Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

Laucirica, Oscar; Gómez, E; Hajianfar, Ramin; Vilanova, Joan C.; Muniesa, Marta

doi:10.1111/iju.14228

Cited by 5 publications

(7 citation statements)

References 30 publications

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“…However, many of these parameters are composed of skeletal measurements alone 11 , 12 , although the pelvic cavity is composed of not only the pelvic bone structure but also the pelvic muscles, fat, and other soft tissue that lie above the bony structure. The musculature is highly important when discussing outcomes of RP, as reflected in studies where preservation of the levator ani muscle is reported to benefit early urinary continence recovery after RP 13 . Accordingly, measurements reflecting the size of the pelvic cavity should contain elements regarding this muscle in addition to the bony structure.…”

Section: Discussionmentioning

confidence: 99%

The ‘prostate-muscle index’: a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

Kimura

Yamada

Takeshima

et al. 2022

Sci Rep

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This study was to show the impact of ‘prostate-muscle index (PMI)’, which we developed as a novel pelvic cavity measurement, in patients undergoing robot-assisted radical prostatectomy (RARP). We defined PMI as the ‘distance between the inner edge of the obturator internus muscle and the lateral edge of the prostate at the magnetic resonance imaging (MRI) slice showing the maximum width of the prostate’. Seven hundred sixty patients underwent RARP at the University of Tokyo Hospital from November 2011 to December 2018. MRI results were unavailable in 111 patients. In total, 649 patients were eligible for this study. Median values of blood loss and console time were 300 mL and 168 min. In multivariate analysis, body mass index (BMI), prostate volume-to-pelvic cavity index (PV-to-PCI), PMI, and surgical experience were significantly associated with blood loss > 300 mL (P = 0.0002, 0.002, < 0.0001, and 0.006 respectively). Additionally, BMI, PMI, and surgical experience were also significantly associated with console time > 160 min in multivariate analysis (P = 0.04, 0.004, and < 0.0001, respectively). In conclusion, PMI may provide useful information to surgeons and patients in preoperative decision-making.

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Section: Discussionmentioning

confidence: 99%

The ‘prostate-muscle index’: a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

Kimura

Yamada

Takeshima

et al. 2022

Sci Rep

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“…From the inner layers are the urethral striated sphincter, the urethral smooth sphincter (circular fibers), and the urethral smooth sphincter (longitudinal fibers). The puboperineal muscle, the puborectal muscle, and the pubococcygeus muscle also support and surround the urethra [7]. Preservation of the nerves including the pudendal and pelvic nerves also contribute to urinary continence after RARP.…”

Section: Discussionmentioning

confidence: 99%

“…The puboperinealis muscle originates from the body of the pubis and courses posteriorly to attach the dorsal medium raphe. The pubococcygeus muscle originates from the body of the pubis and courses posteriorly to attach along the midline as far back as the coccyx [7].…”

Section: Classification Of Pelvic Floor Muscle Injurymentioning

confidence: 99%

Preservation of pelvic floor muscles contributes to early continence recovery after robot-assisted radical prostatectomy

Nakamura

Yamada²,

Sato³

et al. 2022

PLoS ONE

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Purpose Postoperative recovery of urinary continence has a great impact on quality of life for patients undergoing robot-assisted radical prostatectomy (RARP). A variety of surgical techniques including reconstruction of the periurethral structure have been introduced, and yet there are no effective methods that promote early urinary continence recovery after surgery. We hypothesized that the preservation of pelvic floor muscle structure could be responsible for early recovery of urinary continence after surgery. Methods A total of 94 consecutive patients who underwent RARP at our hospital were enrolled in this study. Operative video records were reviewed and the severity of pelvic floor muscle injury was classified according to the scoring system that we devised in this study. Briefly, damage of pelvic floor muscles was classified into 4 categories; intact, fascial injury, unilateral muscle injury, and bilateral muscle injury. The volume of urinary incontinence was measured for 2 days after removal of the urethral catheter, and the incontinence ratio (amount of incontinence/total volume of urine per day) was calculated. Predictive factors for immediate incontinence after catheter removal were identified by multivariate regression analysis. Results The severity of puboperineal muscle injury was significantly associated with the early incontinence ratio after catheter removal (p < 0.001). Age at surgery and severity of puboperineal muscle injury were independent predictors for early incontinence after catheter removal. Conclusion Preservation of the pelvic floor muscle, particularly the puboperineal muscle is an important factor for early continence recovery after RARP.

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“…17 The preservation of anatomical structures, such as the endopelvic fascia, the detrusor apron nerve through intrafascial dissecting, and suitable length of urethral membrane contributed to early recovery of urinary continence. 18 It was shown that nerve-preserving bilateral processes can retain the function of motor control of the urethral sphincter, thereby improving postoperative urinary control. 19 The detrusor apron, extended from the bladder's interior wall with direct continuity of pubis, had aroused widespread concern recently.…”

Section: Discussionmentioning

confidence: 99%

“Sandwich” Technique of Total Urethral Reconstruction in the Laparoscopic Radical Prostatectomy: A Prospective Study

Liu¹,

Zhao²,

Yang³

et al. 2021

CMAR

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Background Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the “Sandwich” urethra reconstruction technique on continence at the early stage after LRP. Methods During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the “Sandwich” technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated. Results There is no statistical difference in patients’ basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49±4.72 minutes in Group A and 20.16±5.75 minutes in Group B ( P <0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B ( P <0.001). Maximum flow rates before and after the “Sandwich” procedure for 12 months were 13.2±2.8 m/s and 15.4±3.6 m/s, respectively ( P =0.034). In addition, residual volumes before and after the “Sandwich” procedure for 12 months were 15 (0–20) mL and 0 (0–12.5) mL, respectively ( P =0.107). Conclusion Our prospective study confirms that the “Sandwich” technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.

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Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence

Cited by 5 publications

References 30 publications

The ‘prostate-muscle index’: a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

The ‘prostate-muscle index’: a simple pelvic cavity measurement predicting estimated blood loss and console time in robot-assisted radical prostatectomy

Preservation of pelvic floor muscles contributes to early continence recovery after robot-assisted radical prostatectomy

“Sandwich” Technique of Total Urethral Reconstruction in the Laparoscopic Radical Prostatectomy: A Prospective Study

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