Assessment of Early Continence After Reconstruction of the Periprostatic Tissues in Patients Undergoing Computer Assisted (Robotic) Prostatectomy: Results of a 2 Group Parallel Randomized Controlled Trial

Menon, Mani; Muhletaler, Fred; Campos, Miguel; Peabody, James O.

doi:10.1016/j.juro.2008.05.046

Cited by 212 publications

(139 citation statements)

References 19 publications

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“…Secondly, at the beginning of the vesicourethral anastomosis, the bladder wall was stitched 1-2 cm dorsocephalad to the bladder neck (at positions 1 and 11 o'clock on the bladder neck) and the musculofascial plate was stitched at 5 and 7 o'clock positions on the urethra instead of using Rocco's second-layer stitch. Although it was previously reported that urinary continence was not improved by PMPR (14), in the present study we demonstrated that urinary continence was recovered significantly earlier in patients undergoing LRPs with our modified PMPR. We also evaluated the postoperative cystograms and compared the bladder shapes between patients undergoing LRP with PMPR and those undergoing LRP without PMPR.…”

Section: Introductioncontrasting

confidence: 76%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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Abstract. The aim of this study was to evaluate the efficacy of our modified posterior musculofascial plate reconstruction (PMPR) procedure in laparoscopic radical prostatectomy (LRP). Prior to 2010, four operative procedures were used to expedite continence recovery: preserving the fascia covering the levator ani muscle, preserving the bladder neck, securing a functional urethral length by using a lateral-view dissection technique and suspending the vesicourethral anastomosis from the puboprostatic ligaments. Since February, 2010, a running suture between Denonvilliers' fascia (DF) and the median fibrous raphe (MFR, the fibrous tissue that lies immediately underneath the urethra) has also been used. In vesicourethral anastomosis, a double-armed running suture was performed. At the beginning of the anastomosis, the first stitches (at 1 and 11 o'clock positions on the bladder neck) were placed 1-2 cm dorsocephalad to the bladder neck (first through the seromuscular layer and then through the full thickness of the bladder neck). At the 5 and 7 o'clock positions of the urethra, the stitches were placed through the urethral mucosa as well as the the reconstructed musculofascial plate. The bladder shape was evaluated by postoperative cystography and the clinical results were compared between patients undergoing LRP without PMPR (group A) and those undergoing LRP with PMPR (group B). The cystograms demonstrated that the PMPR significantly shortened the vertical length of the bladder and significantly decreased the posterior vesicourethral angle. At 1, 3 and 6 months after LRP, the number of daily used pads was significantly lower in group B compared to that in group A and the time to achieve a pad-free status was significantly shorter in group B. Our modified PMPR procedure significantly improved the recovery of urinary continence following LRP and this improvement may be due in part to changes of the bladder shape.

show abstract

Section: Introductioncontrasting

confidence: 76%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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“…1 Late post-prostatectomy continence rates in expert hands are high (76-92%) 2, 3 ; however, early continence rates are routinely lower and vary widely (32-84%). 2,4 Efforts to improve post-prostatectomy continence include maximizing urethral length, 5 using nerve-sparing techniques, 6 and preserving or recreating urethral support through reconstructive techniques. 2,[7][8][9][10] The use of a sling for suspension of the vesicourethral anastomosis at the time of prostatectomy has shown early promise, but has rarely been studied.…”

Section: Introductionmentioning

confidence: 99%

A Parallel Randomized Clinical Trial Examining the Return of Urinary Continence after Robot-Assisted Radical Prostatectomy with or without a Small Intestinal Submucosa Bladder Neck Sling

et al. 2016

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PurposeUrinary continence is a driver of quality of life after radical prostatectomy. The purpose of this study was to evaluate the impact of a biologic bladder neck sling on postoperative return of urinary continence after robot-assisted radical prostatectomy (RARP). Materials and MethodsThis study compared early continence in patients undergoing RARP with a sling and without a sling in a two group, 1:1, parallel, randomized controlled trial. Patients were blinded to group assignment. The primary outcome was defined as urinary continence (0-1 pads per day) at 1 month postoperative. Inclusion criteria included organ-confined prostate cancer and a prostatespecific antigen <15. Exclusion criteria included any prior surgery on the prostate, history of neurogenic bladder, and history of prior pelvic radiation. A chi-squared test was used for the primary outcome. ResultsA total of 147 patients were randomized (control=74, sling=73), and 92% were available for primary endpoint analysis at 1 month. There were no significant differences in baseline or perioperative data except that operating room time was 20.1 minutes longer for the sling group (P=0.04). The continence rate was similar between control and sling groups at both 1 month (47.1% vs. 55.2%, P=0.34) and 12 months (86.7% vs. 94.5%, P=0.15), respectively. Adverse events were similar between control and sling groups (10.8% vs. 13.7%, P=0.59). 3 ConclusionsThe application of an absorbable urethral sling at the time of RARP was well tolerated with no increase in obstructive symptoms in this randomized trial. However, the sling failed to show a significant improvement in continence.4

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“…First, we did not investigate functional outcomes and perioperative complication rates associated with the three surgical techniques. However, this has been the subject of previous studies and was not the primary goal of the present study [21][22][23]. Second, follow-up for biochemical outcome was limited; extended follow-up was not available because of the relatively newer utilization of RARP for treatment of prostate cancer compared to RRP.…”

Section: Discussionmentioning

confidence: 97%

1003 Impact of Surgical Technique (Open vs. Laparoscopic vs. Robotic-Assisted) on Pathological and Biochemical Outcomes Following Radical Prostatectomy: An Analysis Using Propensity Score Matching

Magheli¹,

Gonzalgo²,

Su³

et al. 2011

European Urology Supplements

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Assessment of Early Continence After Reconstruction of the Periprostatic Tissues in Patients Undergoing Computer Assisted (Robotic) Prostatectomy: Results of a 2 Group Parallel Randomized Controlled Trial

Abstract: Early urinary continence rates were high in patients undergoing single or double layer urethrovesical anastomosis. We found no improvement in early continence rates with reconstruction of the periprostatic tissues.

Cited by 212 publications

References 19 publications

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

A Parallel Randomized Clinical Trial Examining the Return of Urinary Continence after Robot-Assisted Radical Prostatectomy with or without a Small Intestinal Submucosa Bladder Neck Sling

1003 Impact of Surgical Technique (Open vs. Laparoscopic vs. Robotic-Assisted) on Pathological and Biochemical Outcomes Following Radical Prostatectomy: An Analysis Using Propensity Score Matching

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