“Total reconstruction” of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy

Abstract

Purpose:To demonstrate the effect of total reconstruction technique on postoperative urinary continence after laparoscopic radical prostatectomy (LRP).Material and Methods:LRP was performed using a standard urethrovesical anastomosis in 79 consecutive patients (Group-A) from June 2011 to October 2012, and a total reconstruction procedure in 82 consecutive patients (Group-B) from June 2012 to June 2013. The primary outcome measurement was urinary continence assessed at 1, 2, 4, 12, 24 and 52 weeks after catheter removal. Other data recorded were patient age, body mass index, International Prostate Symptoms Score, prostate volume, preoperative PSA, Gleason score, neurovascular bundle preservation, operation time, estimated blood loss, complications and pathology results.Results:In Group-A, the continence rates at 1, 2, 4, 12, 24 and 52 weeks were 7.59%, 20.25%, 37.97%, 58.22%, 81.01% and 89.87% respectively. In Group-B, the continence rates were 13.41%, 32.92%, 65.85%, 81.71%, 90.24% and 95.12% respectively. Group––B had significantly higher continence rates at 4 and 12 weeks after surgery (P<0.001 and P=0.001). There were no significant differences between the groups with respect to patient's age, body mass index, prostate-specific antigen level, prostate volume, IPSS, estimated blood loss, number of nerve-sparing procedures and postoperative complications.Conclusions:Total reconstruction technique in the procedure of urethrovesical anastomosis during LRP improved early recovery of continence.

The efficacy and feasibility of total reconstruction versus nontotal reconstruction of the pelvic floor on short-term and long-term urinary continence rates after radical prostatectomy: a meta-analysis

“…A total of ten studies [ 10 , 18 – 23 , 25 – 27 ] comprising 12 trials reported the continence rate. For the study reporting the continence rate at 1 week, a total of five studies [ 18 , 19 , 22 , 25 , 26 ] comprising six trials were included; urinary continence was defined as 0 pads in two trials [ 19 , 22 ] and as 0 pads or 1 pad used for safety (0–1 for safety) in four trials [ 18 , 22 , 25 , 26 ]. For the study reporting the continence rate at 2 weeks, a total of four trials [ 19 , 20 , 25 , 27 ] were included; urinary continence was defined as 0 pads in three trials [ 19 , 20 , 27 ] and 0–1 for safety in one trial [ 25 ].…”

“…For the study reporting the continence rate at 4 weeks, a total of ten studies [ 10 , 18 – 23 , 25 – 27 ] comprising 12 trials were included; urinary continence was defined as 0 pads in five trials [ 19 , 20 , 22 , 23 , 27 ] and 0–1 for safety in seven trials [ 10 , 18 , 21 – 23 , 25 , 26 ]. For the study reporting the continence rate at 12 weeks, a total of six trials [ 10 , 18 – 20 , 25 , 26 ] were included; urinary continence was defined as 0 pads in two trials [ 19 , 20 ] and 0–1 for safety in four trials [ 10 , 18 , 25 , 26 ]. For the study reporting the continence rate at 24 weeks, a total of seven trials [ 10 , 18 – 20 , 25 – 27 ] were included; urinary continence was defined as 0 pads in three trials [ 19 , 20 , 27 ] and 0–1 for safety in four trials [ 10 , 18 , 25 , 26 ].…”

“…For the study reporting the continence rate at 24 weeks, a total of seven trials [ 10 , 18 – 20 , 25 – 27 ] were included; urinary continence was defined as 0 pads in three trials [ 19 , 20 , 27 ] and 0–1 for safety in four trials [ 10 , 18 , 25 , 26 ]. For the study reporting the continence rate at 52 weeks, a total of five trials [ 10 , 18 , 19 , 25 , 26 ] were included; urinary continence was defined as 0 pads in one trial [ 19 ] and 0–1 for safety in four trials [ 10 , 18 , 25 , 26 ].…”

“…For the study reporting the continence rate at 52 weeks, a total of five trials [ 10 , 18 , 19 , 25 , 26 ] were included; urinary continence was defined as 0 pads in one trial [ 19 ] and 0–1 for safety in four trials [ 10 , 18 , 25 , 26 ].…”

“…Only one trial assessed the postoperative UI using interview data. Six studies [ 10 , 18 , 21 , 23 , 25 , 26 ] comprising seven trials defined continence as 0–1 pad used, and five trials [ 19 , 20 , 22 , 23 , 27 ] defined continence as 0 pads used.…”