V6-13 ROBOTIC-ASSISTED LAPAROSCOPIC SIMPLE PROSTATECTOMY: TECHNIQUE AND OUTCOMES

Abstract

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 e 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 longterm results are needed along with larger validated randomized controlled trials.