Radical prostatectomy: bladder neck preservation and puboprostatic ligament sparing—effects on continence and positive margins

Deliveliotis, Ch.; Protogerou, Vassilis; Alargof, E.; Varkarakis, John

doi:10.1016/s0090-4295(02)01956-8

Cited by 150 publications

(94 citation statements)

References 16 publications

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“…Poore et al demonstrated an earlier return to urinary continence for patients who underwent puboprostatic ligament sparing (14). In contrast, Deliveliotis et al revealed that puboprostatic ligament sparing was not essential for rapid return to urinary continence after RP (15). In the present study, puboprostatic ligament sparing and bladder-neck sling suspension was evaluated by Table III.…”

Section: Discussionmentioning

confidence: 67%

Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

et al. 2011

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Abstract. Urinary incontinence is a major complication following radical prostatectomy. The aim of the present study was to assess the association between urinary continence following laparoscopic radical prostatectomy (LRP) and various factors measured using real-time intraoperative transrectal ultrasonography (TRUS). Patients (n=53) with localized prostate cancer underwent LRP in combination with real-time intraoperative TRUS navigation and were evaluated for urinary continence for more than 6 months following LRP. Prostate size, membranous urethral length (MUL) and bladder-urethra angle were measured using real-time intraoperative TRUS immediately before and after surgery. Urinary continence was regained by 4, 15 and 27 patients 1, 3 and 6 months after LRP, respectively. Longer postoperative MUL was significantly correlated with recovery of urinary continence 1, 3 and 6 months after LRP. In addition, an increase in difference between preoperative and postoperative MUL was also associated with superior continence. No correlation was observed between postoperative MUL and the rate of tumor-positive surgical margins. Larger prostate volume was correlated to postoperative continence 6 months after surgery. Shorter operation time and less blood loss resulted in postoperative urinary continence 1 month after LRP. Preoperative MUL, bladder-urethra angle, age and body mass index had no correlation with urinary continence. Postoperative MUL was the most significant factor for early recovery of urinary continence following LRP. These results indicate that preservation of longer urethra during surgery may be recommended without tumor-positive surgical margins.

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Section: Discussionmentioning

confidence: 67%

Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

et al. 2011

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“…Deliveliotis [16] Return of continence was earlier after RRP in bladder neck preservation group compared to puboprostatic ligament sparing or both techniques used together. Final continence rates were unchanged.…”

Section: Primary Author Resultsmentioning

confidence: 92%

“…Standardization of RALP outcome definitions (such as continence) is imperative before adequate comparisons of these variables can be made. A variety of surgical techniques have been employed in an attempt to improve early return of continence after RP (both open and minimally invasive), including bladder neck (BN) preservation [15,16], intussusception of the BN [17], puboprostatic ligament sparing, sling construction [18], incorporation of the striate urethral sphincter to the anastomosis, and tubularization of the bladder neck. Historically, the actual benefits of these modifications have been somewhat controversial.…”

Section: Urinary Continence and The Urethrovesical 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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“…38 A number of groups feel that puboprostatic preservation is important in helping gain early continence. 39,40 Disadvantages of robotic surgery While the current Da Vinci robot appears to be the best system available for RALPs, there are a number of potential problems. Perhaps the main disadvantage is the lack of haptic feedback, which is normally present during open surgery and to a lesser degree during laparoscopic surgery.…”

Section: Robotic Radical Prostatectomy: the Techniquementioning

confidence: 99%

A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom

Goldstraw

Patil

Anderson

et al. 2007

Prostate Cancer Prostatic Dis

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Robot-assisted laparoscopic prostatectomy (RALP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RALP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic programme is a major undertaking for many surgical units. This review discusses some of the challenges in the development of a robotic service drawn from personal experience within the United Kingdom. Furthermore, available data on RALP versus open and laparoscopic approaches are reviewed for surgical and cancer-related outcomes. Preliminary data appear to show an advantage over open prostatectomy with reduced blood loss, decreased pain and early mobilisation and shorter hospital stay. Most intra-institutional studies demonstrate better postoperative continence and potency with RALP; however, this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopic surgery, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging: with continued experience, the hope is that results will continue to improve.

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Radical prostatectomy: bladder neck preservation and puboprostatic ligament sparing—effects on continence and positive margins

Cited by 150 publications

References 16 publications

Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

Urinary continence following laparoscopic radical prostatectomy: Association with postoperative membranous urethral length measured using real-time intraoperative transrectal ultrasonography

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

A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom

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