V6-12 VERY EARLY RECOVERY OF URINARY CONTINENCE AFTER ROBOTIC RADICAL PROSTATECTOMY: INITIAL REPORT OF HAMMOCK STITCH TECHNIQUE

Abstract

You have accessJournal of UrologyNovel Imaging/Prostate Oncology/Robotics1 Apr 2014V6-12 VERY EARLY RECOVERY OF URINARY CONTINENCE AFTER ROBOTIC RADICAL PROSTATECTOMY: INITIAL REPORT OF HAMMOCK STITCH TECHNIQUE Jayram Krishnan, Vishnu Ganeshan, Riccardo Autorino, Idir Ouzaid, and Georges-Pascal Haber Jayram KrishnanJayram Krishnan More articles by this author , Vishnu GaneshanVishnu Ganeshan More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Idir OuzaidIdir Ouzaid More articles by this author , and Georges-Pascal HaberGeorges-Pascal Haber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1875AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Time to recovery of continence after robotic-assisted radical prostatectomy (RARP) remains the most bothersome complaint by patients. Many techniques have been described to shorten recovery to continence, none have thus far been validated. We propose a technique that creates a “hammock” around the urethra at the time of vesico-urethral anastomosis. We believe that this may lead to very early (<30 days) recovery of continence. We report our initial experience of 10 patients. METHODS From August 2013 to October 2013, we performed RARP on 10 patients with organ confined prostate cancer. These patients were randomly selected to undergo the hammock stitch. All patients underwent bilateral interfascial nerve dissections. The pubococcygeus muscle is identified and a bolstered suture is placed prior to initiation of vesicourethral anastomosis and completed after with visual confirmation of urethral “lifting”. Two Hem-o-lock clips are placed on each side of the 0-Vicryl on a CT-1 needle (6 inches) as a bolster. We retrospectively analyzed continence at three days after catheter removal and at one month. Urinary continence was assessed using the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) and continence was defined as the use of 1 safety pad or less as needed. RESULTS Nine of the ten (90%) of the patients who underwent the hammock stitch had immediate return of continence at the time of catheter removal. At one month follow up, all nine patients who were continent remained continent and the one additional patient also became continent. No patients have experienced any episodes of urinary retention. CONCLUSIONS Techniques to improve very early (<30 days) continence after RARP remain controversial. We describe a new technique that may demonstrate rapid recovery of continence but long-term results are needed along with larger validated randomized controlled trials. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e682 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jayram Krishnan More articles by this author Vishnu Ganeshan More articles by this author Riccardo Autorino More articles by this author Idir Ouzaid More articles by this author Georges-Pascal Haber More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...