Abstract
BackgroundTo evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP).MethodsTwo-hundred ninety-two patients who previously underwent radical prostatectomy were retrospectively selected for a case-control study, excluding those with anastomotic strictures and significant perioperative complications and re-called for a medical follow-up visit after their consent to participate the study. They were divided in 3 different groups according to the surgical technique previously received: radical retropubic prostatectomy (RRP) combined with bladder neck preservation (BNP), RARP with bladder neck resection, and RARP combined with BNP and posterior musculofascial reconstruction (PRec).Functional and oncologic outcomes evaluation were integrated by a questionnaire on urinary continence status, abdominal ultrasound scan, uroflowmetry and post-void urine volume measurement.Urinary continence definition included the terms “no pad” or “safety pad”.ResultsTwo hundred thirty-two patients responded to the phone call interview and were enrolled in the study. They presented comparable age, prostate volume and BMI. Differences in comorbidities, ASA score and medications, did not influence the postoperative functional results, focused on continence outcome.Early urinary continence was achieved in 49.38% and 24.73% of patients who previously underwent RARP + BNP + PRec and simple RARP respectively (p = 0.000)as well as late 12-months urinary continence was obtained in 92.59% and 79.56% of patients.(p = 0.01). Late urinary continence in the RRP + BNP group was comparable to the result obtained in the simple RARP group. The potential effects of nerve sparing technique on urinary continence have not been evaluated.ConclusionsThe combined technique of RARP + BNP + PRec seems to be effective to determine early and long term significant effects on urinary continence of patients with comparable body mass index, age and prostate volume. No statistically significant differences were found between the simple RARP and the RRP + BNP groups.
Highlights
To evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP)
The third group included patients who previously underwent RARP with bladder neck preservation (BNP), posterior urethrovesical reconstruction (PRrec) according to Rocco modified by Coelho and urethrovesical anastomosis according to Van Velthoven [12,13,14]
The median age and the body mass index (BMI) of patients operated by retropubic prostatectomy (RRP) procedure were 65.7 ± 6.5 years and 27.14 ± 2.40 respectively while that of patients operated by RARP were 69 ± 6.91 years and 26.31 ± 3.19 respectively. (p = 0.4)
Summary
To evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP). Postoperative urinary continence recovery after laparoscopic robotic assisted radical prostatectomy (RARP) is related to multiple factors such as patient and disease characteristics, surgical skill and experience and techniques used for surgical demolition and reconstruction. Better early and long term continence rates were found in patients who underwent bladder neck preservation (BNP) and RARP in comparison to those treated by bladder neck resection and reconstruction as previously reported by other authors [7, 8]. Ficarra et al concluded that the prevalence of urinary incontinence after RARP is mainly influenced by several factors such as preoperative patient characteristics, surgeon experience but not adjunctive reconstruction techniques. Posterior musculofascial reconstruction seems to offer a slight advantage in terms early continence recovery in comparison with the “noreconstruction” group. [1]
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