Early Urinary Continence Research Articles

Preliminary evidence of the impact of social distancing on psychological status and functional outcomes of patients who underwent robot-assisted radical prostatectomy.

IntroductionSocial distancing is considered the best strategy to prevent the spread of COVID-19 (COronaVIrus Disease 19). We aimed to analyse the effect of ‘social distancing’ on the emotional state, post-operative pain and functional outcomes of patients undergoing robot-assisted radical prostatectomy (RARP).Material and methodsWe retrospectively reviewed data of male patients who underwent RARP within the study period (from March to April 2019 [Group A = 27 patients] and from March to April 2020 [Group B = 29 patients]). Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) results were collected on the first day of hospitalization. Post-operative pain was assessed using the numerical rating scale (NRS) and visual analogic scale (VAS) after surgery in the post-anesthesia care unit (PACU) and at 24 hours. Functional outcomes were evaluated at the one-month follow-up. Demographic, pathological and peri-operative data were collected for all patients.ResultsThere were no significant differences in demographics and pathological characteristics amongst the groups. We observed that patients in Group A had a statistically lower value on the PHQ-9 and GAD-7 questionnaires than patients of Group B. Moreover, Group A showed statistically significant better post-operative pain control in PACU and at 24 hours. At one-month follow-up, patients in Group B required more diapers for incontinence than Group A, showing poor early continence. Patients in Group A showed interest in sexual rehabilitation after 1.11 ±.320 months while patients in Group B after 2.59 ±.712 months (p <.001). Moreover, 17 out of 29 patients (58.62%) in Group B were referred to an andrologist, compared to 100% of patients from Group A (p = 0.0006).ConclusionsSocial distancing during the COVID-19 pandemic is associated with a poor pre-operative emotional state, as well as influencing post-operative pain, early urinary continence and desire for sexual rehabilitation.

SC221 - Impact of early dorsal venous complex ligation on early urinary continence recovery after robot-assisted radical prostatectomy: Results of a pre-specified interim analysis of a randomized clinical trial

SC221 - Impact of early dorsal venous complex ligation on early urinary continence recovery after robot-assisted radical prostatectomy: Results of a pre-specified interim analysis of a randomized clinical trial

Improvement in early urinary continence recovery after robotic-assisted radical prostatectomy based on postoperative pelvic anatomic features: a retrospective review

BackgroundWe investigated the impact of postoperative membranous urethral length and other anatomic characteristics of the pelvic floor shape as measured by magnetic resonance imaging on the improvement in continence following robotic-assisted radical prostatectomy.MethodsWe retrospectively reviewed data from 73 patients who underwent postoperative prostate magnetic resonance imaging following robotic-assisted radical prostatectomy between 2013 and 2018. Patient demographics; pre-, peri-, and post-operative parameters; and pelvic anatomic features on magnetic resonance imaging were reviewed. Patients who used no urinary incontinence pads or pads for protection were considered to have achieved complete continence.ResultsUrinary continence was restored in 27.4, 53.4, 68.5, and 84.9% of patients at 1, 3, 6, and 12 months after robotic-assisted radical prostatectomy, respectively. When patients were divided into early and late continence groups based on urinary continence at 3 months after robotic-assisted radical prostatectomy, no significantly different clinical characteristics or surgical outcomes were found. However, the mean membranous urethral length (18.5 mm for the early continence group vs. 16.9 mm for the late continence group), levator muscle width (7.1 vs. 6.5 mm, respectively), and bladder neck width on the trigone side (7.2 mm vs. 5.4 mm, respectively) were significantly different between groups (all p < 0.05). Multivariate logistic regression analysis showed that membranous urethral length (odds ratio, 1.227; 95% confidence interval, 1.011–1.489; p = 0.038) and bladder neck width (odds ratio, 1.585; 95% confidence interval, 1.050–2.393; p = 0.028) were associated with the period of early urinary continence.ConclusionsPostoperative membranous urethral length and bladder neck width were significantly associated with early urinary continence recovery after robotic-assisted radical prostatectomy. It is highly recommended that surgeons focus on preserving the membranous urethral length and increasing the bladder neck width on the trigone side during surgery to achieve optimal continence outcomes after robotic-assisted radical prostatectomy.

