Posterior musculofascial plate reconstruction promotes early restoration of continence and prevents severe incontinence in patients undergoing laparoscopic radical prostatectomy

Sano, Tsuyoshi; Nakashima, Masakazu; Haitani, Takao; Kajita, Yoichiro; Shichiri, Yasumasa

doi:10.1111/j.1442-2042.2011.02954.x

Cited by 9 publications

(6 citation statements)

References 20 publications

(25 reference statements)

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“…Finally, of the 22 studies defined eligible for the qualitative analysis, one was excluded because of a lack of standardised reporting of the continence recovery outcome (Fig. ), leaving 21 studies .…”

Section: Resultsmentioning

confidence: 99%

“…Table shows the outcomes of urinary continence in the studies included in the meta‐analysis, at 3–7, 30,45–75 90, 180 days and 1 year after removal of urinary catheter in patients undergoing RP (ORP, LRP or RARP) with or without PR of the rhabdosphincter. Table summarises the different surgical techniques used in the studies comprised in the meta‐analyses.…”

Section: Resultsmentioning

confidence: 99%

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Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

et al. 2016

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To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

et al. 2016

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“…In RALP, however, PMPR was not identified as an independent predictor of the early recovery of urinary continence in a multivariate analysis (14). Sano et al (24) suggested that the magnified stereoscopic view and maneuverable instruments in RALP may allow for the preservation of the sphincteric/supporting musculature and, therefore, that PMPR may not be an independent factor in the multivariate analysis. The authors of that study also suggested that plate reconstruction may be beneficial for early continence recovery following standard LRP in a community hospital (i.e., without the extensive fascia preservation possible in RALP).…”

Section: Discussionmentioning

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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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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“…Patient S/CMain outcomes S/CFrancesco Rocco 6 Italy1998–2003Historical Cohort StudyPR(RRP)0 padICIQ-SFN/A161/503 day: 72.0%/14.0% 1 mon: 78.8%/30.0% 3 mon: 86.3%/46.0%U. Anceschi 15 Italy2007–2012Historical Cohort StudyPR(LRP)0 padICQ-SF and SF-36N/A52/541 mo: 69%/37% 3 mons: 86%/54%Rafael Coelho 16 USAN/AHistorical Cohort StudyPR(RALP)0 padEPIC+473/3301 wk: 28.7%/22.7% 4 wks: 51.6%/42.7%Georgios Daouacher 17 Sweden2005–2011Historical Cohort StudyPR(LRP)0/0–1 padsstandard self-assessed questionnaireN/A99/991 mo: 33%/16% 3 mo: 66%/44% 6 mo: 81%/67%Keiichi Ito 18 Japan2008–2011Historical Cohort StudyPR(LRP)0 padUCLA-PCImostly −19/131 mo: 21%/7% 3 mo: 48%/13%Chang Wook Jeong 19 Korea2009–2011Historical Cohort StudyPR(RALP)Complete: 0 pad Social: 0–1 padsEPICmostly +113/116Complete: 2 wk: 30.1%/19.8% 1 mo: 58.4%/45.7% 3 mo: 82.7%/70.5%Isaac Yi Kim 20 USA2007Historical Cohort StudyPR(RALP)0 padEPICN/A25/251 wk: 24%/36% 3 mon: 84%/76%Mike Nguyen 21 USA2006Historical Cohort StudyPR(RALP/LRP)0–1 padsself-reported questionnaire+32/303 day: 34%/3% 6 wk: 56%/17%Francesco Rocco 22 Italy1998–2005Historical Cohort StudyPR(RRP)0–1 padsICIQ-SF+250/503 day: 62.4%/14.0% 1 mon: 74.0%/30.0% 3 mon: 85.2%/46.0%Takeshi Sano 23 Japan2007–2008Historical Cohort StudyPR(LRP)0 padN/A+25/23…”

Section: Resultsmentioning

confidence: 99%

Pelvic Floor Reconstruction After Radical Prostatectomy: A Systematic Review and Meta-analysis of Different Surgical Techniques

Cui

Guo

et al. 2017

Sci Rep

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Radical prostatectomy (RP) is the gold standard for the treatment of localized PCa. A meta-analysis was conducted to evaluate the effect of different techniques of pelvic floor reconstruction on urinary continence. A comprehensive search was made for trials that evaluated the efficacy of pelvic floor reconstruction. Relevant databases included PubMed, Embase, Cochrane, Ovid, Web of Science databases and relevant trials from the references. Random-effects model was used to estimate risk ratios (RRs) statistics. Pooled results of patients treated with posterior reconstruction (PR) demonstrated complete urinary continence improved at 1–4, 28–42, 90, 180 and 360 days following catheter removal. Anterior suspension (AS) was associated with improvement only at 28–42 days. The anterior reconstruction (AR) + PR was associated with urinary continence at 1–4, 90 and 180 days. AS + PR was not associated with any benefit. And PR improved social urinary continence at 7–14 and 28–42 days. No benefit was associated with AS. AR + PR had better outcomes at 90 and 180 days. AS + PR was significant improved at 28–42 and 90 days. Patients who underwent RP and PR had the least urinary incontinence. No significant benefit was observed after AS. AR + PR and AS + PR had little benefit in the post-operative period.

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Posterior musculofascial plate reconstruction promotes early restoration of continence and prevents severe incontinence in patients undergoing laparoscopic radical prostatectomy

Cited by 9 publications

References 20 publications

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta‐analysis

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

Pelvic Floor Reconstruction After Radical Prostatectomy: A Systematic Review and Meta-analysis of Different Surgical Techniques

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