Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-11 URETHRAL FIXATION: A NOVEL TECHNIQUE TO IMPROVE EARLY URINARY CONTINENCE RECOVERY AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Vincenzo Ficarra, Marta Rossanese, Alessandro Crestani, Giuseppe Alario, Giuseppe Mucciardi, Antonino Isgrò, and Gianluca Giannarini Vincenzo FicarraVincenzo Ficarra More articles by this author , Marta RossaneseMarta Rossanese More articles by this author , Alessandro CrestaniAlessandro Crestani More articles by this author , Giuseppe AlarioGiuseppe Alario More articles by this author , Giuseppe MucciardiGiuseppe Mucciardi More articles by this author , Antonino IsgròAntonino Isgrò More articles by this author , and Gianluca GiannariniGianluca Giannarini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We have previously proposed a novel technique based on the concept of fixing the urethral stump laterally and posteriorly instead of supporting it, and have shown that urethral fixation was associated with a significant improvement in early urinary continence recovery compared to standard vesico-urethral anastomosis (VUA) after retropubic radical prostatectomy. In this study, we compared early urinary continence recovery and complications in patients undergoing robot-assisted radical prostatectomy (RARP) with urethral fixation versus standard VUA. METHODS: A prospective single-center, single-surgeon cohort of 70 consecutive patients undergoing RARP between January and December 2019 was analyzed. A study group of 35 patients operated on with the urethral fixation technique was compared with a control group of 35 patients receiving standard VUA. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of levator ani muscle postero-laterally, so as to avoid urethral retraction or deviation, and maintain the urethral sphincter in its natural position in the pelvic floor. The same posterior musculofascial reconstruction incorporating the VUA was performed in both groups. Urinary continence recovery, defined as 0-1 daily safety pads, within 3 months after catheter removal, and perioperative complications were compared between the two groups. RESULTS: The two groups were comparable with regard to all demographic, clinical and pathological variables. Recovery of urinary continence at 3 months after catheter removal was reported by 34 (97.1%) patients in the study, and 28 (80%) patients in the control group (p=0.02). Patients in the study group reported significantly higher rates of urinary continence even at 1 week and 1 month after catheter removal compared to the control group (68.6% vs 45.7%, p=0.04, and 80% vs 54.3%, p=0.04, respectively). No intraoperative complications were observed in either group. Ninety-day postoperative complications were observed in 1 (2.9%) patient in the study, and in 4 (11.4%) in the control group (p=0.3). CONCLUSIONS: We observed a significant improvement in early urinary continence recovery with no increase in perioperative complications using the novel urethral fixation technique versus standard VUA during RARP. These preliminary data seem to corroborate the hypothesis that maintaining the urethral stump in its correct position in the pelvic floor may improve the probability of an earlier urinary continence recovery after RARP. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e268-e268 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vincenzo Ficarra More articles by this author Marta Rossanese More articles by this author Alessandro Crestani More articles by this author Giuseppe Alario More articles by this author Giuseppe Mucciardi More articles by this author Antonino Isgrò More articles by this author Gianluca Giannarini More articles by this author Expand All Advertisement Loading ...

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