Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial

Abstract

We showed that postprostatectomy incontinence can be assuaged using a new technique for vesicourethral anastomosis reconstruction during robot-assisted radical prostatectomy (RARP). This could significantly improve the quality of life of patients after RARP. More studies are needed to support our results.

Quantitative assessment of fascia preservation improves the prediction of membranous urethral length and inner levator distance on continence outcome after robot‐assisted radical prostatectomy

“…In addition, in our population, no men underwent any form of reconstruction of the pelvic floor and our UI rates were similar to earlier reported analyses where no reconstruction or only posterior vesicourethral reconstruction was performed. Compared to the reconstruction of the posterior musculofascial plate of Denonvilliers fascia (Rocco stich), Student et al have shown a 40% improvement in UI rate at 12 months after additionally including the fibers of the levator ani muscle, the retrotrigonal layer and the median dorsal raphe in the reconstruction of vesicourethral support . Moreover, vas deferens urethral support during RARP has been shown to improve early postoperative UI by 40% in a randomized study .…”

“…Using any, even a minimal, amount of urine loss as definition for UI is justified by our previous finding confirming that any urine loss rather than diaper use affected many aspects of quality of life . In addition, in our population, no men underwent any form of reconstruction of the pelvic floor and our UI rates were similar to earlier reported analyses where no reconstruction or only posterior vesicourethral reconstruction was performed. Compared to the reconstruction of the posterior musculofascial plate of Denonvilliers fascia (Rocco stich), Student et al have shown a 40% improvement in UI rate at 12 months after additionally including the fibers of the levator ani muscle, the retrotrigonal layer and the median dorsal raphe in the reconstruction of vesicourethral support .…”

“…Compared to the reconstruction of the posterior musculofascial plate of Denonvilliers fascia (Rocco stich), Student et al have shown a 40% improvement in UI rate at 12 months after additionally including the fibers of the levator ani muscle, the retrotrigonal layer and the median dorsal raphe in the reconstruction of vesicourethral support. 24 Moreover, vas deferens urethral support during RARP has been shown to improve early postoperative UI by 40% in a randomized study. 25 Finally, Retzius-sparing RARP, which avoids all the Retzius structures involved in continence, achieved 96% continence rate at 12 months in a prospective study with 200 patients.…”

Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer

“…Hurtes et al [42] in a multicenter RCT in 74 patients showed that at 1 and 3 months post surgery, the percentage of patients attaining UC (using the University of California Los Angeles Prostate Cancer Index questionnaire) was higher in the reconstructed group when compared to standard RALP ( p  = 0.047 and p  = 0.016, respectively). Similarly, Student et al [43], using a pad free definition, showed that in 66 patients randomized to TAR versus standard RALP, UC rate were 21.9 versus 5.9% at 24 h ( p  = 0.079), 43.8 versus 11.8% at 2 weeks ( p  = 0.005), 62.5 versus 14.7% at 4 weeks ( p  < 0.001), 68.8 versus 20.6% at 8 weeks ( p  < 0.001), 75.0 versus 44.1% at 6 months ( p  = 0.013), and 86.66 versus 61.29% at 12 months ( p  = 0.04) after surgery. Similar results have been echoed in other prospective cohort studies [44–47].…”

How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence‐Research Society 2018

“…A total anatomical reconstruction of the vesicourethral junction has been reported by several authors and showed a better outcome than anterior reconstruction alone . Several modifications have been described, but the techniques generally involve reconstruction of both the anterior and posterior compartment, with optional reattachment of the arcus tendinous to the bladder neck …”