Restoration of Posterior Aspect of Rhabdosphincter Shortens Continence Time After Radical Retropubic Prostatectomy

Rocco, Francesco; Carmignani, Luca; Acquati, P.; Gadda, Franco; Dell’Orto, P.; Rocco, Bernardo; Bozzini, Giorgio; Gazzano, Giacomo; Morabito, Albeno

doi:10.1016/s0022-5347(06)00262-x

Cited by 287 publications

(194 citation statements)

References 18 publications

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“…Since we did not modify other surgical procedures intented to improve continence recovery, our PMPR procedure appeared to exert a significant effect on the recovery of urinary continence. Previous studies reported that PMPR improves the recovery of urinary continence (7)(8)(9)(10)22). In RALP, however, PMPR was not identified as an independent predictor of the early recovery of urinary continence in a multivariate analysis (14).…”

Section: Discussionmentioning

confidence: 76%

“…Early multi-institutional studies in Japan found the recovery of urinary function following LRP to be slower compared to that following retropubic radical prostatectomy (RRP) (2,3). The operative procedures used to improve the recovery of urinary continence following radical prostatectomy include preserving the fascia covering the levator ani muscle (4), preserving the bladder neck (4), preserving neurovascular bundles (NVBs) (5), securing a longer functional urethra (6,7), reconstructing the posterior musculofascial plate (PMPR) (8)(9)(10), suspending the vesicourethral anastomosis (11) and performing an anterior reconstruction (12).…”

Section: Introductionmentioning

confidence: 99%

“…However, as these four procedures did not appear to improve the recovery of urinary continence in LRP, in Feburary, 2010, we initiated the application of a PMPR procedure. Our procedure differs from the original Rocco stitch (8,9) in the aspects described below. Firstly, we used a running suture to connect the Denonvilliers' fascia (DF) with the fibrous tissue underneath the urethra (median fibrous raphe, MFR).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…9 PRDMP is one of the most common procedures. Although the technique was originally proposed by Rocco et al to acquire an early recovery of urinary continence in open retropubic RP, 10 similar results have been reported in LRP and robotic prostatectomy. 11,12 In Japan, however, no study has examined the efficacy of this procedure.…”

Section: Introductionmentioning

confidence: 68%

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

et al. 2012

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Abbreviations & AcronymsAbstract: The objective of the present study was to assess the efficacy of posterior reconstruction of Denonvilliers' musculofascial plate for restoring urinary continence after laparoscopic radical prostatectomy. A total of 48 consecutive patients who underwent laparoscopic radical prostatectomy were retrospectively reviewed. Of them, 23 underwent laparoscopic radical prostatectomy without posterior reconstruction of Denonvilliers' musculofascial plate (group 1) and 25 underwent laparoscopic radical prostatectomy with posterior reconstruction of Denonvilliers' musculofascial plate (group 2). Patients' demographics were analyzed and continence rates between the two groups at 1, 3, 6 and 12 months after surgery were compared. Patients in group 2 had significantly larger prostates than in group 1. There were no significant differences between the two groups in terms of the other patient characteristics. The urinary continence rates were significantly higher in group 2 than in group 1 at 1, 3 and 12 months after surgery, and the rates of severe incontinence were significantly lower in group 2 at all time-points considered. These findings suggest that posterior reconstruction of Denonvilliers' musculofascial plate helps in restoring early continence and decreasing severe incontinence in patients undergoing laparoscopic radical prostatectomy.

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“…This supporting system extends from the peritoneum of the pouch of Douglas to the perineal membrane and the central tendon of the perineum 35,36) . Prostate removal causes the destruction of this supporting system anatomically and functionally, separates the urethral sphincter complex from the prostatic apex and Denonvilliers' fascia, and thus may result in postoperative incontinence.…”

Section: ) Posterior Reconstruction (Fig 3)mentioning

confidence: 99%

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

FJMS

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: Although open retropubic radical prostatectomy has been the most commonly used surgical technique for patients with localized prostate cancer for decades, robot -assisted radical prostatectomy (RARP) has recently become an alternative option and widely used in Japan as well as around the world. RARP has been shown to have higher postoperative continent rates than retropubic and laparoscopic radical prostatectomy ; however, urinary incontinence has remained one of the most significant causes for concern among patients who seek surgical treatment for prostate cancer, even after the introduction of RARP. The literature has shown that certain technical modifications to improve urinary continence are advocated as potential aids to reduce the risk of urinary incontinence after RARP. These modifications might be divided into 3 categories to realize the improvement of early return of urinary continence after RARP : 1) preservation, 2) reconstruction, and 3) reinforcement of the anatomic structures in the pelvis, which will make a new supporting system after radical prostatectomy. In this review, we discuss the intraoperative techniques to improve outcomes for early return of urinary continence following RARP, and provide a critical summary of current knowledge on its outcome in the literature.

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Restoration of Posterior Aspect of Rhabdosphincter Shortens Continence Time After Radical Retropubic Prostatectomy

Abstract: Careful reconstruction of the posterior aspect of the rhabdosphincter markedly shortens time to continence.

Cited by 287 publications

References 18 publications

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

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

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

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

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