Effect of laparoscopic radical prostatectomy on postoperative urinary continence in localized prostate cancer patients with non-neurogenic detrusor underactivity

Objective To evaluate the effect of laparoscopic radical prostatectomy (LRP) on postoperative urinary continence in localized prostate cancer patients with non-neurogenic detrusor underactivity(DU). Methods A total of 75 patients who received LRP from January 2020 to January 2023 were selected, including 25 patients with laparoscopic extrafascial radical prostatectomy (LERP) and 50 patients with laparoscopic intrafascial radical prostatectomy (LIRP). There were 28 DU patients and 47 non-DU patients. According to the results of baseline urodynamic examination, the patients were divided into four groups: a control group (n=28), a bladder outlet obstruction (BOO) group (n=19), a DU group (n=14) and a BOO+DU group (n=14). The baseline characteristics of patients were recorded. Their postoperative lower urinary tract symptoms, including international prostate symptom score (IPSS),and quality of life score (QOL), and urodynamic indexes, including the maximum urinary flow rate (Qmax) and post void residual (PVR) were recorded. The number of postoperative urinary incontinence cases was recorded to compare the urinary continence rate. Results Compared with non-DU patients, DU patients were older, and showed increased IPSS scores, increased QOL scores and decreased Qmax, with statistical difference (P＜0.05). Compared with those before operation, both DU and non-DU patients presented remarkably increased Qmax and decreased QOL scores at postoperative 12 months, while reduced IPSS and PVR were seen in non-DU patients, with statistical significance (P＜0.05). The urinary incontinence of DU patients was significantly improved 12 months after operation, while non-DU patients showed significantly improved urinary incontinence 3 months after LIRP and 6 months after LERP. Stratified analysis indicated that urinary incontinence in the control group and the BOO group began to improve 3 months after operation. Urinary incontinence was serious in the DU group and the BOO+DU group after LRP, and improved 12 months after LRP. Conclusions After LRP, the recovery of urinary continence is achieved at postoperative 12 months in DU patients, which is prolonged by more than 6 months compared with non-DU patients.