V4-03: Technique and Outcomes of Bladder Neck Intussusception During Robotic-Assisted Radical Prostatectomy: a Parallel Comparative Trial

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Introductions and Objectives
Post-prostatectomy incontinence rates vary widely, ranging from 4 to 31% of treated men, with many more experiencing urinary dysfunction during the early recovery period. For open radical retropubic prostatectomy, bladder neck intussusception has been reported to accelerate the recovery of urinary function. Although promising, the adaption to minimally invasive and robotic platforms and subsequent outcomes remain uncertain. Our objective is to compare early urinary function outcomes in men treated with and without bladder neck intussusception during robotic-assisted laparoscopic prostatectomy.

Methods
We performed a comparative, single surgeon trial of 48 men undergoing robotic-assisted laparoscopic prostatectomy alternating between bladder neck intussusception (N=24) and non-intussusception (N=24). Bladder neck intussusception was performed using using 3-0 polyglactin horizontal mattress sutures anterior and posterior to the bladder neck during robotic-assisted laparoscopic prostatectomy. Urinary domain of the Expanded Prostate Cancer Index – Short Form (EPIC-SF) were scored from 0-100 at 2 days, 2-weeks, 2-months, and a mean of 7-months post-catheter removal. Secondary outcomes included operative time, pathologic findings, length of stay, catheter duration, and postoperative complications.

Results
Baseline patient characteristics including age, body mass index, race, and D’Amico risk stratification were similar between treatment groups (p>0.05). In both unadjusted and adjusted analyses, EPIC-SF urinary scores became significantly higher for the intussusception arm at 2 weeks (adjusted EPIC-SF 65.4 vs. 46.6, p=0.019) before converging at 2 months (adjusted EPIC-SF 69.1 vs. 68.3, p=0.929) and remaining similar at a median follow-up of 7 months (adjusted EPIC-SF 80.5 vs. 77.0, p=0.665).

Conclusions
Compared to non-intussusception, bladder neck intussusception during robotic-assisted laparoscopic prostatectomy appears feasible and safe with men achieving higher levels of urinary function as early as 2-weeks post-prostatectomy.

Funding: None