METHOD OF INTRAOPERATIVE PREVENTION OF ERECTILE DYSFUNCTION AND URINARY INCONTINENCE IN PATIENTS AFTER NERVE-SPARING RADICAL PROSTATECTOMY WITHOUT LYMPH NODE DISSECTION Russian patent published in 2023 - IPC A61B17/00 A61B1/313 A61M25/10 A61K35/16 A61P13/08 

FIELD: medicine; surgical urology.

SUBSTANCE: trocar port is installed 1 cm below the navel, after which auxiliary ports are installed. Next, transperitoneal or extraperitoneal access is performed with dissection to the lateral umbilical ligaments and the space of Retzius. Then the bladder neck is opened and the vesicoprostatic muscle is dissected, after which the vas deferens and seminal vesicles are visualized medially and the latter are separated from the prerectal fat. Next, with upward traction of the vas deferens, dissection is carried out caudally in the plane between Denonvilliers' fascia and the vas deferens until the posterior surface of the apex of the prostate gland is reached. Next, posterolateral dissection is performed, traction of the vas deferens is continued until the plane between the prostate gland and the neurovascular bundle is exposed, after which the pedicles of the prostate gland are identified, clipped and cut. Afterwards, athermic intrafascial dissection is performed and 5-mm titanium clips are used to control the hemostasis of small vessels running along the lateral surface of the prostate gland. Next, anterior dissection and division of the urethra are performed. Then, from the front, the apex of the prostate gland is approached posteriorly from the puboprostatic ligaments and the deep dorsal venous complex, and the puboprostatic ligaments and the dorsal venous complex are separated from the prostate gland. Distal traction of the catheter is carried out and the anterior part of the apex of the prostate gland is dissected and separated from the urethra located next to the prostate gland. The prostate gland is placed in an endobag. Then the stump of the dorsal venous complex is fixed with a continuous suture and a vesicourethral anastomosis is applied starting at 3 o’clock position. Next, after anastomosis along the posterior semicircle, the urethral catheter is reinserted into the bladder and the anastomosis is continued along the anterior semicircle towards the right side until it reaches the starting point. Next, the tightness of the urethrovesical anastomosis is monitored, the balloon of the urethral catheter is inflated and drainage is installed in the pelvis. After that, the endobag with the macropreparation is removed by expanding the chamber port, the trocar-port sites are sutured, treated and an aseptic bandage is applied. After placing the removed prostate gland into the endobag, the stage of manufacturing platelet-enriched autoplasma is performed, which is then injected into the area of the nerve bundles and into the area of the future urethrovesical anastomosis on each side.

EFFECT: method allows to increase the efficiency of restoration of erectile function and reduce the incidence of urinary incontinence in patients after radical prostatectomy.

1 cl, 2 ex