The efficacy and feasibility of total reconstruction versus nontotal reconstruction of the pelvic floor on short-term and long-term urinary continence rates after radical prostatectomy: a meta-analysis

Abstract

BackgroundRecently, total pelvic floor reconstruction (TR) has been the treatment of choice for improving urinary incontinence (UI) after radical prostatectomy (RP). However, the superiority of TR with respect to urinary continence recovery following RP remains controversial. This study identified the effect of TR versus nonTR of the pelvic floor on short-term and long-term continence rates after RP.MethodsA literature search was performed in November 2017 using the PubMed, Embase, and Web of Science databases. Only comparative research or clinical studies reporting urinary continence outcomes was included in the meta-analysis, and the quality of evidence was evaluated using the 2011 Level of Evidence for therapy research.ResultsWe analyzed ten studies reporting urinary continence rates after RP at one or more postoperative time points (1, 2, 4, 12, 24, and 52 weeks). TR was associated with significantly better urinary continence outcomes at 1 week (OR 2.76, 95% CI 1.58–4.84, P < 0.001), 2 weeks (OR 2.57, 95% CI 1.74–3.80, P < 0.001), 4 weeks (OR 2.61, 95% CI 1.56–4.38, P < 0.001), 12 weeks (OR 4.33, 95% CI 2.01–9.33, P < 0.001), 24 weeks (OR 3.83, 95% CI 1.54–9.55, P = 0.004), 52 weeks (OR 4.10, 95% CI 1.80–9.38, P < 0.001) after RP. There was no difference in the rate of complications between the two arms (OR 0.54, 95% CI 0.19–1.54, P = 0.25).ConclusionsCompared with nonTR, TR is significantly and positively associated with a return to continence but not with complication rate in men following RP, suggesting that TR may be useful for decreasing the urinary incontinence rate after surgery.

Reconstruction of the Denonvillier's fascia and posterior ligament of the external urethral sphincter: Assessment of its effect on urinary continence after laparoscopic radical prostatectomy

“…The results of this study suggest that posterior reconstruction of the rhabdosphincter improves the early continence of patients undergoing LRP, as it is described in several studies (11,(22)(23)(24). Rocco et al (2007) conducted a prospective study on patients undergoing LRP, defining continence as no pads or one diaper/day.…”

Total anatomical reconstruction during robot‐assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures

“…According to these results, in a recent meta‐analysis that compared total vs non‐total reconstruction techniques for the recovery of continence, Wu et al. reported the superiority of total reconstruction techniques in terms of shorter time to recovery of continence after RP at every time point. Concerning early recovery of continence, the outcomes were statistically in favour of the total reconstruction techniques at 1 week (OR 2.76, 95% CI 1.58–4.84; P < 0.001), 2 weeks (OR 2.57, 95% CI 1.74–3.80; P < 0.001), 4 weeks (OR 2.61, 95% CI 1.56–4.38; P < 0.001), and 12 weeks (OR 4.33, 95% CI 2.01–9.33; P < 0.001) after RP.…”

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

“…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. There was a significant benefit on urinary incontinence at 52 weeks (OR, 4.10; 95% CI, 1.80-9.38; p < 0.001) in addition to short-term outcomes (1, 2, 4, 12, and 24 weeks); however, the continence outcome at longer than 52 weeks was not reported.…”