Preservation of Pubovesical Fascia During Robotic Radical Prostatectomy

Abstract

Introduction: One potential complication of radical prostatectomy is urinary incontinence. The acceptance of robotic surgery for prostate cancer has been accompanied by an evolution of robotic techniques. Recently, the importance of anatomic structures supporting the urethra and bladder neck in maintaining continence has been appreciated. The purpose of this video is to demonstrate a novel technique designed to improve continence by preserving the anterior support and the pubovesical fascia during robotic prostatectomy. Materials and Methods: The pubovesical fascia sparing approach involves a more medial incision on the endopelvic fascia when compared to the traditional method. This spares the puboprostatic ligaments, pubovesical fascia, and the arcus tendineus support structures. An automatic stapling device used for dorsal vein transection also serves to secure the urethra anteriorly against the pubic symphysis. Results: This video demonstrates a novel technique designed to preserve the support of the urethra and bladder neck. A stapling device is used to anchor the urethra to the puboprostatic ligaments, which are, in turn, left with a broad attachment to the arcus tendineus levator ani and the pubovesical fascia. This maintains the natural support of the urethra and bladder neck. The patient demonstrated in this video had total continence with no leakage at 3 weeks follow-up. Conclusions: Preservation of urethral and bladder neck support may contribute to post-prostatectomy continence. Although prospective, randomized trials will be required to validate this technique, it has the potential to improve the patient's quality of life after prostatectomy. No competing financial interests exist. Runtime of video: 4 mins 42 secs