“Sandwich” Technique of Total Urethral Reconstruction in the Laparoscopic Radical Prostatectomy: A Prospective Study

Figures & data

Figure 1 The first layer of the reconstruction of the posterior wall of total urethral reconstruction of “Sandwich”. (A) The structural location of the medial dorsal raphe (MDR) during the operation. (B) The structural location of the severed end of Denonvillier’s fascia. (C) The severed Denonvillier’s fascia was sutured with MDR.

Figure 2 The second layer of the reconstruction of the posterior wall of total urethral reconstruction of “Sandwich”. (A) The structural location of the MDR during the operation. (B) The structural location of the posterior lip of the ladder neck. (C) MDR was sutured with the bladder wall at the back of the posterior lip of the bladder neck.

Figure 3 Anastomosis of bladder and urethra of total urethral reconstruction of the “Sandwich”. (A) The structural location of the bladder neck during the operation. (B) The structural location of the urethra. (C) A running urethrovesical anastomosis was performed with the posterior wall suturing from 4 o’clock to 8 o’clock. (D) A urethrovesical anastomosis was performed with the front wall suturing from 3 o’clock to 9 o’clock.

Figure 4 The reconstruction of the anterior of total urethral reconstruction of the “Sandwich”. (A) The structural location of the detrusor apron (DA) during the operation. (B) The structural location of the pubicoprostatic ligament. (C) The pubicoprostatic ligament is sutured with the bladder wall behind the anterior lip of the bladder neck (equivalent to the position of DA).

Table 1 Baseline Characteristics of the Patients

	Group A	Group B	P-value
Patient, n	66	64
Age, years	67.74±5.20	66.22±6.50	0.255
BMI, kg/m^2	25.35±3.37	24.60±3.18	0.06
Prostate weight, g	46.59±20.85	41.41±14.95	0.697
Biopsy Gleason score, n(%)			0.904
≤6	15 (22.73)	15 (23.44)
7	28 (42.42)	29 (45.31)
≥8	23 (34.85)	20 (31.25)

Note: Data is represented as mean±SD or n (%), unless otherwise stated.

Abbreviation: BMI, body mass index.

Table 2 Operative Date of the Patients

	Group A	Group B	P-value
Operative time, minutes (range)	120.64±58.36	106.06±45.07	0.094
Reconstruction Time, minutes (range)	23.49±4.72	20.16±5.75	<0.01
Estimated blood loss, mL	120.77±88.86	108.41±75.77	0.444
Hospital length of stay, days	8.14±3.75	7.47±3.66	0.079
Duration of Catheter, days	11.80±5.68	10.34±5.07	0.094
Procedure with sparing nerve, n (%)			0.267
Bilateral nerve sparing	9 (13.64)	4 (6.25)
Unilateral nerve sparing	6 (9.09)	4 (6.25)
Non-nerve sparing	51 (77.27)	56 (87.5)
Complications, n (%)
Complications grade I	5 (7.58)	5 (7.81)
Complications grade II	0 (0)	1 (1.56)

Note: Data is represented as mean±SD or n (%), unless otherwise stated.

Table 3 Postoperative Data of the Patients

	Group A	Group B	P-value
Pathologic stage, n			0.771
pT0	0	0
pT2a	4	5
pT2b	12	10
pT2c	41	43
pT3	9	6
pT4	0	0
PSM rate, n (%)	21 (31.82)	13 (20.31)	0.136
Gleason sore-final specimen, n (%)			0.675
≤6	10 (15.16)	10 (15.62)
7	40 (60.61)	35 (54.69)
≥8	16 (24.24)	19 (29.69)

Note: Data is represented as mean±SD or n (%), unless otherwise stated. Abbreviation: PSM, positive surgical margin.

Table 4 Postoperative Urinary Continence Rate of Both Groups

Continence Rates n (%)	Group A	Group B	P-value
2 weeks	36 (54.55)	7 (10.94)	<0.01
4 weeks	55 (83.33)	9 (14.06)	<0.01
8 weeks	62 (93.94)	24 (37.50)	<0.01
12 weeks	64 (96.97)	46 (71.88)	<0.01

Note: Data is represented as n (%), unless otherwise stated.