Optimizing Vesicourethral Anastomosis Healing After Robot-Assisted Laparoscopic Radical Prostatectomy: Lessons Learned from Three Techniques in 1900 Patients

Abstract

TR of the continence mechanism optimizes vesicourethral anastomosis healing and hastens early continence return after RALP.

Single Running Suture versus Single-Knot Running Suture for Vesicourethral Anastomosis in Laparoscopic Radical Prostatectomy: A Prospective Randomised Comparative Study

“…Our results showed clinically significant anastomotic leak rates of 3.7% in group 1 vs. 4.9% in group 2. These are comparable with the rates reported in other series, which ranged from 0.8 to 17% of cases [5,11,26]. Similarly, the rate of bladder neck stricture, which in this study was 3.7% in group 1 and 1.2% in group 2, remains in line with the previously published rates [11,12].…”

“…It has to be noted that in this study, we preserved the bladder neck using our own technique in all patients to avoid a potential bias that could have affected the analysis of continence outcomes [13,14]. Sparing of bladder neck has been associated with better functional outcomes after surgery due to a lower risk of urethral injury and bladder neck stricture [24,25,26]. It has been suggested that bladder neck preservation may compromise oncological outcomes by increasing the risk of positive surgical margins.…”

Robot Yardımlı Laparoskopik Radikal Prostatektomide Tam Kontinans İçin Neler Yapılmalı?

“…Tablo (5,6,19,20), hastanın mevcut komorbiditeleri (7), alt üriner sistem semptomlarının şiddeti ve ameliyat öncesi erektil disfonksiyon varlığı (5,8); RYLP geçiren hastalardaki kontinansı doğru orantılı olarak bozan diğer anlamlı faktörler olarak bildirilmiştir.…”

“…Tan ve ark. 'larının 1600 hastayı içeren serilerinde total rekonstrük-siyon grubunda anlamlı avantaj sağlandığı gösterilmiştir (19). Atuğ ve ark.…”

Urinary Incontinence

“…For this reason, reconstruction of the posterior rhabdosphincter to restore anatomic relations is one approach to improve urinary outcomes [70][71][72] . Based on an improved understanding of the male continence mechanism, anatomic restoration of the vesicourethral junction has also been postulated to improve early continence outcomes [ 42,73,74 ] . Moreover, the fascial investments of the rhabdosphincter fuse anteriorly with the pubourethral, i.e., puboprostatic ligamentsextensions of the arcus tendineus, and provide stabilization to the continence mechanism [ 42,49 ] .…”