V1272: Enhancement of Total Anatomic Reconstruction by adding Dynamic Detrusor Cuff Trigonoplasty and Supra Pubic Tube Placement
VideoIntroduction and Objectives
With the basic principle of restoring a patient’s anatomy to its original state postoperatively, we attempted to identify technical aspects of total anatomical reconstruction that led to early return of urinary continence after robot-assisted laparoscopic prostatectomy (RALP).
An analysis was performed in 107 consecutive men who underwent RALP as well as total anatomic reconstruction (TR) with the additions of a circum-apical urethral dissection, a dynamic detrusor cuff trigonoplasty, and placement of a suprapubic catheter by a single surgeon at a tertiary care center between June 2012 and September 2012. Patient demographics and post-operative urinary control was recorded at interval follow-up visits. Additionally, telephone interviews and follow-up questionnaires were used to assess pad usage and continence.
Of the 107 patients operated between June 2012 and September 2012, 14 patients were lost to follow-up. Therefore, data is reported on 93 patients. We defined early continence as patients using zero pads at 6 weeks or less. 39.8% of men who underwent the modified TR achieved early continence. 65.5% of the patients operated achieved continence with the use of 0-1 pad at 6 weeks.
Reconstructing the pelvic anatomy and supporting bladder structures leads to an earlier return to continence. Larger randomized trials will need to confirm these key steps.