Abstract
Robot-assisted radical prostatectomy (RARP) has largely replaced open radical prostatectomy as the standard surgical treatment for prostate cancer. However, postoperative urinary incontinence still persists and has a significant impact on quality of life. We report the superior results of the detrusorrhaphy technique during RARP that helps achieve early continence. Our prospective study involved 95 consecutive patients who underwent RARP between March 2015 and May 2017; fifty patients underwent RARP using the new detrusorrhaphy technique (group 1) and 45 underwent standard RARP (group 2). The postoperative oncological and functional outcomes were compared between the two groups. The postoperative continence was assessed at 0 day, 1 week, 4 weeks, 8–12 weeks, and 6 months after catheter removal. Continence was defined as the use of no pad over a 24 h period. Mean operative time in groups 1 and 2 were 250 and 220 min, respectively. Intraoperative complications were not encountered in any patient. The continence rates after catheter removal in groups 1 and 2 were 68% and 0% at 0 day, 78% and 17.8% at 1 week, 86% and 64.4% at 4 weeks, 92% and 73.3% at 8–12 weeks, and 100% and 91.1% at 6 months, respectively. In the multivariate analysis, the nerve sparing technique, D'Amico risk groups, and prostate volume were involved in the early recovery of urinary continence. The detrusorrhaphy technique is simple, safe, and feasible, which helped achieve earlier continence. It showed significantly better outcomes than those achieved with the standard RARP technique in terms of urinary incontinence. Nevertheless, our findings need to be validated in further studies.
Highlights
Over the last decade, robot-assisted radical prostatectomy (RARP) has been increasingly adopted as a surgical treatment option for patients with localized prostate cancer [1, 2]
Posttreatment quality of life (QoL) of patients with prostate cancer with respect to the recovery of urinary and sexual function has been an important area of study over the last decade
We identified and implemented key operative techniques during RARP that are essential to achieve early continence in a step-wise manner
Summary
Robot-assisted radical prostatectomy (RARP) has been increasingly adopted as a surgical treatment option for patients with localized prostate cancer [1, 2]. The incidence of incontinence at 12 months after surgery is estimated to range from 69% to 96% and can markedly impair the QoL of patients, of those who are younger and more active [6]. This long recovery period is troublesome and psychologically distressful for patients. It has financial implications because of the need for medications and additional surgical procedures, such as the placement of a sling, urethral bulking agents, or an artificial urinary sphincter [7]
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