Analysis of the use of integral combinations of efficacy radical prostatectomy and the evaluation of a new method for the formation of vesico-urethral anastomosis in endoscopic radical prostatectomy in patients with clinically localized prostate cancer
Authors: С. О. Возіанов  , С. М. Шамраєв  , А. М. Леоненко  
Published: December 2018

The objective: is to conduct the search, systematization and analysis of existing literature publications on the use of various integral combinations of efficacy (ICE) of radical prostatectomy (RPE) in the treatment of patients with prostate cancer (PC), as well as to evaluate the efficiency of the new method for the formation of vesico urethral anastomosis (VUA) with performing endoscopic radical prostatectomy (EPPE) using the ICE and to compare the findings with other studies.Materials and methods. Information search was conducted using the international databases PubMed, Google Scholar and electronic databases of the National Library of Ukraine named after V.I. Vernadskiy according to July 2017. Only original research was selected, literary reviews, or works published only as theses for consideration were not included. Each literary source was analyzed in a full text version, separately determined: author’s team, year of publication of the study, the number of patients, in relation to which the ICE were calculated, the number of operating surgeons, the type of RPE, the time of observation of patients, the number of patients who reached one or another ICE of RPE and its individual components. Urine continence (UC) and erectile function (EF) after the RPE were described in the focus of the method of their fixation and evaluation, followed by analysis of the obtained data, this approach is due to the problem of the lack of standardization of these states. Some author’s comments and conclusions are given at the end of the description of the source. The works, in which several ICE were defined, were described in the part of the review of the ICE, which of them is newer.The experimental group included 24 patients who had undergone a modified ERPE in the conditions of the SI «Institute of Urology of NAMS Ukraine» for 2015–2016 years. The average follow up time for patients was 17,4±5,3 months, a monitoring point of observation was 12 months. Biochemical recurrence (BCR) was detected in the case of PSA>0,2 ng/ml, positive surgical margin (PSM) was determined by the staff of the Laboratory of pathomorphology of the SI «Institute of Urology of NAMS Ukraine». UC were determined by subjective, non strict method (no pad/one safety pad). The EF was evaluated in accordance with the possibility for intercourse in patients with more than half of the cases with or without the of 5 phosphodiesterase inhibitors. Complications were classified by P.A. Clavien (2004). The evaluation of the results was carried out by determining the number of patients who achieved trifecta and pentafecta as the most commonly used ICE’s.Results. Generally, six separate ICE of RPE were identified, which were proposed by various authors from 2003 to 2012 years. The most commonly used were trifecta and pentafecta. The results obtained in the studies of other authors are summarized in tabular form. An analysis of the methods used by the authors to evaluate UC and EF are carried out. There were in the study group, a new method for the formation of VUA PSM was absent in 91,7%, the absence of BCR was established at 87,5%, the UC was noted at 91,7%, the preservation of EF was 62,5%, the complications were absent at 70,8% of patients. Thus, trifecta were reached 58,3%, and pentafecta were reached 50% of operated patients using a new method for the formation of VUA.Conclusions. At present time, various authors have developed 6 different integral combinations of the efficiency of the RPE, of which the scientific community has universally recognized and the most frequently used «trifecta» (M. Benson, 2004) and «pentafecta» (V. Patel, 2011). In this paper, there were, for the first time, integrated combinations of efficacy of endoscopic RPE in patients with localized PC, as well as detailed ways of evaluating the results of the RPE according to the criteria of objectivity and severity. The obtained performance indicators of ERPE with the proposed method for the formation of VUA correspond to the data of modern literature, the implementation of the new method does not compromise the oncological results of ERPE with the achievement of trifecta in 58,3%, and pentafecta – in 50% of patients with localized PC. The use of the «octafecta» concept regarding the surgical treatment of PC contravenes the norms of generally accepted clinical practice in Ukraine and is not recommended for implementation in clinical work.