Bladder Neck Plication Stitch: A Novel Technique During Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence

Lee, David I.; Wedmid, Alexei; Mendoza, Pierre J.; Sharma, Saurabh; Walicki, Mary; Hastings, Rachel; Monahan, Kelly; Eun, Daniel

doi:10.1089/end.2011.0279

Cited by 29 publications

(19 citation statements)

References 15 publications

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“…The mean time to total continence was significantly shorter than that with no stitch technique (5.10±3.80 vs. 8.49±6.32 weeks, respectively ; p=0.002). The likelihood of total continence improved with the bladder plication stitch : odds ratios of 1.95±0.72 (p<0.001) at 1 month, 1.25±0.56 (p=0.113) at 3 months, and 2.07±0.66 (P=0.005) at 12 months 54) . The bladder neck stitch may decrease the amount of stretch on 2) Bladder neck sling suspension (Fig.…”

Section: Reinforcementmentioning

confidence: 96%

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Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

Fukushima J. Med. Sci.

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: Although open retropubic radical prostatectomy has been the most commonly used surgical technique for patients with localized prostate cancer for decades, robot -assisted radical prostatectomy (RARP) has recently become an alternative option and widely used in Japan as well as around the world. RARP has been shown to have higher postoperative continent rates than retropubic and laparoscopic radical prostatectomy ; however, urinary incontinence has remained one of the most significant causes for concern among patients who seek surgical treatment for prostate cancer, even after the introduction of RARP. The literature has shown that certain technical modifications to improve urinary continence are advocated as potential aids to reduce the risk of urinary incontinence after RARP. These modifications might be divided into 3 categories to realize the improvement of early return of urinary continence after RARP : 1) preservation, 2) reconstruction, and 3) reinforcement of the anatomic structures in the pelvis, which will make a new supporting system after radical prostatectomy. In this review, we discuss the intraoperative techniques to improve outcomes for early return of urinary continence following RARP, and provide a critical summary of current knowledge on its outcome in the literature.

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Section: Reinforcementmentioning

confidence: 96%

“…(Fig. 6) The bladder neck plication technique is a simple and effective technical modification for shortening the period of recovery of urinary continence in RARP patients 54) . In this technique, the anterior bladder plication stitch is positioned 2 cm proximal to the vesicourethral anastomosis at 3 o'clock and 9 o'clock.…”

Section: Reinforcementmentioning

confidence: 99%

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

Fukushima J. Med. Sci.

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“…A bladder neck plication stitch has also been reported to improve urinary continence during bladder neck reconstruction. 15 This stitch was derived from the intussusception stitch technique introduced for open radical prostatectomy procedures to improve the postoperative recovery of continence. 16 Altering the bladder neck plication technique resulted in shorter recovery times to urinary continence, with multivariate analysis showing significantly increased odds of recovery 1 and 12 months after surgery.…”

Section: Introductionmentioning

confidence: 99%

“… 16 Altering the bladder neck plication technique resulted in shorter recovery times to urinary continence, with multivariate analysis showing significantly increased odds of recovery 1 and 12 months after surgery. 15 That the study, however, had several limitations, being retrospective and nonrandomized in design. Therefore, this prospective, randomized, control study was designed to evaluate the efficacy of the bladder neck plication stitch technique in facilitating an earlier return to continence.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy

2015

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Urinary incontinence after robot-assisted radical prostatectomy (RARP) is one of the most bothersome complications affecting patients’ daily lives. The efficacy of the bladder neck plication stitch technique in promoting an earlier return of continence was prospectively evaluated in 158 patients who underwent RARP for clinically localized prostate cancer by a single surgeon at our institute from March 2012 to January 2013. Patients were randomized 1:1 to undergo surgery with (n = 79) or without (n = 79) the bladder neck plication stitch, and their time to recovery from incontinence, defined as being pad free, was compared. Recovery from incontinence at 1, 3, and 6 months were observed in 22 (27.8%), 42 (53.2%), and 57 (72.2%) patients, respectively, treated with, and 23 (29.1%), 47 (59.5%), and 59 (74.7%) patients, respectively, treated without the bladder neck plication stitch, with no significant difference in time to recovery from incontinence between the two groups. Multivariate analysis showed that age, membranous urethral length and shape of the prostatic apex on magnetic resonance imaging were independent predictors of early recovery from urinary incontinence after RARP. The bladder neck plication stitch had no effect on time to recovery from postoperative urinary incontinence following RARP.

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“…4,5 In 2001, robot-assisted laparoscopic radical prostatectomy (RALRP) was introduced and soon became the gold standard for prostatic cancer surgery. To achieve the trifecta-cancer free, potent, and continent-in RALRP, which is the "holy grail" of urologists, 6 a variety of surgical techniques has been applied including intrafascial neurovascular bundle saving, 7 membranous urethra maximization, 8 bladder neck preservation, 9 bladder neck reconstruction, 10 posterior reconstruction, 11 anterior retropubic suspension, 12 and lateral prostatic preservation. 13 RALRP shows similar oncological outcomes with less postoperative urogenital dysfunction than retropubic RP.…”

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confidence: 99%

Clinical Anatomy of the Puboprostatic Ligament for the Safe Guidance for the Prostate Surgery

Choi

Jung

Kim

et al. 2020

Urology

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OBJECTIVE To provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy. MATERIALS AND METHODS Pelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments. RESULTS The puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament. CONCLUSION Puboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.

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Bladder Neck Plication Stitch: A Novel Technique During Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence

Abstract: The bladder plication stitch is a simple and effective technical modification for shortening the period of recovery of urinary continence in RARP patients. Randomized controlled trials are under way to further evaluate this technique.

Cited by 29 publications

References 15 publications

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Randomized clinical trial of a bladder neck plication stitch during robot-assisted radical prostatectomy

Clinical Anatomy of the Puboprostatic Ligament for the Safe Guidance for the Prostate Surgery

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