The Powerful Impact of Double-Layered Posterior Rhabdosphincter Reconstruction on Early Recovery of Urinary Continence After Robot-Assisted Radical Prostatectomy

Gondo, Tatsuo; Yoshioka, Kunihiko; Hashimoto, Takeshi; Nakagami, Yoshihiro; Hamada, Riu; Kashima, Takeshi; Shimodaira, Kenji; Takeuchi, Hisashi; Satake, Naoya; Tachibana, Masaaki; Rocco, Bernardo

doi:10.1089/end.2012.0067

Cited by 21 publications

(8 citation statements)

References 33 publications

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“…Finally, of the 22 studies defined eligible for the qualitative analysis, one was excluded because of a lack of standardised reporting of the continence recovery outcome (Fig. ), leaving 21 studies .…”

Section: Resultsmentioning

confidence: 99%

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

et al. 2016

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To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence.

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Section: Resultsmentioning

confidence: 99%

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

et al. 2016

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“…We initiated posterior rhabdosphincter reconstruction in case 28. Details of our technique have been previously reported . The anterior reconstruction technique was initiated in case 12 and randomly used during RARP, in which the ligated DVC and the anterior muscle layer of the bladder (2 cm away from the neck) were approximated to reduce tension of the anastomosis.…”

Section: Methodsmentioning

confidence: 99%

“…Details of our technique have been previously reported. 9 The anterior reconstruction technique was initiated in case 12 and randomly used during RARP, in which the ligated DVC and the anterior muscle layer of the bladder (2 cm away from the neck) were approximated to reduce tension of the anastomosis. The DVC was ligated initially, but after case 70, the DVC was first incised without ligation and thereafter, was ligated with a running suture.…”

Section: Technical Modification With Increasing Experiencementioning

confidence: 99%

Predictors for positive surgical margins after robot‐assisted radical prostatectomy: A single surgeon's series in Japan

et al. 2013

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Abbreviations & Acronyms AUC = area under the curve BCR = biochemical recurrence BMI = body mass index DVC = dorsal venous complex PSA = prostate-specific antigen PSM = positive surgical margin RARP = robot-assisted radical prostatectomy ROC = receiver operating characteristics RP = radical prostatectomy SM = surgical margin TRUS = transrectal ultrasound Objective: Positive surgical margin after radical prostatectomy has been shown to be an independent predictive factor for biochemical and local recurrence in patients with prostate cancer. The present study was undertaken to identify predictive factors for positive surgical margin after robot-assisted radical prostatectomy in Japanese patients. Methods: Between August 2006 and September 2011, a cohort of 244 men underwent robot-assisted radical prostatectomy carried out by a single surgeon. Univariate and multivariate logistic regression analyses were carried out to identify clinical covariates significantly associated with an increased positive surgical margin. The preoperative variables included age, body mass index, prostate-specific antigen level, prostatespecific antigen density, clinical T stage, prostate volume, surgeon volume, number of positive cores and percentage of positive cores. Results: In the univariate analyses, serum prostate-specific antigen level, prostatespecific antigen density and surgeon volume were significantly associated with positive surgical margin. In the multivariate analysis, prostate-specific antigen density (hazard ratio 3.13, 95% confidence interval 1.57-6.24; P = 0.001) and surgeon volume (hazard ratio 2.15, 95% confidence interval 1.06-4.35; P = 0.034) were independent predictive factors for positive surgical margin. Using these two independent factors, we divided the patients into four groups and calculated the predictive probability of positive surgical margin. The predictive probability for positive surgical margin in each group was well correlated with the rates at 10.8% and 10.2%, 19.8% and 20.0%, 26.4% and 26.4%, an 43.5% and 43.3%, respectively. Conclusion: Prostate-specific antigen density and surgeon volume are independent predictors of positive surgical margin after robot-assisted radical prostatectomy. A combination of these two factors can provide useful information about positive surgical margins. Correspondence

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“…Gondo et al . have recently reported that posterior reconstruction was significantly associated with early recovery of urinary continence 1 month after catheter removal in univariate analysis . Their multivariate logistic regression analysis also showed that posterior reconstruction and attempted nerve‐sparing were the only independent predictive factors of urinary continence recovery 1 month after catheter removal (OR 15.01, P = 0.0003; and OR 2.248, P = 0.0402, respectively).…”

Section: Intraoperative Techniques To Improve Outcomes For Early Retumentioning

confidence: 99%

Urinary incontinence after robot‐assisted radical prostatectomy: Pathophysiology and intraoperative techniques to improve surgical outcome

et al. 2013

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Abbreviations & AcronymsAbstract: Robot-assisted radical prostatectomy has been shown to have comparable and possibly improved postoperative continent rates compared with retropubic and laparoscopic radical prostatectomy. However, postoperative urinary incontinence has remained one of the most bothersome postoperative complications. The basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. Therefore, improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of urinary continence. It might be necessary to carry out three steps to realize improvement of the early return of urinary continence after robot-assisted radical prostatectomy: (i) preservation (bladder neck, neurovascular bundle, puboprostatic ligament, pubovesical complex, and/or urethral length, etc.); (ii) reconstruction (posterior and/or anterior reconstruction, and/or reattachment of the arcus tendineus to the bladder neck, etc.); and (iii) reinforcement (bladder neck plication and/or sling suspension, etc.). On the basis of these steps, further modifications during robot-assisted radical prostatectomy should be developed to improve urinary continence and quality of life after robot-assisted radical prostatectomy.

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The Powerful Impact of Double-Layered Posterior Rhabdosphincter Reconstruction on Early Recovery of Urinary Continence After Robot-Assisted Radical Prostatectomy

Cited by 21 publications

References 33 publications

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

Predictors for positive surgical margins after robot‐assisted radical prostatectomy: A single surgeon's series in Japan

Urinary incontinence after robot‐assisted radical prostatectomy: Pathophysiology and intraoperative techniques to improve surgical outcome

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