Retrotrigonal muscular layer sling associated with total anatomical reconstruction in robot-assisted radical prostatectomy and early continence

Zanoni, Matteo; Grizzi, Fabio; Maffei, Davide; Vota, Paolo; Frego, Nicola; Toia, G.; Mazzieri, Cinzia; Lazzeri, Massimo; Buffi, Nicolò Maria; Lughezzani, Giovanni; Casale, Paolo; Saita, Alberto; Guazzoni, Giorgio; Mandressi, A.; Taverna, Gianluigi

doi:10.1007/s00345-020-03500-9

Cited by 3 publications

(8 citation statements)

References 33 publications

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“…Included trials consisted of five RCTs 18 , 19 , 20 , 21 , 22 and five retrospective cohort studies. 10 , 23 , 24 , 25 , 26 All slings were positioned on the bladder neck, and sling material used included rectus fascia (n = 3), small intestinal submucosa (n = 2), vas deferens (n = 3), Denonvilliers’ fascia (n = 1), median umbilical ligament (n = 1), and retrotrigonal muscular layer (n = 1). All slings identified and included in the study were nonsynthetic slings (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“… 10 , 18 , 19 , 20 , 22 , 23 , 24 However, with continence definition of ≤ 1pad/day, there was a low to moderate‐quality evidence that sling procedures did not reduce the risk of incontinence at 1 month (RR:1.12; 95%CI: 1.00 to 1.24), 3 months (RR:1.07; 95%CI: 0.95 to 1.21), 6 months (RR:1.01; 95%CI: 0.95 to 1.07), and 12 months (RR: 1.02; 95%CI: 0.93 to 1.13) postoperatively (n = 794) (Figure 2 ). 10 , 18 , 22 , 24 , 26 …”

Section: Resultsmentioning

confidence: 99%

“…3.6.1 | Continence defined by number of pads 10,[18][19][20][22][23][24]26 Our meta-analysis demonstrated a very-low to moderate-quality evidence that with continence defined as using zero pad/day, number of continent patients is significantly increased in the sling group at 1 month (RR:1.41; 95%CI: 1.10 to 1.83), but not at 3 months (RR:1.29; 95%CI: 0.98 to 1.69), 6 months (RR:1.10; 95%CI: 1.00 to 1.21), or 12 months (RR:1.12; 95%CI: 1.00 to 1.25) postoperatively (n = 746) (Figure 2). 10,[18][19][20][22][23][24] However, with continence definition of ≤ 1pad/day, there was a low to moderate-quality evidence that sling procedures did not reduce the risk of incontinence at 1 month (RR:1.12; 95%CI: 1.00 to 1.24), 3 months (RR:1.07; 95%CI: 0.95 to 1.21), 6 months (RR:1.01; 95%CI: 0.95 to 1.07), and 12 months (RR: 1.02; 95%CI: 0.93 to 1.13) postoperatively (n = 794) (Figure 2).…”

Section: Continence Outcomesmentioning

confidence: 99%

“…About 21 articles were excluded due to | 229 the following reasons: conference abstracts (n = 2); ineligible study design (n = 3); and no outcome of interest (n = 16). Therefore, 10 studies 10,[18][19][20][21][22][23][24][25][26] were included in this systematic review (n = 1,447) (Figure 1).…”

Section: Literature Searchmentioning

confidence: 99%

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To sling or not to sling? Impact of intraoperative sling procedures during radical prostatectomy on postoperative continence outcomes: A systematic review and meta‐analysis

et al. 2021

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Continence Outcomesmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

See 2 more Smart Citations

To sling or not to sling? Impact of intraoperative sling procedures during radical prostatectomy on postoperative continence outcomes: A systematic review and meta‐analysis

et al. 2021

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“…Population characteristics of the intervention group may explain the higher risk of postoperative incontinence due to the impact of non‐nerve‐sparing, larger bladder necks and shorter urethral lengths—factors associated with worse incontinence 6 . A RARP sling technique using the retrotrigonal muscular layer demonstrated a significant improvement in early continence rates at 1 ( p = 0.0049) and 4 weeks ( p = 0.035) 20 . Jones et al examined the use of a non‐autologous sling during ORP with the use of either the porcine small intestine submucosa or polyglactin mesh underneath the anastomosis 21 .…”

Section: Discussionmentioning

confidence: 99%

Improved early and late continence following robot‐assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling)

et al. 2023

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ObjectiveTo describe a novel RoboSling technique performed at the time of robot‐assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively.Materials and MethodsThe surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes.ResultsThe two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p = 0.005) and continence rates, defined as EPIC score ≥ 85 (p = 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p = 0.029). The RoboSling technique added on average 16 min to OT.ConclusionsThe RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.

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Anatomy of muscle connections in the male urethra and anorectal canal

Muro,

Shoji,

Suriyut

et al. 2024

BJU International

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ObjectivesTo elucidate the male urethral muscular structure and its relationship with the anorectal canal muscles, as establishing an anatomical foundation for urethral function will contribute to the prevention, diagnosis, and treatment of urinary incontinence.MethodsEight male cadavers were used. Using a multifaceted approach, we performed macroscopic anatomical examination, histological analysis of wide‐range serial sectioning and immunostaining, and three‐dimensional (3D) reconstruction from histological sections. In the macroscopic anatomical examination, pelvic halves were meticulously dissected in layers from the medial aspect. In the histological analysis, the tissue, including the urethra and anorectal canal, was serially sectioned in the horizontal plane. The muscular structures were reconstructed and visualised in 3D.ResultsThe membranous portion of the urethra had three muscle layers: the longitudinal and circular muscles (smooth muscle) and the external urethral sphincter (skeletal muscle). The circular muscle was connected posteriorly to the longitudinal rectal muscle. The external urethral sphincter had a horseshoe shape, with its posterior ends continuing to the external anal sphincter, forming a 3D ring‐like sphincter.ConclusionThis study revealed skeletal and smooth muscle connections between the male urethra and anorectal canal, enabling urethral compression and closure. These anatomical muscle connections suggest a functional linkage between them.

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Retrotrigonal muscular layer sling associated with total anatomical reconstruction in robot-assisted radical prostatectomy and early continence

Cited by 3 publications

References 33 publications

To sling or not to sling? Impact of intraoperative sling procedures during radical prostatectomy on postoperative continence outcomes: A systematic review and meta‐analysis

To sling or not to sling? Impact of intraoperative sling procedures during radical prostatectomy on postoperative continence outcomes: A systematic review and meta‐analysis

Improved early and late continence following robot‐assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling)

Anatomy of muscle connections in the male urethra and anorectal canal

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