Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques

Vis, André N.; Poel, Henk G. van der; Ruiter, A.E.C.; Hu, Jim C.; Tewari, Ashutosh; Rocco, Bernardo; Patel, Vipul; Razdan, Sanjay; Nieuwenhuijzen, Jakko A.

doi:10.1016/j.eururo.2018.11.035

Cited by 46 publications

(42 citation statements)

References 37 publications

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“…If adequate prediction of PPI is possible, it may be a helpful tool in the counseling of patients in their choice of treatment after a diagnosis of prostate cancer. Also, patients at high risk for PPI could be withheld surgery, or if surgery remains mandatory, specific surgical techniques could be used to maximize functional outcomes [9]. This is one of the few studies that is aimed to develop an online prediction model for PPI after RARP that may be used by both clinicians and patients before treatment.…”

Section: Discussionmentioning

confidence: 99%

Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience

et al. 2020

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The prediction of post-prostatectomy incontinence (PPI) after robot-assisted radical prostatectomy (RARP) depends on multiple clinical, anatomical and surgical factors. There are only few risk formulas, tables or nomograms predicting PPI that may assist clinicians and their patients in adequate risk counseling on postoperative side-effects. Prospective data collection of 1814 patients who underwent RARP between 2009 and 2017 was done. Pre-operative parameters were age, body mass index (BMI), prostate volume, the American Society of Anesthesiologists (ASA) score, severity of Lower Urinary Tract Symptoms (LUTS), type of planned nerve-sparing surgery and surgical experience. The continence status was reported using Patient Reported Outcome Measurements (PROMs) using the validated pad-use questionnaire EPIC26. Continence was defined as either the use of zero pads or one safety pad. Multivariable logistic regression analysis was performed to identify predictors of PPI within one year after RARP. An online prediction tool was developed and validated. The median follow-up was 36 months (range 12–108). The response rate was high at 85.2%. A total of 85% (1537/1814) of patients was continent on follow-up. One-year continence rate was 80.1% (95% CI 78.3–81.9%) (1453/1814) and increased to 87.4% (95% CI 85.4–89.4%) after 5 years. On multivariable analysis, severity of LUTS (OR = 0.56 p = 0.004), higher age (OR = 0.73 p = 0.049), extend of nerve-sparing surgery (OR = 0.60 p = 0.001) and surgeon experience (OR = 1.48 p = 0.025) were significant independent predictors for PPI. The online prediction model performed well in predicting continence status with poor discrimination and good calibration. An intuitive online tool was developed to predict PPI after RARP that may assist clinicians and their patients in counseling of treatment.

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Section: Discussionmentioning

confidence: 99%

Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience

et al. 2020

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“…We added the periurethral suspension stitch to our standard RARP technique with the initial purpose of improving the hemostasis of the dorsal venous complex and facilitating dissection of the prostate apex and urethra. The continence mechanism is the anatomical support of the urethra by the suspension of the tissues ventral to the urethra on the fascia of the pubic bone [38]. We reported that the suspension stitch resulted in a significantly shorter interval to the recovery of continence (suspension group: median, 6 weeks; 95% confidence interval [CI], 6.387 to 8.288 vs. non-suspension group: median, 7 weeks; 95% CI, 7.558 to 11.612; log-rank test, p=0.02) and higher continence rates 3 months after the procedure (p=0.013, 94 without suspension vs. 237 with suspension) [37].…”

Section: Periurethral Suspension Stitchmentioning

confidence: 99%

“…Lessons learned from 12,000 cases of RARP scribed by Rocco et al [22] in an open approach. It was further investigated and modified in detail as in a review of literature on RARP [39,40] and the most recent description of the technique was implemented in our study [38]. Briefly, we performed the first layer of the reconstruction between the remaining Denonvillier's fascia and the posterior aspect of the rhabdosphincter/posterior median raphe.…”

Section: Arcus Tendineus Fascia Pelvismentioning

confidence: 99%

“…The second layer of reconstruction was then performed between the bladder neck and the posterior urethra. The supposed mechanism for achieving continence is the realignment of the tissues dorsal to the bladder and urethra, which in turn provides a tension-free VUA and the ability to recreate posterior support [38] (Fig. 3).…”

Section: Arcus Tendineus Fascia Pelvismentioning

confidence: 99%

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Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?

et al. 2020

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Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared).

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“…Urinary incontinence after a robot assisted radical prostatectomy (RARP) appears to have a multifactorial origin 1–5 . Several studies have identified factors that contribute to early urinary continence in patients that underwent RARP 1,2,6–10 . One of these factors is the length of the membranous urethra (MUL) 4,11,12 .…”

Section: Introductionmentioning

confidence: 99%

Identifying the relationship between postoperative urinary continence and residual urethra stump measurements in robot assisted radical prostatectomy patients

Beulens

Brinkman

Umari

et al. 2020

Robotics Computer Surgery

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Objective To investigate the feasibility of urethral stump length and width measurements in recorded videos of robot assisted radical prostatectomy procedures using the Kinovea software and to assess if these measurements could be used as predictors of postoperative urinary continence. Methods Fifty‐three patients were selected from an institutional database of 1400 cases and included in the study. All videos were analysed using the computer software ‘Kinovea’. All measurements were performed using the inserted bladder catheter as a reference point. Results The reference point (bladder catheter) was available in 33 out of 53 patients. The median surgical urethral length (SUL) was significantly higher in the continent group (1050 vs. 1294 mm, p = 0.018). The urethral width measurements did not show a difference between the groups. In order to validate the Kinovea software as an accurate tool for the measurement of the urethral stump length and width results were correlated with the magnetic resonance imaging measurements of the urethra. Conclusions The results of this study showed a significantly longer median SUL incontinent patients.

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Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques

Cited by 46 publications

References 37 publications

Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience

Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience

Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome?

Identifying the relationship between postoperative urinary continence and residual urethra stump measurements in robot assisted radical prostatectomy patients

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