Posterior Rhabdosphincter Reconstruction During Robotic Assisted Radical Prostatectomy: Results From a Phase II Randomized Clinical Trial

Sutherland, D. E.; Linder, Brian J.; Guzman, Anna M.; Hong, Mark; Frazier, Harold A.; Engel, Jason D.; Bianco, Fernando J.

doi:10.1016/j.juro.2010.11.085

Cited by 65 publications

(44 citation statements)

References 18 publications

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“…Sutherland et al [31] did not find any advantage in the early continence In the present study, we reported a ''tension-free'' anastomosis technique that aimed to restore the anterior and posterior supports to the sphincter. The proposed technique obtained promising outcomes in terms of early continence immediately after catheter removal and at 1 mo, 3 mo, and 6 mo postoperatively.…”

Section: Discussionmentioning

confidence: 49%

Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence

et al. 2016

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BackgroundThe introduction of robotics revolutionized prostate cancer surgery because the magnified threedimensional vision system and wristed instruments allow microsurgery to be performed. The advantages of robotic surgery could lead to improved continence outcomes in terms of early recovery compared with the traditional surgical methods. ObjectiveTo describe the total anatomical reconstruction (TAR) technique during robot-assisted radical prostatectomy (RARP). Primary endpoint: evaluation of the continence rate at different time points. Secondary endpoint: evaluation of urine leakage and anastomosis stenosis rates related to the technique.Design, setting, and participants June, 2013 to November, 2014; prospective consecutive series of patients with localized prostate cancer (cT1-3, cN0, cM0).Surgical procedure RARP with TAR was performed in all cases. Lymph node dissection was performed if the risk of lymph nodal metastasis was over 5%, according to the Briganti updated nomogram. MeasurementsPreoperative, intraoperative, postoperative, and pathological variables were analyzed. Enrolled patients were arbitrarily divided into three groups according to a time criterion. The relationships between the learning curve and the trend of the above-mentioned variables were analyzed using LOESS analysis. Continence was rigorously analyzed preoperatively and at 24 h, 1 wk, 4 wk, 12 wk, and 24 wk after catheter removal. Results and limitationsIn total, 252 patients were analyzed. The continence rates immediately after catheter removal and at 1 wk, 4 wk, 12 wk, and 24 wk after RARP were 71.8%, 77.8%, 89.3%, 94.4%, and 98.0%, respectively. Multivariate analysis revealed that the nerve sparing technique, D'Amico risk groups, lymph node dissection, and prostate volume were involved in the early recovery of urinary continence. One ileal perforation requiring reoperation was recorded. The transfusion rate was 0.8%. Thirty-one (12.3%) postoperative complications were recorded up to 6 mo after surgery. Among these, eight acute urinary retentions (3.2%) and three urine leakages (1.2%) were recorded. There was a lack of randomization and comparison with other techniques. Both anatomical dissection of the prostatic apex and TAR were used. The results may not be generalized to lowvolume centers. ConclusionsThe TAR technique showed promising results in the early recovery of urinary continence, as well as watertight anastomosis and a low rate of urine leakage. The oncologic results were not affected. Comparative studies are needed to support the quality of reported results. Patient summaryOn the basis of our findings, it seems that the risk of urinary incontinence following radical prostatectomy can be lowered via meticulous anatomical reconstruction using a robotic system. Comparative studies are required to support the reported results.

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Section: Discussionmentioning

confidence: 49%

Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence

et al. 2016

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“…Although Menon et al [27] showed high continence rates for anterior and posterior reconstruction, these authors also found similar results in their control group (single-layer E U R O P E A N U R O L O G Y X X X ( 2 0 1 6 ) X X X -X X X anastomosis). Sutherland et al [28] reported no improvement for posterior reconstruction and interestingly found better results in the control group, even in terms of pad weight (24-h pad test). Our functional reconstruction technique was associated with few complications, and these were similar in both groups.…”

Section: Discussionmentioning

confidence: 97%

Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial

et al. 2017

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“…Joshi [25] Posterior reconstruction did not improve continence after RALP. Sutherland [24] Posterior reconstruction did not increase early return of continence after RALP.…”

Section: Double Layer Anastomosismentioning

confidence: 75%

“…Joshi et al evaluating 94 and 107 patients, respectively [24,25]. Barbed suture has been theorized to simplify and decrease time for the BN anastomosis.…”

Section: Double Layer Anastomosismentioning

confidence: 99%

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

Kwon

Lee

et al. 2017

Korean J Urol Oncol

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Since the introduction of robot-assisted radical prostatectomy (RALP), robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

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Posterior Rhabdosphincter Reconstruction During Robotic Assisted Radical Prostatectomy: Results From a Phase II Randomized Clinical Trial

Abstract: In this randomized clinical trial posterior rhabdosphincter reconstruction offered no advantage for return of early continence after robotic assisted radical prostatectomy.

Cited by 65 publications

References 18 publications

Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence

Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence

Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

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