% vs 78.4% for sparing and division groups, respectively; p = 0.28). Moreover, continence was significantly improved at 3 months compared to 1 week in both groups.

Conclusion

Sparing of puboprostatic ligaments during radical prostatectomy significantly improves postoperative early recovery of urinary continence.

Keywords:

• Prostate cancer
• laparoscopic radical prostatectomy
• puboprostatic ligaments sparing
• urinary continence
• randomized clinical trial

Ethical approval

Approved by the Ethics committee of Faculty of Medicine, Alexandria University, Egypt. (IRB No. 00012098, FWA No. 00018699, protocol No. 0201074).

Informed consent

All patients consented to participate in the study and to data publication after appropriate information through institutional consent.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data collection was done in our center and protected by patient confidentiality.