Improved Continence after Radical Retropubic Prostatectomy Using Two Pubo-Urethral Suspension Stitches

Abstract

Objectives: To determine if placement of urethral suspension stitches during radical retropubic prostatectomy improves postoperative urinary continence. Methods: Between January 1997 and January 1998 we performed radical retropubic prostatectomy on 50 men. The first 25 consecutive men had their surgery without urethral suspension stitches while the next 25 received placement of two anastomotic urethral suspension stitches anchored to the lower portion of the pubic bone. Patients were interviewed six months postoperatively and each underwent valsalva leak-point pressure measurement. Patients were categorized as either completely continent (requiring no pads and having no measurable valsalva leak point), socially continent (zero or one pad per day), or incontinent (two or more pads per day). Results: In the urethral suspension group, 8/25 (32%) patients were completely continent and did not have a measurable valsalva leak-point pressure while 3/25 (12%) without urethral suspension were completely continent. Of the remaining patients in the urethral suspension group, 13/17 (76%) patients were socially continent while 4/17 (24%) were incontinent. The mean valsalva leak-point pressure in the 17 patients with suspension stitches was 89.6 ± 21.6 cm H₂O. In the patients without urethral suspension, there were 22 patients who had some degree of incontinence. Among non-stitch patients, 13/22 (59%) were socially continent while 9/22 (41%) were incontinent. The average valsalva leak-point pressure in these patients was 74.0 ± 16.7 cm H₂O, which was significantly lower than those with the suspension (p = 0.015). Conclusion: Placement of anastomotic urethral suspension stitches during radical retropubic prostatectomy may increase the likelihood of complete postoperative urinary continence. The urethral suspension stitches also increase valsalva leak-point pressure, which may improve the percentage of patients with socially acceptable incontinence.

Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients

“…Campenni et al 28 performed VUA suspension by placing two pubourethral suspension stitches during RRP. This method does not interfere with the anatomy or introduce a foreign body (sling).…”

“…The majority of these studies were prospective studies, but they were not always randomized. 6,28 All studies evaluated continence 3 months postoperatively, 6,[26][27][28] and Noguchi et al 26 performed continence evaluation as early as 1 month after RP. Thus, early postoperative continence evaluation after catheter removal was never assessed.…”

“…6,[26][27][28] In our study, we evaluated the BNS technique in both EERPE and nsEERPE and assessed the influence of the EERPE technique on early postoperative continence. Patients were selected for EERPE or nsEERPE procedures according to specific criteria and were prospectively randomized to receive bladder suspension.…”

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

“…As documented by Campenni et al, some patients who have had an anterior urethropexy stitch placed appear to increase continence as measured by leak-point pressures [20]. This maneuver has been described to increase overall continence and decrease time to return of continence [21].…”

“…Anterior reconstruction Campenni [20] Anterior anastomotic urethral suspension sutures increase Valsalva LLP and may speed the return of continence. Patel [21] Suspension stitch in RALP leads to improved continence at 3 months.…”