V8-07: Modified Milan Sling technique during robot-assisted radical prostatectomy for early recovery of urinary continence without nerve-sparing: A pilot study
_x000D_ Urinary incontinence after radical prostatectomy for localized prostate cancer strongly influences patients' quality of life. Postoperative urinary continence tends to recover early since robot-assisted radical prostatectomy has been introduced, but the results of the procedure are still not satisfactory. Various modifications of pelvic floor reconstruction during radical prostatectomy, including pelvic floor structure preservation with nerve-sparing technique, have been reported for the purpose of early recovery of urinary continence. However, wide excision without nerve-sparing is necessary depending on a case, such as high risk stratified group, while it may cause poor recovery of urinary continence. We modified the previously reported Milan vas deferens sling technique by adding reinforcement of under-anastomosis layers during robot-assisted radical prostatectomy, which significantly accelerates early recovery of postoperative urinary continence in cases without nerve-sparing.
_x000D_ Modified sling technique;_x000D_ Sling suture was made from autologous vas deferens. After putting the vas deferens sling on the sub-urethral perirectal fat, three independent layers were constructed below the urethrovesical anastomosis, and a single anterior layer was made. Then, both ends of the sling were transfixed to Cooper ligaments bilaterally with adequate sling suspension._x000D_ Between October 2015 and July 2016, consecutive 35 patients who underwent robot-assisted radical prostatectomy without nerve-sparing at our institution with a single surgeon were investigated. The patients were classified into two groups: 15 using the sling technique (sling group) and 20 using the non-sling technique with simple posterior reconstruction (nonsling group). Urinary continence defined as 0 or safety 1 pad use daily was compared between the groups._x000D_
_x000D_ Patients' characteristics were comparable between the groups. Urinary continence rate significantly improved in the sling group (60.0%, p=0.0365) as compared to the nonsling group (25.0%) at 1 month despite no difference at 3 months (86.7% in the sling group vs. 65.0% in the nonsling group, p=0.1467) postoperatively. Postoperative complications related to sling procedure were not detected.
_x000D_ Despite a small sample size in the single-institution study, this sling technique may improve early urinary continence recovery after robot-assisted radical prostatectomy even without nerve-sparing. A larger study is needed to confirm its efficacy.
Funding: The Stiftelsen Japanese Swedish Research Foundation Japanese Section