V07-11 VARYING APPROACHES TO THE PROSTATE APEX TO OPTIMIZE URETHRAL STABILITY AND EARLY CONTINENCE RECOVERY AFTER ROBOTIC RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyCME1 May 2022V07-11 VARYING APPROACHES TO THE PROSTATE APEX TO OPTIMIZE URETHRAL STABILITY AND EARLY CONTINENCE RECOVERY AFTER ROBOTIC RADICAL PROSTATECTOMY Claudia Mercader, J. Francisco Lopez, Nitesh Ranasinha, Mutie Raslan, Ruth McPherson, Richard Bell, Tom Leslie, Richard Bryant, Freddie Hamdy, Alastair, and Lamb Claudia MercaderClaudia Mercader More articles by this author , J. Francisco LopezJ. Francisco Lopez More articles by this author , Nitesh RanasinhaNitesh Ranasinha More articles by this author , Mutie RaslanMutie Raslan More articles by this author , Ruth McPhersonRuth McPherson More articles by this author , Richard BellRichard Bell More articles by this author , Tom LeslieTom Leslie More articles by this author , Richard BryantRichard Bryant More articles by this author , Freddie HamdyFreddie Hamdy More articles by this author , AlastairAlastair More articles by this author , and Lamb Lamb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pre-operative membranous urethral length (MUL) is a well-known non-modifiable factor predicting continence recovery after surgery, but there are also refinements in surgical techniques to optimize early continence after robotic-assisted radical prostatectomy (RARP). These include modifications in apical dissection to maximize urethral length and maximizing preservation of periurethral structures responsible for urethral stability. METHODS: We reviewed data of patients who underwent RARP between January 2018 and October 2021. MUL, anterior Retzius sparing approach and continence (pads) 6-weeks after surgery were recorded. We present five surgical scenarios often encountered while planning the apical dissection in RARP: non urethral preservation, half-supported full or non-full-length urethral preservation, full length unstable urethra, full length stable urethra and full-length stable preservation in the context of unusual apical anatomy. All patients consented to data storage and video-recording. RESULTS: Following on from the video footage of this surgical scenarios, we present 342 patients for quantitative analysis. Those patients with a MUL >10 mm had 9.7 increased chance of being completely dry at 6-weeks (OR 9.7 CI 95% 2.2–42.1). Those patients with a MUL >10 mm who also had anterior Retzius sparing their chances increased by a further 4.3 (OR 4.3 IC 95% 2.1–8.8). CONCLUSIONS: The apical approach in a RARP can be planned and tailored for each case depending on both patients and tumour anatomy to optimize urethral stability post-RARP and early continence recovery. We advocate both preservation of urethral length and those structures responsible for urethral stability. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e662 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claudia Mercader More articles by this author J. Francisco Lopez More articles by this author Nitesh Ranasinha More articles by this author Mutie Raslan More articles by this author Ruth McPherson More articles by this author Richard Bell More articles by this author Tom Leslie More articles by this author Richard Bryant More articles by this author Freddie Hamdy More articles by this author Alastair More articles by this author Lamb More articles by this author Expand All Advertisement PDF downloadLoading ...