A œmparative analysis of various methods of hemostasis in the treatment of neurovascular bundles during nerve-sparing extraperitoneal endovideosurgical radical prostatectomy
The aim of our study was to compare different methods of hemostasis in the treatment of neurovascular bundles during endovideosurgical extraperitoneal radical prostatectomy (EERPE) regarding the risk of developing erectile dysfunction and urinary incontinence. Materials and methods. The prospective study comprised 35 patients, who underwent nerve-sparing EERPE over the period of 2009-2013. The mean age of patients was 62.2 ± 4.3 years (from 54 to 69 years). The median volume of the prostate was 39 cm3, according to the ultrasonography data (interquartile range [32, 56]). The median level of the total prostate-specific blood antigen was 11.1 ng/ml (interquartile range [8.1, 17.4]). All patients demonstrated complete urinary continence before the surgery and marked the presence of erectile function. All patients were divided into three groups, depending on the method of hemostasis in the treatment of neurovascular bundles during EERPE: Group I - the use of titanium clips (n = 12); Group II - the application of bipolar coagulation (n = 12); III group - the use of an ul trasonic dissector (n = 11). Erectile function and urinary continence were assessed at 2 control points: after the removal of urethral catheter and 12 months after the surgery. Results: 12 months after surgery, 100% of patients in Group I demonstrated urinary continence, which is higher than in Groups II (91.6%) and III (91%) (p <0.05 in all cases, U-test). The proportion of patients with a sufficient erection was significantly higher in Group I, where titanium clips were used for hemostasis (p <0.05, U-test). Conclusion. The provided data of a comparative analysis of various methods of hemostasis in the treatment of neurovascular bundles during endovideosurgical radical prostatectomy show that the recovery of urinary continence and the erectile function depends on the method used for hemostasis. Wherein the use of titanium clips makes it possible to reduce the frequency of this complication.