V8-06: Advanced Reconstruction of Vesico-Urethral Support during Robot-assisted Radical Prostatectomy: experience with 526 cases
To date, several modifications of robot-assisted radical prostatectomy (RARP) aimed at improving continence have been introduced. In 2014, we presented Advanced Reconstruction of Vesico-Urethral Support (ARVUS) - innovative reconstruction technique during RARP using fibres of levator ani muscle as support for the anastomosis. We conducted a randomized trial , which showed improved continence rates of ARVUS compared to posterior reconstruction of rhabdosphincter according to Rocco. We then implemented the new technique into our daily practice. Here we present functional results on larger group of patients from a single center.
Between July 2014 and July 2016, we performed consecutive 526 RARPs using ARVUS technique. We prospectively collected all the oncological and functional data. Continence was defined as using 0 pads per day. The time points for evaluation were 24h after catheter removal, then 4 and 8 weeks and 6 and 12 months. Erection was assessed using International Index of Erectile Function (IIEF-5) questionnaire. Patients who required radiotherapy and patients lost to follow up were excluded from the analysis.
Median age was 63.2 years with median preoperative PSA 7.4 ng/ml. Median console time was 87 minutes and median blood loss 160 ml. Nerve sparing surgery had 78% of the patients. The positive surgical margin rate was 11.97%. Urinary continence assessed after 24 hours showed 20.91% (110/526) continence rate. In 4 weeks the continence rate was 60.45% (318/526), 68.06% (358/526) in 8 weeks, 73.8% (279/378) in 6 months and 84.94% (220/259) in 12 months. There were no major side effects associated with the reconstruction technique, no patient experienced perineal pain or urinary retention. Erection was evaluated in patients with initial IIEF-5 score ?19. In 12 months the potency rate was 71.04%.
ARVUS technique in our setting showed good functional results with no major side effects. Nevertheless, we believe that multi-center external validation is needed. _x000D_ _x000D_ 1. Student V Jr, Vidlar A, Grepl M, Hartmann I, Buresova E,Student V. Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two group Randomised Controlled Trial. Eur Urol. 2016 Jun 6 [Epub ahead of print]._x000D_