PE39 - Developing a nomogram for prediction of early urinary continence after robotic prostatectomy incorporating patient, MRI and operative factors

PE39 - Developing a nomogram for prediction of early urinary continence after robotic prostatectomy incorporating patient, MRI and operative factors

Early Urinary Continence After Radical Prostatectomy: Surgical Procedure and Anatomic Landmarks

Early Urinary Continence After Radical Prostatectomy: Surgical Procedure and Anatomic Landmarks

PT280 - Impact of early dorsal venous complex ligation on early urinary continence recovery after robot-assisted radical prostatectomy: Results of a pre-specified interim analysis of a randomized clinical trial

PT280 - Impact of early dorsal venous complex ligation on early urinary continence recovery after robot-assisted radical prostatectomy: Results of a pre-specified interim analysis of a randomized clinical trial

Does Type 2 Diabetes Mellitus Have an Impact on Postoperative Early, Mid-Term and Late-Term Urinary Continence After Robot-Assisted Radical Prostatectomy?

We evaluated the effect of diabetes mellitus (DM) on urinary continence after robotic radical prostatectomy (RARP). Overall, 99 patients with DM and 213 patients without DM who underwent RARP with at least 2-year follow-up were included. The preoperative prostate biopsy Gleason scores and clinical stages of the groups were similar. The patients who were dry or used one safety pad per day were regarded as continent. Early (0-3 months), mid-term (4-12 months), and late-term (>12 months) continence rates were evaluated. In diabetic and nondiabetic groups, mean age was 63.3 ± 6.5 and 61.3 ± 6.8 years, respectively (p = 0.015). On the day of the removal of the urethral catheter, 61.6% (n = 61) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At third-month follow-up, 80.8% (n = 80) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At sixth-month follow-up, 89.9% (n = 89) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At first-year follow-up, 93.9% (n = 93) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.001). At 18th-month follow-up, 96.0% (n = 95) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.013). At second-year follow-up, 98.0% (n = 97) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.115). Multivariate analysis showed that age and body mass index had no impact on urinary continence (p > 0.05). Presence of diabetes (p = 0.008) and duration (≥5 years) of diabetes (p = 0.004) were independent factors that had a significant negative impact on urinary continence. Diabetes seems to be a significant disadvantage in gaining urinary continence compared with nondiabetic patients particularly in the first 18 months after RARP. Diabetic patients should be informed about possible late recovery of postoperative urinary continence compared with nondiabetic patients after RARP.

Objective assessment of early urinary continence by analysis and visualisation of intraoperative variables of radical robotic prostatectomies with a video editor

IntroductionUI after RP is a factor that has a major impact on patients’ quality of life and the associated healthcare costs. The definition of UI is very variable in the literature. Similarly, a great many predictors have been studied that affect recovery of continence after surgery, the most important of which are intraoperative. Material and methodsA retrospective and observational study performed between September 2008 and March 2015. We studied intraoperative factors through visualisation using a video editor of 148 patients who underwent robot-assisted radical prostatectomy, together with other perioperative factors associated with continence, and described in the literature. We assessed continence through ICQ questionnaires, urinary loss calculated by pad count, and clinical interview in the first, third, sixth month and at one year after surgery. We defined continence as not having to use a pad or using a pad for protection socially, or an ICQ≤7. We used binary and lineal logistic regression analysis to study the relationship between the intraoperative and perioperative variables on urinary continence measured at the first, third, sixth month and one year after the operation, and on continence stability. ResultsIn our study, 72.9% of the patients were continent at one year after surgery with a mean continence stabilisation time at 4.3 months. In our lineal logistic regression analyses we found no significant relationship with the continence variable analysed during the first year.In the lineal logistic regression analysis we found that tension-free sutures had a direct positive effect (p≤0.05) on the stability time of continence, as well as the urinary losses measured in the first month after surgery. ConclusionIn conclusion, we found in our study that the tension-free sutures were able to help towards early stability of continence. We found no other intraoperative predictors that influenced urinary continence. The urinary losses measured in the first month related to early recovery of continence.

