Objective: To evaluate urinary continence outcomes after laparoscopic radical prostatectomy (LRP), and explore the learning curve for continence.
Methods: Between May 2006 and May 2011, 200 consecutive patients with clinically localized prostate cancer underwent LRP in Peking University Third Hospital, of whom 160 were performed by a single surgeon and followed up successfully. The average age was (71.9±5.5) years (their age range: 56 to 85 years). All the patients were continent before operation. Of these patients, 11 had undergone previous transurethral resection of the prostate (TURP) and the other 149 were diagnosed by transrectal prostate biopsy. No metastasis was found before surgery. The data about the patients and the operations were recorded. The time from operation till urinary continence was obtained and accessed by interviews. Continence was defined as the use of no pad and no urinary leakage or loss of a few drops occasionally. The patients were divided into 4 equal groups in the 40 consecutive series to determine whether continence was statistically different in group A (1-40) as compared with the other groups.
Results: All the operations were performed laparoscopically without any conversion to open surgery. The mean operative duration was (230±57) min (ranging from 110 to 493 min), the median estimated blood loss was 200 mL (ranging from 30 to 1 200 mL), 12 patients (7.5%) received blood transfusions intraoperatively, and the average hospital stay after surgery was (11.8±7.9) d (ranging from 5 to 60 days). The distribution of pathologic stages was as follows: T2a 20%, T2b 16.9%, T2c 40%, T3a 15%, T3b 5.6% and T4 2.5%. The overall positive surgical margin (PSM) rate was 32.5%. The overall continence rates (no pad) were 14.4% after 1 month, 48.8% after 3 months, 77.5% after 6 months and 86.3% after 12 months. At the end of the follow-up, 21 patients (13.1%) were still incontinent . There was a significant difference in continence between the early (Group A) and later groups (P<0.05).
Conclusion: Continence results after LRP were encouraging, which were comparable to the results in previously published open series. Continence could be improved with increasing surgical experience, and it takes 40-50 cases to reach a plateau for surgeons who have some experiences of laparoscopic operations.