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Testing the Relationship Between Patient Age and Erectile Dysfunction


Table 3.38. Chi-square test of PT preserving neurovascular bundle-RLC.


Parameter

Index

Degree of freedom

p-value

Chi squared

15,333

2

0.001

Difference coefficient

15,792

2

0.002

Linear relationship between two variables

13,888

1

0.001

Total

41



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Testing the Relationship Between Patient Age and Erectile Dysfunction

With p = 0.001 < 0.05, the study can reject the hypothesis, meaning that there is a relationship between neurovascular bundle preservation and postoperative erectile dysfunction.


3.5.5. Verifying the relationship between patient age and erectile dysfunction

To test the relationship between patient age and erectile dysfunction, the study performed a chi-square test.

Hypothesize that there is no relationship between patient age and postoperative erectile dysfunction.

Table 3.39. Chi-square test of patient age - erectile dysfunction.


Parameter

Index

Degree of freedom

p-value

Chi squared

1,1321

2

0.517

Difference coefficient

1,414

2

0.493

Linear relationship between two variables

1,061

1

0.303

Total

41




In the test, with p = 0.517 > 0.05, the study could not reject the hypothesis, meaning that there was no association between patient age and postoperative erectile dysfunction.


3.5.6. Examination of the association between neurovascular bundle preservation and urinary incontinence

To test the association between neurovascular sparing surgery and urinary incontinence, the chi-square test was performed.

Hypothesize that there is no association between neurovascular preservation and postoperative urinary incontinence.

Table 3.40. Chi-square test for preservation of neurovascular bundles - TKKS.


Parameter

Index

Degree of freedom

p-value

Chi squared

2,687

2

0.261

Difference coefficient

3,425

2

0.180

Linear relationship between two variables

2,134

1

0.144

Total

41




With p = 0.261 > 0.05, the study could not reject the hypothesis, meaning there was no association between neurovascular preservation surgery and urinary incontinence.


3.5.7. Verify the relationship between surgical time and blood loss during surgery

To test the relationship between operative time and intraoperative blood loss, the study performed a mean test between operative time and intraoperative blood loss.

The study was divided into two groups: group 1: cases with surgical time ≤ 194.69 minutes (this was the average surgical time of the study), and group 2: cases with surgical time > 194.69 minutes. The mean test was used to test the difference in intraoperative blood loss. The hypothesis was that there was no difference in blood loss between the two groups.

Table 3.41. Relationship between surgical time and blood loss during surgery.



Surgery time

(minute)

Number TH

Medium

Deviation

standard

Blood loss

(ml)

≤ 194.69

27

312.96

185,323

> 194.69

22

581.82

377,821


Table 3.42. Mean test between operative time - blood loss during surgery.


Leven test

t test

F

p-value

t

Degree of freedom

p-value

Blood loss (ml)

Relative variance

present

9,231

0.004

-3,253

47

0.002

Zero variance

equivalent



-3052

29, 136

0.005

With p = 0.002 < 0.005, the study can reject the hypothesis, meaning that there is a relationship between surgical time and intraoperative blood loss.


3.5.8. Verifying the relationship between surgery time and prostate volume

To test the relationship between surgical time and prostate volume, the study performed a mean test between surgical time and prostate volume.

The study was divided into 2 groups: group 1: cases with surgical time ≤ 194.69 minutes (this was the average surgical time of the study), and group 2: cases with surgical time > 194.69 minutes.

Hypothesize that there is no difference in prostate volume between the 2 groups.

Table 3.43. Relationship between surgical time and TTL volume.



Surgery time (minutes)

Number TH

Medium

Standard deviation

TTL weight (gr)

≤ 194.69

27

31.11

6,699

> 194.69

22

40.23

16,510


Table 3.44. Mean test of surgical time – TTL volume.



Leven test

t test

F

p-value

t

Degree of freedom

p-value

TTL Weight

(gr)

Equivalent variance

6,889

0.012

-2,621

47

0.012

Non-equivalent variances



-2,432

26,625

0.022

With p = 0.012 < 0.05, the study can reject the hypothesis, meaning that there is a relationship between surgical time and TTL volume.


3.5.9. Test the relationship between prostate mass and blood loss during surgery

To test the relationship between prostate volume and intraoperative blood loss, a mean test was performed.

The study was divided into 2 groups: group 1: cases with prostate mass ≤ 40 grams, and group 2: cases with prostate mass > 40 grams [29].

Hypothesize that there is no difference in blood loss between the two groups. Table 3.45. Relationship between TTL volume - blood loss during surgery.


Weight

(gr)

Number TH

Medium

Deviation

standard

Blood loss

(ml)

≤ 40

27

418.42

319,717

> 40

22

486.36

307,482


Table 3.46. Mean test between TTL volume and blood loss during surgery.


Leven test

t test

F

p-value

t

Degree of freedom

p-value

Blood loss (ml)

Relative variance

present

0.027

0.869

-626

47

0.535

Zero variance

equivalent



-646

16,794

0.531

With p = 0.535 > 0.05, the study could not reject the hypothesis, meaning that there is a relationship between prostate mass and blood loss during surgery.


