Pelvic Floor Reconstruction After Radical Prostatectomy: A Systematic Review and Meta-analysis of Different Surgical Techniques

Abstract

Radical prostatectomy (RP) is the gold standard for the treatment of localized PCa. A meta-analysis was conducted to evaluate the effect of different techniques of pelvic floor reconstruction on urinary continence. A comprehensive search was made for trials that evaluated the efficacy of pelvic floor reconstruction. Relevant databases included PubMed, Embase, Cochrane, Ovid, Web of Science databases and relevant trials from the references. Random-effects model was used to estimate risk ratios (RRs) statistics. Pooled results of patients treated with posterior reconstruction (PR) demonstrated complete urinary continence improved at 1–4, 28–42, 90, 180 and 360 days following catheter removal. Anterior suspension (AS) was associated with improvement only at 28–42 days. The anterior reconstruction (AR) + PR was associated with urinary continence at 1–4, 90 and 180 days. AS + PR was not associated with any benefit. And PR improved social urinary continence at 7–14 and 28–42 days. No benefit was associated with AS. AR + PR had better outcomes at 90 and 180 days. AS + PR was significant improved at 28–42 and 90 days. Patients who underwent RP and PR had the least urinary incontinence. No significant benefit was observed after AS. AR + PR and AS + PR had little benefit in the post-operative period.

Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis

“…Grasso et al [42] reported a meta-analysis demonstrating that posterior reconstruction during RALP had a significant advantage on urinary continence in the first 30 days (relative risk, 1.60; 95% CI, 1.20-2.12; p < 0.0001); however, there was no significant advantage in terms of urinary incontinence after 90 and 180 days. Cui et al [43] demonstrated that anterior suspension (Patel's stitch) was also associated with short-term urinary continence, but not with long-term outcomes. Wu et al [44] performed a meta-analysis to evaluate the efficacy of total reconstruction (anterior plus posterior reconstruction) versus non-total reconstruction of the pelvic floor on the urinary continence rate after RP, with eight robotic and two laparoscopic RP series.…”

Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration

“…Since its first description in 2006 ( 16 ), the technique gradually spread and has been successfully adapted to minimally invasive surgery. Its benefit on early urinary continence recovery after radical prostatectomy has been reported in a Cochrane review by Rosemberg et al ( 17 ) and another meta-analysis ( 18 ).…”

Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy

“…As this development can vary substantially from patient to patient, the fascia can have a multilayer configuration, fragmentation into short pieces, or be composed of a thick leaf (28). Reconstruction of the posterior musculofascial plate (initially described by Rocco et al "Rocco stitch") has been demonstrated to have a beneficial impact predominantly on short-term continence rates (30)(31)(32)(33). Whether some specific modifications in the reconstruction approach, such as a 3-layer/2-step approach (including peritoneum) instead of the initially 2-layer/2-step approach by Rocco et al will result in remarkable continence improvements has to be proven in the future (30,34).…”