Can Robot-assisted Radical Prostatectomy Improve Functional Outcomes Compared to Laparoscopic Radical Prostatectomy? Experience at a Laparoscopic Center

Purpose: This study compared the perioperative parameters and early functional outcomes between robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) at a urological laparoscopic center. Materials and Methods: Between January 2006 and May 2017, 242 patients underwent endoscopic radical prostatectomy (LRP for 208 cases; RARP for 34 cases). Patients who were followed up &gt; 12 months were included in the study. Propensity score-matched groups of patients who underwent LRP or RARP were created based on age, body mass index, history of diabetes mellitus, history of smoking, preoperative prostate-specific antigen level, clinical T status, risk group classification, American Society of Anesthesiologists score, and whether the nerve-sparing technique was performed. Results: There were no significant differences in the blood transfusion rate, surgical margin status, length of stay, catheterization time, or days to oral intake for both procedures. Although RARP is more time-consuming, it provided significant benefits regarding the yield of dissected lymph nodes (19 vs. 9; P &lt; 0.001) and early urinary continence recovery (i.e., continence rates after 1 month [56.2% vs. 21.9%; P = 0.006] and after 3 months [84.4% vs. 53.1%; P = 0.001]). No difference was observed for early complications, although the RARP group had more late complications. Conclusion: Our experience indicated that RARP could provide less blood loss and faster recovery of urinary continence and yield more dissected lymph nodes compared to LRP. Further studies are needed to determine whether the long-term clinical, functional, and oncological outcomes are superior.

Does Presence of a Median Lobe Affect Perioperative Complications, Oncological Outcomes and Urinary Continence Following Robotic-assisted Radical Prostatectomy?

To evaluate of the presence of a median lobe(ML) affect perioperative complications, positive surgical margins(PSM), biochemical recurrence(BCR) and urinary continence(UC) following robotic-assisted radical prostatectomy(RARP). Data of 924 consecutive patients who underwent RARP for prostate cancer (PCa) and who have at least 1-year follow-up were evaluated retrospectively. All patients were divided into two groups: Group 1(n=252) included patients with ML and Group 2 (n=672) included patients without ML. The primary endpoint of this study was to compare complication rates between two groups. The secondary endpoints were to compare PSM, BCR and UC rates. Both groups were statistically similar in terms of demographics and variables about PCa. Mean prostate volume was higher in Group 1 vs. Group 2 (69± 31 vs. 56±23 mL, p<.001). Total operative time was longer in Group 1 vs. Group 2 (144±38 vs. 136±44 min, p=.01). Biochemical recurrence, PSM, perioperative and postoperative complication rates of our population were 13.6%, 14.9%, 1.7% and 8.7%, respectively. There were no statistical differences in terms of perioperative complication, PSM and BCR rates between the groups(p>0.05). At the first month after RARP, total continence rate was statistically significant lower in Group 1 vs. Group 2 (49.2% and 56.5%, p=.03), respectively. However, there were no significant differences in terms of continence rates at 3rd month, 6th month and 1st-year follow-up. Due to our experience, the presence of ML does not seem to affect perioperative complication, intraoperative blood loss, PSM and BCR following RARP. However, the presence of ML seems to be a disadvantage in gaining early UC following RARP.

Bidirectional Barbed Only vs Poliglecaprone Suture with Rhabdosphincter Reconstruction for Urethrovesical Anastomosis During Robotic Radical Prostatectomy: Does It Make Any Difference?

