TREATMENT OF PROSTATE CANCER USING ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY WITH RECONSTRUCTION OF THE PROXIMAL PROSTATIC URETHRA

Introduction: Prostate cancer (PCa) has been one of the leading oncologic pathologies for decades. In the low-risk group the nerve-sparing technique of surgery is used, which is supplemented by preservation and reconstruction of the prostatic urethra. The effectiveness of this technique in preserving the quality of urination, a significant reduction in the rehabilitation time of patients without reducing the quality of the oncologic result of the operation is described. The aim of the study: To evaluate the long-term results of robot-assisted laparoscopic radical prostatectomy with prostatic urethra reconstruction. Materials and Methods: 60 patients were included in the study. Patients’ selection criteria: low risk of disease prevalence, focal form, tumor location more than 4 mm from the prostatic urethra. During the operation a precision dissection of the prostatic urethra from the prostate is performed. Up to 2cm of the proximal section is preserved, a similar manipulation is performed with the distal urethra. After removal of the prostate, the integrity of the urethra is restored by applying urethro-urethral anastomosis. Before the operation the patients underwent standard examination, including general clinical tests, blood test for prostate-specific antigen (PSA), ultrasound, magnetic resonance imaging (MRI) with 3D modeling. There are also results of pathohistological report, International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), Quality of Life due to urinary disorders, Partin nomogram. Results: All studied parameters showed good results after 1 month, which were maintained after 6 and 12 months. In 1 patient (1.67%) there was a biochemical recurrence after 6 months (PSA 0.35 ng/ml), which was visualized by MRI as an area of contrast accumulation in the area of neurovascular bundles, the preserved urethra was intact. Conclusion: Based on the results of the study, there is preservation of the quality of life and no increase in oncologic risk one year after surgery. It is possible to expand the selection criteria and perform prostatic urethra preservation without performing nerve-sparing.