Three-Layer Two-Step Posterior Reconstruction Using Peritoneum During Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence: A Prospective Comparative Study

Abstract

We present our experience with a novel three-layer two-step posterior reconstruction (PR) technique using peritoneum during robot-assisted radical prostatectomy (RARP) to improve recovery of postoperative urinary continence. Forty-eight patients with localized prostate cancer were enrolled in this study and were divided randomly into two groups, which were treated by the standard PR technique (standard PR group; n = 24) or the three-layer PR technique using peritoneum (three-layer PR group; n = 24) during RARP. We prospectively analyzed the continence rate by the 1-hour pad test. All patients underwent urethrocystography at 6 days postoperatively to evaluate position of vesicourethral junction. Pelvic MRI was also performed at 6 months postoperatively for anatomical evaluation. Four weeks after RARP, the urinary continence rate was significantly higher in the three-layer PR group (57%) than in the standard PR group (26%, p = 0.036). Urethrocystography demonstrated that the postoperative craniocaudal distance from the symphysis pubis to the level of the vesicourethral junction was significantly shorter in the three-layer PR group than in the standard PR group (p < 0.01), suggesting that there was less tension on the vesicourethral anastomosis after three-layer PR. MRI confirmed that three-layer PR provided firmer reinforcement of the structures, supporting the posterior aspect of the urethral sphincter complex. This prospective comparative study might suggest that three-layer two-step PR using peritoneum during RARP is a simple and feasible method seeming to improve early recovery of postoperative continence compared with standard two-step PR, although larger multicenter randomized controlled trials will be needed.