We investigated the use of bidirectional barbed suture only vs poliglecaprone suture with posterior rhabdosphincter reconstruction for urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP) on cystographic leakage, duration of catheterization, and early urinary continence. Bidirectional double-armed barbed suture only was used for UVA (n = 50) in Group 1. Two 3/0 poliglecaprone 25 sutures were tied to each other to form a double-armed suture used for UVA with posterior rhabdosphincter reconstruction in Group 2 (n = 50). Groups were similar regarding patient demographics and operative parameters. Groups were compared regarding leakage on cystography, duration of urethral catheterization after RARP, immediate urinary continence (continence at the time of urethral catheter removal), and continence rates at first and third-month follow-up. Leakage on cystography was detected in 4 (8%) and 10 (20%) of the patients in Group 1 and 2, respectively (p = 0.08). Urinary catheter removal duration was 7.8 and 8.5 days in Group 1 and 2, respectively (p = 0.1). Immediate urinary continence was achieved in 38 (76%) and 20 (40%) of the patients in Group 1 and 2, respectively (p = 0.002). Urinary continence in first-month follow-up was achieved in 46 (92%) and 38 (76%) of the patients in Group 1 and 2, respectively (p = 0.02). Urinary continence in third-month follow-up was achieved in 48 (96%) and 47 (94%) of the patients in Group 1 and 2, respectively (p = 0.64). Mean UVA time was 16.8 and 21.2 minutes, respectively, in Group 1 and 2 (p < 0.001). Because of our experience, use of a barbed suture for UVA during RARP seems to lead to better immediate and early (first month) urinary continence rates and a shorter UVA time.

Technical details to achieve perfect early continence after radical prostatectomy.

Urinary incontinence after radical prostatectomy (RP) is still an issue and may compromise patient quality of life and psychosocial behavior, regardless of oncologic outcomes. As this condition usually resolves by the end of the first postoperative year, many surgeons focused their attention on "early" return of urinary continence (UC). The aim of this non-systematic review is to present an overview of the current knowledge on the anatomy and the surgical techniques addressed to early functional recovery of continence after RP. The available literature data suggest that the preservation of bladder neck, pubo-prostatic ligaments, endopelvic fascia and vesico-urethral complex may play a role in recovery of early UC. Similarly, bladder neck reconstruction, anterior and/or posterior myo-fascio-ligamentous support to the anastomosis and tension-free watertight vesico-urethral anastomosis can improve early UC recovery post RP. More recently surgical approaches (i.e. Retzius-sparing technique) seem to add a piece in the jigsaw in the scenario of the early recovery of UC. Notwithstanding the efforts of the surgeons, more evidence from randomized studies is required to prove benefits of the different approaches and the "ideal" RP is far to be standardized.

Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy.

IntroductionTo determine the clinical predictive factors affecting the recovery from postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP).Materials and methodsWe consecutively analyzed 320 patients who underwent RARP between January 2012 and March 2015. The restoration of urinary continence was defined as follows: the use of no pads/no leakage of urine or the use of a safety pad. Preoperative covariates were statistically assessed by multivariate logistic regression analysis to investigate their predict factor to recovery of urinary incontinence. Therefore, in this study, we sought to identify predictors of early urinary continence status in a single-center retrospective study of consecutive patients who underwent RARP.ResultsContinence rates at 1, 3, 6, and 12 months after the catheter was removed were 44%, 71%, 83%, and 93%, respectively. Age, body mass index, and prostate volume had no significant association with urinary continence recovery. In contrast to this, longer preoperative membranous urethral length (MUL) was significantly associated with earlier postoperative continence recovery. Multivariate analysis demonstrated that longer preoperative MUL is significantly associated with continence recovery at 1 month (P = 0.0235).ConclusionApproximately 70% of patients achieved urinary continence within 3 months after RARP. Multivariate analysis showed that age, body mass index, and prostate volume had no significant association with urinary continence recovery. Preoperative MUL assessed by magnetic resonance imaging was an independent predictor of early recovery from urinary incontinence after RARP.

Time of catheterization as an independent predictor of early urinary continence recovery after radical prostatectomy

