Effect of Reconstructive Techniques on Continence in Robot-Assisted Laparoscopic Prostatectomy: Novel Combination of Long Urethral Stump and Anterior Suspension Suture.

Ibrahim Karabulut,Erkan Cem Celik,Senol Adanur,Onur Ceylan,Ali Haydar Yilmaz,Ozkan Polat,Fatih Ozkaya,Fatih Kursat Yilmazel

doi:10.5152/eurasianjmed.2020.19234

Ibrahim Karabulut, Erkan Cem Celik + Show 6 more

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https://doi.org/10.5152/eurasianjmed.2020.19234

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To investigate the effects of the novel combination of a long urethral stump and anterior suspension suture in patients who underwent Robot-Assisted Laparoscopic Prostatectomy (RALP) for localized prostate cancer. Of the 40 participating patients, 20 did not undergo any reconstructive technique, whereas the remaining 20 patients underwent reconstructive technique that included the combination of long urethral stump and anterior suspension suture. Body mass index (BMI) (kg/m2), age, preoperative prostate-specific antigen (PSA) levels, prostate volume, Gleason score, D'Amico risk class, clinical stage, operation type and the application of either perioperative or postoperative reconstructive techniques, and the duration of catheterization were the parameters investigated. Continence rate was measured in the 3rd, 6th, and 12th month after the removal of the catheter. Both techniques were compared statistically. The control and reconstructive groups each comprised 20 patients. Between the groups, no statistically significant differences were observed in age, BMI, American Society of Anesthesiologists class, risk group, prostate weight, perioperative PSA, duration of surgery, duration of hospitalization, surgical margins, and the total amount of bleeding (p>0.05). Continence rate was significantly higher in the reconstructive group in the 3rd and 6th months compared with the control group (p<0.05). The combination of anterior suspension suture and long urethral stump contributed to early improvement in the continence rates.

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Radical prostatectomy is the main therapeutic technique for localized prostate cancer (LPCa) in patients who have a life expectancy of over 10 years [1, 2]
No statistically significant differences were observed in age, Body mass index (BMI), American Society of Anesthesiologists class, risk group, prostate weight, perioperative prostate-specific antigen (PSA), duration of surgery, duration of hospitalization, surgical margins, and the total amount of bleeding (p>0.05)
Continence rate was significantly higher in the reconstructive group in the 3rd and 6th months compared with the control group (p

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Introduction

Radical prostatectomy is the main therapeutic technique for localized prostate cancer (LPCa) in patients who have a life expectancy of over 10 years [1, 2]. The primary goal of this intervention, along with controlling the disease, is to maintain quality of life by preserving both erectile function and continence rate, defined by Salomon et al [3] as the trifecta. Several patients complain of urinary incontinence and sexual function disorders regardless of the whether the cancer is under control. The robotic arms of the technology along with the utilization of optic magnification, 3D visualization, and seven degrees of mobility enable the preservation of anatomic regions related to continence and erectile functions and decrease the rate of perioperative complications. A recently introduced reconstructive technique in RALP reported significant improvements in continence rates [8]

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