V4-01: Our Successful Experience Utilizing Posterior Rhabdosphincter Reconstruction During Robotic Prostatectomy
There have been numerous techniques employed to maximize continence after robot-assisted radical prostatectomy (RARP), including posterior rhabdosphincter reconstruction (PRR). However optimum PRR_x000D_ stitch location remains relatively undefined. We aimed to apply our modified posterior reconstruction of the rhabdosphincter (M-PRR) in 570 consecutive patients undergoing RARP for adenocarcinoma of the prostate. In this video, we demonstrate our technique for M-PRR performed during RARP.
This patient had his prostate removed in the standard fashion as previously described. The M-PRR uses the posterior layer of whitish connective tissue that may by reproducibly seen on dissection after_x000D_ division of the posterior bladder wall during the bladder neck transection, and prior to identification of the vasa deferentia and seminal vesicles. This retrotrigonal layer anchor tissue is in clear distinction to Denonvilliers’ fascia, which should not be encountered until after division of the vasa deferentia and seminal vesicles._x000D_
Patient and intraoperative variables were similar between the PRR and M-PRR groups, and there were no_x000D_ surgical technique differences between the two groups. Weeks to 0 PPD was statistically different at the_x000D_ three month interval (p=0.0466). Mean weeks to 1 PPD was 13.1 weeks in the control group and 11.76 weeks in the intervention arm. There were no significant differences in post-operative AUASS or EPIC scores between groups. Console time in this case was 112 minutes. Estimated blood loss was 100 ml. Hospital stay was 26_x000D_ hours. The foley catheter was removed 6 days after surgery. By also utilizing preoperative kegel exercises, our patient was continent on urethral catheter removal.
Retrotrigonal stitch placement during PRR resulted in statistically significant improvement in time to reach total continence post-operatively. Our M-PRR robotic approach for radical prostatectomy is safe and effective. This study is one of the largest to date examining the effect of varied stitch location at the time of_x000D_ RARP on continence outcomes._x000D_