Chapter 4: DISCUSSION


To achieve good results in radical prostatectomy, in addition to the surgeon's experience, patient selection plays an important role. When performing surgery in cases that are too indicated, the results are often not good.

4.1. DISCUSSION ON TREATMENT


4.1.1. Discussion of surgical methods


Although there are many methods of treating localized cancer, surgery is still the treatment method chosen by many doctors. The purpose of radical prostatectomy (open or laparoscopic surgery) is to remove the entire prostate, seminal vesicles, and vas deferens into one block, avoiding missing or dropping cancer cells.

Of the 49 patients who underwent radical prostatectomy in the study, 9/49 underwent radical prostatectomy without pelvic lymphadenectomy. The longest operative time of these cases was 240 minutes (2 cases), the shortest was 120 minutes (1 case). There were 3 cases with operative time of 150 minutes. Because no time was spent on lymphadenectomy, the operative time was shortened, with an average operative time of 179.44 minutes.

± 43.33 minutes.


40/49 cases performed radical prostatectomy with pelvic lymph node dissection. The longest surgery time was 315 minutes (1 case) and the shortest was 120 minutes (2 cases). 9 cases had surgery time > 240 minutes. The average surgery time for laparoscopic surgery with pelvic lymph node dissection was 198.13 ± 46.66 minutes (18.69 minutes longer than surgery without lymph node dissection).


The average blood loss in 9/49 cases of laparoscopic surgery without lymph node dissection was 316.67 ± 222.20 ml. The minimum blood loss was 150 ml (2 cases), the maximum was 700 ml (2 cases). Meanwhile, the average blood loss in laparoscopic surgery with lymph node dissection was 460 ± 328.98 ml (144 ml more than laparoscopic surgery without lymph node dissection). The minimum blood loss in laparoscopic surgery with pelvic lymph node dissection was 100 ml (6 cases) and the maximum was 1500 ml (1 case). The cases with blood loss of 100 ml were cases of small prostates, not much adherent to surrounding tissues, and easy to separate. There were 18 cases of laparoscopic surgery with lymph node dissection requiring blood transfusion during surgery.

In Mariano's study, the average surgical time was 125 minutes, with an average blood loss of 335 ml. According to the author, long surgical time is common when patients have a large prostate mass or when cancer adheres to surrounding tissues. In the author's study, 17.39% of post-operative cancer stage diagnosis was pT3 [58]. The results were similar to those in Guilloneau's study. In 3 years, the author performed radical prostatectomy in 567 cases, of which 80.6% did not perform pelvic lymph node dissection. The average surgical time was 134 minutes, with an average blood loss of 380 ml.

± 195ml, the rate of patients requiring blood transfusion during surgery was 4.9% [39].


In the study, 18/49 cases of retrograde endoscopic prostatectomy and 31/49 cases of antegrade surgery. Radical prostatectomy can be performed retrograde, meaning cutting the urethra first and then going upstream to cut the seminal vesicles and prostate. But it can also be performed antegrade, in which the seminal vesicles and vas deferens are cut first, then the prostate and finally the urethra is cut. In the study, the average time of antegrade surgery was shorter than that of retrograde surgery (188.87 minutes vs. 204.72 minutes). The shortest time of antegrade endoscopic surgery was 120


minutes (1 case) and the longest was 270 minutes (2 cases). The average blood loss during antegrade surgery was less than that during retrograde surgery (391.94 ml compared to 505.56 ml during retrograde cutting). The least amount of blood loss during antegrade cutting was 100 ml (4 cases) and the most was 1200 ml (1 case). After performing retrograde and antegrade cutting, the study found that the venous plexus was the cause of the most bleeding, so when antegrade cutting, the venous plexus and urethra were cut last, the bleeding time would be less, the amount of blood loss would be less than with retrograde cutting.

Another advantage the study found during antegrade resection: the urethra is more clearly dissected, so after prostatectomy, the remaining urethra will be long, making it easier to suture the bladder neck - urethra with continuous sutures [56]. In 18 cases of retrograde resection in the study, after prostatectomy, 8 cases had continuous bladder - urethral sutures. 10 cases had separate sutures. While if antegrade resection, continuous sutures could be used in 29 cases.

In Van Velthoven's study, when performing continuous anastomosis in 122 cases after endoscopic retrograde prostatectomy, the author found that the urethra was clearly dissected, so the bladder neck could be anastomosis.

- urethral suture with continuous sutures, thereby shortening the anastomosis time. The author's anastomosis time was 35 minutes, and no cases of bladder neck stenosis were recorded after surgery [95].

4.1.2. Discussion on lymph node dissection


In the study, lymph node dissection was performed in 40/49 patients (81.6%). In 2 cases, lymph node dissection was not indicated before surgery, but during surgery, unilateral pelvic lymph nodes were observed (1 patient had right lymph nodes and 1 patient had left lymph nodes), so lymph node dissection was performed.

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