The purpose of the present study was to investigate the potential impact of catheter removal time on immediate and early urinary continence recovery in a series of patients who underwent radical prostatectomy (RP). We prospectively collected and analyzed the clinical records of 197 patients who underwent open RP between January 2014 and December 2016. A single surgeon using the urethral fixation technique performed all procedures. Patients receiving surgery between Monday and Wednesday performed a cystogram on postoperative day (POD) 2. Conversely, other cases treated on a Thursday or Friday performed a cystogram on the following Monday (POD 3 or 4). The catheter removal was planned the day after the cystogram if there was a watertight anastomosis or with a little extravasation (<5%). Urinary continence recovery was evaluated 1 week, 1, 2 and 3 months after catheter removal. Patients self-reporting no urine leak were considered continent. Logistic regression analysis was used to identify independent predictors of urinary continence recovery at different follow-up durations. The median catheterization time was 3 (IQR: 3-4.2) days and acute urinary retention (AUR) was observed in 13 (6.5%) cases. At median follow-up of 12 (IQR: 9-12) months, no case of bladder neck contracture was observed. Urinary continence probabilities were 43%, 63%, 87%, 91% and 95% after 1 week, 1, 3, 6, and 12 months, respectively. On multivariable analyses, time of catheter removal was an independent predictor of urinary continence recovery after 1 week (OR 1.2; P=0.02); 1 month (OR 1.2; P=0.01); 3 months (OR 1.1; P=0.04) and 6 months (OR 1.1; P=0.03) after catheter removal. Time of catheterization should be considered as a postoperative parameter able to influence the immediate and early urinary continence recovery in patients undergoing RP. The impact of new surgical techniques on urinary continence recovery should be tested also considering such potential confounding factor.

Clinical significance of preservation of bladder neck by sling suspension technique at seminal vesicle for urinary continence in laparoscopic radical prostatectomy

Objective To investigate the clinical significance of urinary continence after laparoscopic radical prostatectomy with the technique of preserving bladder neck with sling suspension technique by the seminal vesicle. Methods Sixty-eight patients’ clinical data from January 2014 to December 2016 in our hospital who underwent laparoscopic radical prostatectomy were retrospectively analyzed. 35 cases with sling suspension(experimental group). Preoperative Gleason score ≤6, 11 cases; Gleason score 7, 15 cases; Gleason score ≥8, 9 cases. Stage T1 1 cases, stage T2 28 cases, and T3a 6 cases .The traditional method of bladder neck group(control group) contained 33 cases.Preoperative Gleason score ≤6, 9 cases; Gleason score 7, 14 cases; Gleason score ≥8, 10 cases. Stage T1 2 cases, stage T2 29 cases, and T3a 2 cases. The mean ages[(64.3±4.3)years old and (62.6±3.8)years old], BMI[(22.85±1.69)kg/m2 and (22.15±1.32)kg/m2], prostate volume[(45.93±9.08)ml and (44.12±6.85)ml], preoperative PSA[(18.76±5.43)ng/ml and (21.18±6.55)ng/ml], preoperative Gleason of the two groups were not statistically different (both P>0.05). All patients had no urinary incontinence.All the surgery was done by the same senior surgeon. The continence status was assessed at 1 month, 2 month, 3 month, and 6 month after operation. The operation time, bleeding volume, urinary leakage rate, the length of hospital stay, and positive margin between the two groups were compared. Urinary continence was assessed by daily urinary pad volume: 0-1 /d for urinary continence was normal, 2-3/d for mild urinary incontinence, and >3/d for severe urinary incontinence. Results 68 cases were operated successfully. There was no conversions to open surgery.1 month, 2 month, 3 month and 6 month after operations, the continence rates of the experimental group were 57.1%(20/35), 77.1%(27/35), 85.7%(30/35), 97.14%(34/35), respectively. The control group’s continence rates were 36.4%(12/35), 54.5%(18/35), 75.8%(25/35), 93.9%(31/35), respectively. At 1 month and 2 month after surgery, there was a statistically significant difference in urinary continence between the two groups (P=0.047 and P=0.040), and there was no significant difference in urinary continence between the two groups at 3 and 6 month (P=0.274 and P=0.523). There were 3 cases and 4 cases of positive margins in the experimental group and the control group, with no statistical significance(P=0.705). Conclusions Technique of preservation of bladder neck by sling suspension technique at seminal vesicle may improve the recovery of early postoperative urinary continence, and does not increase the rate of positive margin. Key words: Laparoscopic radical prostatectomy; Sling suspension by seminal vesicle; Preservation of bladder neck; Urinary continence

V30 - Intraoperative evaluation of retrograde leak point pressure (RLPP) during robotic assisted radical prostatectomy (RALP) for proper autologous sling tensioning to improve early urinary continence (EUC): The technique

