Early Continence Recovery after Open Radical Prostatectomy with Restoration of the Posterior Aspect of the Rhabdosphincter

Rocco, Francesco; Carmignani, Luca; Acquati, P.; Gadda, Franco; Dell’Orto, P.; Rocco, Bernardo; Casellato, Stefano; Gazzano, Giacomo; Consonni, Dario

doi:10.1016/j.eururo.2007.01.109

Cited by 208 publications

(141 citation statements)

References 21 publications

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“…Since we did not modify other surgical procedures intented to improve continence recovery, our PMPR procedure appeared to exert a significant effect on the recovery of urinary continence. Previous studies reported that PMPR improves the recovery of urinary continence (7)(8)(9)(10)22). In RALP, however, PMPR was not identified as an independent predictor of the early recovery of urinary continence in a multivariate analysis (14).…”

Section: Discussionmentioning

confidence: 82%

“…Early multi-institutional studies in Japan found the recovery of urinary function following LRP to be slower compared to that following retropubic radical prostatectomy (RRP) (2,3). The operative procedures used to improve the recovery of urinary continence following radical prostatectomy include preserving the fascia covering the levator ani muscle (4), preserving the bladder neck (4), preserving neurovascular bundles (NVBs) (5), securing a longer functional urethra (6,7), reconstructing the posterior musculofascial plate (PMPR) (8)(9)(10), suspending the vesicourethral anastomosis (11) and performing an anterior reconstruction (12).…”

Section: Introductionmentioning

confidence: 99%

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Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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Abstract. The aim of this study was to evaluate the efficacy of our modified posterior musculofascial plate reconstruction (PMPR) procedure in laparoscopic radical prostatectomy (LRP). Prior to 2010, four operative procedures were used to expedite continence recovery: preserving the fascia covering the levator ani muscle, preserving the bladder neck, securing a functional urethral length by using a lateral-view dissection technique and suspending the vesicourethral anastomosis from the puboprostatic ligaments. Since February, 2010, a running suture between Denonvilliers' fascia (DF) and the median fibrous raphe (MFR, the fibrous tissue that lies immediately underneath the urethra) has also been used. In vesicourethral anastomosis, a double-armed running suture was performed. At the beginning of the anastomosis, the first stitches (at 1 and 11 o'clock positions on the bladder neck) were placed 1-2 cm dorsocephalad to the bladder neck (first through the seromuscular layer and then through the full thickness of the bladder neck). At the 5 and 7 o'clock positions of the urethra, the stitches were placed through the urethral mucosa as well as the the reconstructed musculofascial plate. The bladder shape was evaluated by postoperative cystography and the clinical results were compared between patients undergoing LRP without PMPR (group A) and those undergoing LRP with PMPR (group B). The cystograms demonstrated that the PMPR significantly shortened the vertical length of the bladder and significantly decreased the posterior vesicourethral angle. At 1, 3 and 6 months after LRP, the number of daily used pads was significantly lower in group B compared to that in group A and the time to achieve a pad-free status was significantly shorter in group B. Our modified PMPR procedure significantly improved the recovery of urinary continence following LRP and this improvement may be due in part to changes of the bladder shape.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Ito

Seguchi

Yoshii

et al. 2013

Molecular and Clinical Oncology

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“…It can also reduce the tension on the anastomosis itself and reduce anastomotic leakage by creation of an additional strength layer 38) . This posterior rhabdosphincter reconstruction was first introduced by Rocco et al as a modification to ameliorate urinary incontinence after RRP 37 . A recent systematic review of the literature showed that posterior reconstruction improves the early return of continence within the first 30 days after RP (p=0.004), while continence rates 90 days after surgery are not affected by use of the reconstruction technique.…”

Section: ) Posterior Reconstruction (Fig 3)mentioning

confidence: 99%

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

FJMS

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: Although open retropubic radical prostatectomy has been the most commonly used surgical technique for patients with localized prostate cancer for decades, robot -assisted radical prostatectomy (RARP) has recently become an alternative option and widely used in Japan as well as around the world. RARP has been shown to have higher postoperative continent rates than retropubic and laparoscopic radical prostatectomy ; however, urinary incontinence has remained one of the most significant causes for concern among patients who seek surgical treatment for prostate cancer, even after the introduction of RARP. The literature has shown that certain technical modifications to improve urinary continence are advocated as potential aids to reduce the risk of urinary incontinence after RARP. These modifications might be divided into 3 categories to realize the improvement of early return of urinary continence after RARP : 1) preservation, 2) reconstruction, and 3) reinforcement of the anatomic structures in the pelvis, which will make a new supporting system after radical prostatectomy. In this review, we discuss the intraoperative techniques to improve outcomes for early return of urinary continence following RARP, and provide a critical summary of current knowledge on its outcome in the literature.

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“…Механическую поддержку сфинктерного аппарата обеспечивают: спереди -пубо простатические (пубоуретральные) связки, лате-рально -медиальный край m. levator ani. По задней полуокружности уретрального сфинктера точкой опо-ры служит срединный сухожильный шов (продолже-ние фасции Денонвилье), что, по мнению ряда авто-ров, в совокупности с сокращением m. levator ani играет решающее значение в механизме удержания мочи, подтягивая уретру вперед и вверх, облегчая тем самым закрытие сфинктера [17,18].…”

Section: диагностика и лечение опухолей мочеполовой системы рак предunclassified

“…Континенция в 1-й группе на момент выписки из стационара, через 1 и 3 мес наблюдения достигнута у 62,4; 74,0 и 85,2 % пациентов, тогда как во 2-й группе -у 14,04; 30,0 и 46,0 % больных соответственно. Через 12 мес после операции результаты в обеих группах оказались сопо-ставимы -94,0 и 90,0 % [17].…”

Section: диагностика и лечение опухолей мочеполовой системы рак предunclassified

Preservation of the Puboprostatic Collar and Puboperineoplasty for Early Recovery of Urinary Continence after Robotic Prostatectomy: Anatomic Basis and Preliminary Outcomes

et al. 2007

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Early Continence Recovery after Open Radical Prostatectomy with Restoration of the Posterior Aspect of the Rhabdosphincter

Cited by 208 publications

References 21 publications

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Preservation of the Puboprostatic Collar and Puboperineoplasty for Early Recovery of Urinary Continence after Robotic Prostatectomy: Anatomic Basis and Preliminary Outcomes

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