V4-01 OUR SUCCESSFUL EXPERIENCE UTILIZING POSTERIOR RHABDOSPHINCTER RECONSTRUCTION DURING ROBOTIC PROSTATECTOMY

Abstract

You have accessJournal of UrologyRobotics – Prostate/Novel Imaging1 Apr 2016V4-01 OUR SUCCESSFUL EXPERIENCE UTILIZING POSTERIOR RHABDOSPHINCTER RECONSTRUCTION DURING ROBOTIC PROSTATECTOMY Mona Yezdani, Ben Katz, Sylvia Yu, daniel maas, Alexa Lee, Alice McGill, Kelly Monahan, and David Lee Mona YezdaniMona Yezdani More articles by this author , Ben KatzBen Katz More articles by this author , Sylvia YuSylvia Yu More articles by this author , daniel maasdaniel maas More articles by this author , Alexa LeeAlexa Lee More articles by this author , Alice McGillAlice McGill More articles by this author , Kelly MonahanKelly Monahan More articles by this author , and David LeeDavid Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1805AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There have been numerous techniques employed to maximize continence after robot-assisted radical prostatectomy (RARP), including posterior rhabdosphincter reconstruction (PRR). However optimum PRR stitch location remains relatively undefined. We aimed to apply our modified posterior reconstruction of the rhabdosphincter (M-PRR) in 570 consecutive patients undergoing RARP for adenocarcinoma of the prostate. In this video, we demonstrate our technique for M-PRR performed during RARP. METHODS This patient had his prostate removed in the standard fashion as previously described. The M-PRR uses the posterior layer of whitish connective tissue that may by reproducibly seen on dissection after division of the posterior bladder wall during the bladder neck transection, and prior to identification of the vasa deferentia and seminal vesicles. This retrotrigonal layer anchor tissue is in clear distinction to Denonvilliers’ fascia, which should not be encountered until after division of the vasa deferentia and seminal vesicles. RESULTS Patient and intraoperative variables were similar between the PRR and M-PRR groups, and there were no surgical technique differences between the two groups. Weeks to 0 PPD was statistically different at the three month interval (p=0.0466). Mean weeks to 1 PPD was 13.1 weeks in the control group and 11.76 weeks in the intervention arm. There were no significant differences in post-operative AUASS or EPIC scores between groups. Console time in this case was 112 minutes. Estimated blood loss was 100 ml. Hospital stay was 26 hours. The foley catheter was removed 6 days after surgery. By also utilizing preoperative kegel exercises, our patient was continent on urethral catheter removal. CONCLUSIONS Retrotrigonal stitch placement during PRR resulted in statistically significant improvement in time to reach total continence post-operatively. Our M-PRR robotic approach for radical prostatectomy is safe and effective. This study is one of the largest to date examining the effect of varied stitch location at the time of RARP on continence outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e516 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Mona Yezdani More articles by this author Ben Katz More articles by this author Sylvia Yu More articles by this author daniel maas More articles by this author Alexa Lee More articles by this author Alice McGill More articles by this author Kelly Monahan More articles by this author David Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...