V30 - Intraoperative evaluation of retrograde leak point pressure (RLPP) during robotic assisted radical prostatectomy (RALP) for proper autologous sling tensioning to improve early urinary continence (EUC): The technique

Combined bladder neck preservation and posterior musculofascial reconstruction during robotic assisted radical prostatectomy: effects on early and long term urinary continence recovery

BackgroundTo evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP).MethodsTwo-hundred ninety-two patients who previously underwent radical prostatectomy were retrospectively selected for a case-control study, excluding those with anastomotic strictures and significant perioperative complications and re-called for a medical follow-up visit after their consent to participate the study. They were divided in 3 different groups according to the surgical technique previously received: radical retropubic prostatectomy (RRP) combined with bladder neck preservation (BNP), RARP with bladder neck resection, and RARP combined with BNP and posterior musculofascial reconstruction (PRec).Functional and oncologic outcomes evaluation were integrated by a questionnaire on urinary continence status, abdominal ultrasound scan, uroflowmetry and post-void urine volume measurement.Urinary continence definition included the terms “no pad” or “safety pad”.ResultsTwo hundred thirty-two patients responded to the phone call interview and were enrolled in the study. They presented comparable age, prostate volume and BMI. Differences in comorbidities, ASA score and medications, did not influence the postoperative functional results, focused on continence outcome.Early urinary continence was achieved in 49.38% and 24.73% of patients who previously underwent RARP + BNP + PRec and simple RARP respectively (p = 0.000)as well as late 12-months urinary continence was obtained in 92.59% and 79.56% of patients.(p = 0.01). Late urinary continence in the RRP + BNP group was comparable to the result obtained in the simple RARP group. The potential effects of nerve sparing technique on urinary continence have not been evaluated.ConclusionsThe combined technique of RARP + BNP + PRec seems to be effective to determine early and long term significant effects on urinary continence of patients with comparable body mass index, age and prostate volume. No statistically significant differences were found between the simple RARP and the RRP + BNP groups.

Impact of dose intensified salvage radiation therapy on urinary continence recovery after radical prostatectomy: Results of the randomized trial SAKK 09/10

IntroductionAdjuvant radiation therapy (aRT) after radical prostatectomy (RP) is associated with impaired urinary continence recovery as compared to surveillance. Less is known regarding the effect of salvage radiation therapy (sRT) dose intensification on continence outcomes. Materials and methodsUrinary continence recovery was investigated within a multicentre randomized trial in biochemically recurrent prostate cancer patients who received either 64 Gy (32 fractions) or 70 Gy (35 fractions) sRT. Incontinence was assessed using Common Toxicity Criteria for Adverse Events v4.0 at baseline, at the end of sRT and 3 months afterward. Quality of life (QoL) was assessed with the EORTC QoL questionnaires C30 and PR25 at baseline and 3 months after completion of sRT. A total of 344 patients were evaluable. ResultsAt baseline 233 (68%) of patients were fully continent and 14% in both arms became incontinent three months after treatment. Of the remaining 111 (32%) patients being incontinent at baseline, continence recovery was achieved 3 months after sRT by 44% vs. 41% with 64 vs. 70 Gy, respectively (p = 0.8). This analysis is limited by its short follow-up. ConclusionsDose intensification of sRT had no impact on early urinary continence recovery or prevalence of de novo incontinence.

VE09 - Surgical techniques to optimise early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer

VE09 - Surgical techniques to optimise early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer

The body of evidence to consider the Retzius-sparing approach favors early urinary continence recovery after robot-assisted radical prostatectomy is increasing

Radical prostatectomy is arguably the most frequently offered treatment patients with low or intermediate risk cancer of the prostate. Its main objective is complete cancer removal without sequelae, but results are sometimes darkened by the functional impairment posed by the emergence of urinary incontinence, erectile dysfunction or other voiding and vowel problems that negatively impact patient satisfaction. With the attempt to overcome these drawbacks, radical prostatectomy has undergoing a remarkable transformation in the last decades, determined by the tendency to favor minimally invasive approaches and high-volume therapeutic units because surgeon experience with the technique offers the best results.