Editorial Comment

Abstract

This is a nice review of the techniques of reconstruction of the posterior periurethral plate and their effect on continence. The clinical series reviewed were of 2 categories: cohort studies with historical controls 1 Rocco F. Carmignani L. Acquati P. et al. Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter. Eur Urol. 2007; 52: 376-383 Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar , 2 Rocco B. Gregori A. Stener S. et al. Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol. 2007; 51: 996-1003 Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar , 3 Tewari A. Jhaveri J. Rao S. et al. Total reconstruction of the vesicourethral junction. BJU Int. 2008; 101: 871-877 Crossref PubMed Scopus (166) Google Scholar , 4 Nguyen M.M. Kamoi K. Stein R.J. et al. Early continence outcomes of posterior musculofascial plate reconstruction during robotic and laparoscopic prostatectomy. BJU Int. 2008; 101: 1135-1139 Crossref PubMed Scopus (96) Google Scholar , 5 Woo J.R. Shikanov S. Zorn K.C. et al. Impact of posterior rhabdosphincter reconstruction during robot-assisted radical prostatectomy: retrospective analysis of time to continence. J Endourol. 2009; 23: 1995-1999 Crossref PubMed Scopus (22) Google Scholar and randomized clinical trials (1 published and 1 as an abstract). As the authors point out, the interpretation of the results is bedeviled by slight differences in technique, length of follow-up, and definitions of continence. The cohort studies showed a 30%-50% improvement of continence from a baseline of 30%-40% without reconstruction to 80%-85% with reconstruction, if using 0-1 pad were considered continent. If the definition of continence were no pads, the continence rates were much lower at about 40%. The 1 published randomized trial was powered to detect a 30% difference in continence rates. It showed that the 0-1 pad continence rate was 74% without reconstruction and 80% with reconstruction. 6 Menon M. Muhletaler F. Campos M. et al. Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. J Urol. 2008; 180: 1018-1023 Abstract Full Text Full Text PDF PubMed Scopus (174) Google Scholar Thus, it did not show a significant difference in continence, primarily because the continence results were close to 80% without any reconstruction. The unpublished abstract showed no difference in continence or EPIC scores with reconstruction, although the overall continence rates were somewhat lower than in the other studies. 7 Sutherland D. Tacoma W.A. Hong M. et al. Posterior rhabdosphincter reconstruction after RARP: results from a phase 2 RCT. J Urol. 2009; 181: 457 Abstract Full Text PDF Google Scholar Posterior Rhabdosphincter Reconstruction During Robot-assisted Radical Prostatectomy: Critical Analysis of Techniques and OutcomesUrologyVol. 76Issue 3PreviewMany centers have recently implemented posterior rhabdosphincter reconstruction (PRR) into robot-assisted radical prostatectomy (RARP) with the objective of earlier continence recovery. We comprehensively review the anatomic and functional changes occurring post prostatectomy along with the reconstructive techniques and published outcomes of PRR. Several case control studies show a better continence rate within the first 3 months, whereas the only randomized control trial presents a conflicting conclusion. Full-Text PDF ReplyUrologyVol. 76Issue 3PreviewAlthough radical prostatectomy (RP) delivers excellent long-term survival outcomes, postoperative incontinence remains a potential complication. Increasing age, shorter pre- and postoperative membranous urethral length, anastomotic strictures, obesity, low surgeon volume, variations in surgical technique, and previous prostate surgery have been reported as negative risk factors for delayed continence recovery after radical prostatectomy. Over the past decade, with increased use of robotic and laparoscopic technology, coupled with cadaveric and video urodynamic studies, there has been an increased interest in elucidating the functional anatomy and physiology of the male continence mechanism. Full-Text PDF