Improving Time to Continence After Robot-Assisted Laparoscopic Prostatectomy: Augmentation of the Total Anatomic Reconstruction Technique by Adding Dynamic Detrusor Cuff Trigonoplasty and Suprapubic Tube Placement

Abstract

After robot-assisted laparoscopic prostatectomy, total anatomic reconstruction (TR) with the additions of a circumapical urethral dissection, a dynamic detrusor cuff trigonoplasty, and placement of a suprapubic catheter was performed in 49 patients from June to July 2012. Continence at 6 weeks after catheter removal was assessed for an initial group of 23 patients, and also at 2 weeks in an additional 26 patients who most recently had undergone surgery. Follow-up appointments and telephone interviews were used to assess pad use and continence. Of the initial 23 patients receiving the modified TR, 60.9% had 0 pad use at 6 weeks. By 2 weeks, 65.4% of the most recent 26 patients operated on achieved continence with 0-1 pad use. Preservation and reconstruction of the pelvic floor and supporting bladder structures leads to an earlier return of continence. These key steps need to be validated and confirmed in larger and randomized trials.

Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches

“…We postulate that the improved early continence rate is mainly attributable to the minimisation of surgical trauma and tissue retraction associated with this technique. The pubovesical complex, detrusor apron, levator ani, arcus tendinous and anterior fixation of the bladder to the abdominal wall served as an important suspensory mechanism, preventing pelvic floor prolapse and urethral hypermobility and maintaining the angulation of the vesicoprostatic junction . These important structures are preserved with this technique.…”

Robot-assisted radical prostatectomy with clipless intrafascial neurovascular bundle-sparing approach: surgical technique and one-year functional and oncologic outcomes

“…Recent studies suggest that the course of NVBs is more complex than Walsh described previously 1 . Tewari et al described that the prostate rests on a hammock-like nerve distribution, demonstrating that the NVBs are more a network of multiple finely dispersed nerves than a distinct structure 20 , 21 . Furthermore, Eichelberg et al showed that only 46%–66% of all nerves are found in the classical posterolateral location in relation to the prostate, while 21%–29% are identified on the anterolateral surface 22 .…”

Robot Yardımlı Laparoskopik Radikal Prostatektomide Tam Kontinans İçin Neler Yapılmalı?

“…'larının prospektif çalışmasında da; erken Tewari ve ark. 'ları total rekonstrüksiyonun yanında apikal uretranın çepeçevre diseksiyonu, detrusor trigonoplasti ve suprapubik tüp konmasıyla birleştirdikleri teknikleri ile postoperatif 6. haftada %60.9 oranında tam kontinans oranı bildirmişlerdir (40).…”