A new method of anterior reconstruction of pelvic structures in robot-assisted radical prostatectomy for improving of early urinary continence.

Abstract

Introduction. Prostate cancer is one of the most common oncological diseases in men. Robot-assisted radical prostatectomy is associated with better urinary continence, compared with open and laparoscopic technique. Their oncologic outcomes are comparable. However, urinary incontinence after this surgery remains a challenge. Aim. To present a new technique of anterior reconstruction of pelvic structures during robot-assisted radical prostatectomy and evaluate its efficacy and safety. Materials and methods. We evaluated the results of treatment of 50 patients after robot-assisted radical prostatectomy for localised prostate cancer. They treated during the period from November 2020 till June 2021 in one medical centre. All surgeries were performed using transperitoneal access with anatomical-sparing technique. The anterior reconstruction of pelvic structures was performed with endopelvic fascia. All patients were informed about the study and signed the consent. The main perioperative parameters were assessed, as well as early oncological and functional outcomes. Evaluation the results of immediate and early urinary continence was carried out on the basis of questionnaire data. Results. The mean operative time was 140 min (110–170 min), mean console time was 72,5 min (45–100 min), the duration of the anterior reconstruction was 5,25 min (3,0–7,5 min). The average intraoperative blood loss was 50 ml (15–75 ml). There were no III-IV Clavien-Dindo complications. The 74% of patients were continent immediately after the surgery. The continent rate in a month after the surgery was 93%. Conclusion. This technique of robotic-assisted radical prostatectomy with anterior reconstruction is safe and effective. It does not increase the risk of complications and have no detrimental effect the oncological outcomes, while its early functional results are promising.