Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques

Laparoscopic (including robot-assisted) radical prostatectomy has become an alternative to open radical retropubic surgery. The main surgical techniques for reducing the period of urinary incontinence after radical prostatectomy are aimed at preserving, reconstructing and strengthening the structures that provide a complex mechanism for urine retention, namely, the pubo-prostate-vesicular ligaments, bladder neck, Denonvilliers` fascia, in procuring the functional length of the urethra, etc. Despite advances in the study of urinary continence mechanism there exists a large number of problems that need to be discussed. Therefore, researchers continue to search for solutions to create an optimal technique that ensures the earliest possible of urine retention, which is one of the main tasks in the social and medical rehabilitation of a patient who has undergone radical prostatectomy. This article describes the main modern techniques and methods for performing radical laparoscopic prostatectomy, which are aimed at achieving the earliest possible recovery of the urine retention mechanism.

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Final results of a prospective, randomized controlled trial assessing the impact of early Dorsal Venous Complex (eDVC) ligation on urinary continence recovery after robot-assisted radical prostatectomy

European Urology ◽

10.1016/s0302-2838(21)01239-2 ◽

2021 ◽

Vol 79 ◽

pp. S1211

Author(s):

F. Montorsi ◽

C.A. Bravi ◽

G. Gandaglia ◽

N. Fossati ◽

A. Stabile ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Radical Prostatectomy ◽

Controlled Trial ◽

Urinary Continence ◽

Robot Assisted ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial ◽

The Impact

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Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

BMC Urology ◽

10.1186/s12894-021-00844-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shigenori Kakutani ◽

Yuta Takeshima ◽

Yuta Yamada ◽

Tetsuya Fujimura ◽

Shoichi Nagamoto ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Radical Prostatectomy ◽

Clinical Significance ◽

Final Analysis ◽

Urinary Continence ◽

Robot Assisted ◽

Urinary Leakage ◽

Postoperative Continence ◽

The University

Abstract Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

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Level 1 Evidence of Better Early Urinary Continence at 3 Months Following Robot-assisted Laparoscopic Radical Prostatectomy Compared with Laparoscopic Radical Prostatectomy. Results of the LAP-01 Randomised Controlled Trial

European Urology ◽

10.1016/j.eururo.2021.02.039 ◽

2021 ◽

Author(s):

John W. Yaxley ◽

Geoff Coughlin ◽

Vipul Patel

Keyword(s):

Randomised Controlled Trial ◽

Radical Prostatectomy ◽

Controlled Trial ◽

Laparoscopic Radical Prostatectomy ◽

Urinary Continence ◽

Robot Assisted ◽

Level 1 ◽

Randomised Controlled

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Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.738421 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiang-Nan Xu ◽

Zhen-Yu Xu ◽

Hu-Ming Yin

Keyword(s):

Radical Prostatectomy ◽

Lower Incidence ◽

Meta Analysis ◽

Cochrane Library ◽

Urinary Continence ◽

Robot Assisted ◽

Postoperative Continence ◽

Estimated Blood Loss ◽

Significant Difference ◽

Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P < 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P < 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P < 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

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