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

Yong Liu,^1,2 Qinxin Zhao,³ Feiya Yang,³ Mingshuai Wang,¹ Nianzeng Xing<sup>1,3

1</sup>Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People’s Republic of China; ²Department of Urology, Weihai Municipal Hospital, Weihai, 264200, People’s Republic of China; ³Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China

Correspondence: Nianzeng Xing
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan South Li, Chaoyang, Beijing, 100021, People’s Republic of China
Email [email protected]

Background: Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the “Sandwich” urethra reconstruction technique on continence at the early stage after LRP.
Methods: During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the “Sandwich” technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated.
Results: There is no statistical difference in patients’ basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49± 4.72 minutes in Group A and 20.16± 5.75 minutes in Group B (P< 0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (P< 0.001). Maximum flow rates before and after the “Sandwich” procedure for 12 months were 13.2± 2.8 m/s and 15.4± 3.6 m/s, respectively (P=0.034). In addition, residual volumes before and after the “Sandwich” procedure for 12 months were 15 (0– 20) mL and 0 (0– 12.5) mL, respectively (P=0.107).
Conclusion: Our prospective study confirms that the “Sandwich” technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.

Keywords: Sandwich, urethral reconstruction, laparoscopic radical prostatectomy, urinary incontinence, urodynamic tests