V4-05 ROBOTIC ASSISTED RADICAL PROSTATECTOMY BLADDER NECK RECONSTRUCTION WITH ANTERIOR AND POSTERIOR INTUSSUSCEPTION

Abstract

You have accessJournal of UrologyRobotics – Prostate/Novel Imaging1 Apr 2015V4-05 ROBOTIC ASSISTED RADICAL PROSTATECTOMY BLADDER NECK RECONSTRUCTION WITH ANTERIOR AND POSTERIOR INTUSSUSCEPTION Fernando Bianco, Igor Kislinger, Isabel Lopez, and Marilin Nicholson Fernando BiancoFernando Bianco More articles by this author , Igor KislingerIgor Kislinger More articles by this author , Isabel LopezIsabel Lopez More articles by this author , and Marilin NicholsonMarilin Nicholson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.717AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary continence represents a competitive TRIFECTA goal of Robot Assisted Laparocopic Radical Prostatectomy (RALP). Continence outcomes relate to methodological instruments, source of data (patient v. physcian), definitions, preoperative risk factors and pivotal intraoperative factors driven by execution of surgical technique. In terms of technique, several factors have been evaluated, such as: Preserving the urethral complex (vascular control, urethral length, neurovascular bundles and puboprostatic ligaments) and keeping pudendal nerve branches intact. Improving the management of the bladder neck (preservation, tubularization, reconstruction). Reconstruction of Rhabdophincter of the bladder neck was introduced by Walsh & Marschke (J Urol-2002) as the use of buttressing sutures, aimed to prevent the bladder neck from pulling apart as the bladder fills. These investigators found patient-reported early continence outcomes of: 3-month continence rates of 84%. 7% rate of bladder neck contracture. METHODS We participated in a phase IIIb randomized clinical trial (RCT) employing personal digital device (PDA) that asked continence related questions to patients screened and randomized on a daily basis. Patients were screened the day of catheter removal and provided with the PDA. Those reporting 2 or more pad per day usage were eligible for randomization to study drug vs. control for 12 weeks. This video clip shows our vesico-urethral anastomosis surgical technique with posterior and anterior intussusception of the bladder neck. A wide bladder neck is managed with posterior tennis racquet reconstruction. Otherwise a “parachute” approach is used. RESULTS 96 patients were screened between October 2011 and August 2013. 46 patients did not met criteria for randomization. 40 of these failed because they met continence outcome (0-1 PPD). 4 of the whom 6 failed for other reasons (UTI, other) met continence outcome within 3 months of RALP. 50 patients were randomize. 38 patient met study continence outcome (0-1 PPD). All together 82/96 (85%) within 3 months of RALP CONCLUSIONS Intussusception of the bladder neck is feasible, reproducible and time efficient. The 3 month continence outcomes from patients involved in a RCT was superior by 21% from those observed in of prior RCT that evaluated the reconstruction of the rhabdosphinter (Sutherland et al. J Urol 2011) © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e405 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fernando Bianco More articles by this author Igor Kislinger More articles by this author Isabel Lopez More articles by this author Marilin Nicholson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...