V4-05: A novel technique of dynamic lateral suspension of posterior reconstruction suture (dlsprs) after vesico-urethral anastomosis during robotic radical prostatectomy- Improves early continence
Search for techniques to achieve maximum continence after robotic radical prostatectomy (RRP) is ongoing. We describe a novel technique DLSPRS after vesico-urethral anastomosis during robotic radical prostatectomy in the accompanying video and comparing early continence rates in patients who underwent DLSPRS versus those with only posterior reconstruction group (PRS).
Continence rates of 25 consecutive patients who underwent DLSPRS was compared with 25 patients with PRS. In brief technique include posterior rocco repair of sphincter complex. After urethrovesical anastomosis is completed, needles of posterior suture are passed through levator ani muscle and lateral arcuate ligament pulled to elevate the entire sphincter complex. It is presumed that while contracting pelvic floor muscles the entire complex elevates still further helping continence mechanism. Early continence was assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3 and 6 months.
Patients' characteristics and perioperative outcomes were comparable. In DLSPRS group , the continence rates at 1, 3 and 6 months were 65%, 76% and 88% in PRS group it was 38%, 60% and 69% respectively. DLSPRS group had significantly higher continence at 1 and 3 months with p value of 0.04. There were no complications related to suspension of posterior suture.
Dynamic lateral suspension of the posterior reconstruction sutures may acts like bladder neck sling. Our very early experience performing this suspension technique at the time of RRP had better early continence recovery. Further prospective non randomized study is underway in our institute to give further insight.