V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY

Abstract

You have accessJournal of UrologyProstate and Renal Oncology1 Apr 2017V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY Yuji MAEDA, Toshimitsu MISAKI, Osamu UEKI, Tetsuyuki KUROKAWA, Yukinosuke OSHINOYA, Ken-ichi NAGANO, and Haruo HISAZUMI Yuji MAEDAYuji MAEDA More articles by this author , Toshimitsu MISAKIToshimitsu MISAKI More articles by this author , Osamu UEKIOsamu UEKI More articles by this author , Tetsuyuki KUROKAWATetsuyuki KUROKAWA More articles by this author , Yukinosuke OSHINOYAYukinosuke OSHINOYA More articles by this author , Ken-ichi NAGANOKen-ichi NAGANO More articles by this author , and Haruo HISAZUMIHaruo HISAZUMI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2343AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary incontinence after radical prostatectomy for localized prostate cancer strongly influences patients' quality of life. Postoperative urinary continence tends to recover early since robot-assisted radical prostatectomy has been introduced, but the results of the procedure are still not satisfactory. Various modifications of pelvic floor reconstruction during radical prostatectomy, including pelvic floor structure preservation with nerve-sparing technique, have been reported for the purpose of early recovery of urinary continence. However, wide excision without nerve-sparing is necessary depending on a case, such as high risk stratified group, while it may cause poor recovery of urinary continence. We modified the previously reported Milan vas deferens sling technique by adding reinforcement of under-anastomosis layers during robot-assisted radical prostatectomy, which significantly accelerates early recovery of postoperative urinary continence in cases without nerve-sparing. METHODS Modified sling technique; Sling suture was made from autologous vas deferens. After putting the vas deferens sling on the sub-urethral perirectal fat, three independent layers were constructed below the urethrovesical anastomosis, and a single anterior layer was made. Then, both ends of the sling were transfixed to Cooper ligaments bilaterally with adequate sling suspension. Between October 2015 and July 2016, consecutive 35 patients who underwent robot-assisted radical prostatectomy without nerve-sparing at our institution with a single surgeon were investigated. The patients were classified into two groups: 15 using the sling technique (sling group) and 20 using the non-sling technique with simple posterior reconstruction (nonsling group). Urinary continence defined as 0 or safety 1 pad use daily was compared between the groups. RESULTS Patients' characteristics were comparable between the groups. Urinary continence rate significantly improved in the sling group (60.0%, p=0.0365) as compared to the nonsling group (25.0%) at 1 month despite no difference at 3 months (86.7% in the sling group vs. 65.0% in the nonsling group, p=0.1467) postoperatively. Postoperative complications related to sling procedure were not detected. CONCLUSIONS Despite a small sample size in the single-institution study, this sling technique may improve early urinary continence recovery after robot-assisted radical prostatectomy even without nerve-sparing. A larger study is needed to confirm its efficacy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e908-e909 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yuji MAEDA More articles by this author Toshimitsu MISAKI More articles by this author Osamu UEKI More articles by this author Tetsuyuki KUROKAWA More articles by this author Yukinosuke OSHINOYA More articles by this author Ken-ichi NAGANO More articles by this author Haruo HISAZUMI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...