V4-06: Anterior Suspension of Posterior Reconstruction Suture- a Novel Technique to Improve Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy
VideoIntroductions and Objectives
Various intraoperative technical modifications have been described with the goal of improving early return of continence following robot-assisted radical prostatectomy (RARP). This video illustrates our new technique of anterior suspension of posterior reconstruction sutures to Cooper’s ligament to create a sling-effect on the bladder neck following RARP. In addition, we assess continence rates in patients who underwent anterior suspension of posterior reconstruction sutures (ASPRS) versus those treated with our standard posterior reconstruction (SPR).
After institutional review board approval, demographic, intra and postoperative data of the two cohorts of patients (ASPRS versus SPR) were reviewed from a prospectively collected database of a single high-volume surgeon. Early continence was defined as usage of 0-1 pad for safety per 24 hours at 3 months or less from surgery, as determined by question 3 of the validated expanded prostate cancer index composite (EPIC-26). Two-sample t-test and Pearson Chi Square test were used to compare the difference between the two groups for continuous and categorical variables respectively.
The ASPRS group included 132 patients treated between Sep. 2012 and Jun. 2014, while the SPR group included 146 patients treated between Apr. 2011 and Aug. 2012. There were no significant differences in recognized variables that affect continence following a prostatectomy such as age (61.9 ± 6.4 vs. 61.9 ± 6.7 yrs., p=0.94), body mass index ( 29.5 ± 5.1 vs. 30.2 ± 7.2 kg/m2, p=0.34), prostate weight (61.4 ± 24.4 vs. 62.1 ± 21.8 g, p=0.79) and neurovascular bundle sparing status (none/partial/complete: 4.2/73.1/22.6 vs. 10.4/72/17.4 %, p=0.12) in the ASPRS and SPR groups. Early continence rates were higher in patients managed with ASPRS, although this difference was not statistically significant (44.6% vs. 36.9%, difference = 7.7%, p=0.24).
Continence recovery relies on multiple factors. Anterior suspension of the posterior reconstruction sutures is similar to a bladder neck sling commonly done for post prostatectomy incontinence. Performing this suspension technique at the time of RARP may improve early continence recovery. Additional work is required with larger number of patients to further test this hypothesis.