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Restoration of Posterior Aspect of Rhabdosphincter Shortens Continence Time After Radical Retropubic Prostatectomy

2006; Lippincott Williams & Wilkins; Volume: 175; Issue: 6 Linguagem: Inglês

10.1016/s0022-5347(06)00262-x

1527-3792

F. Rocco, Luca Carmignani, Pietro Acquati, Franco Gadda, P. Dell’Orto, Bernardo Rocco, Giorgio Bozzini, Giacomo Gazzano, Albeno Morabito,

Urinary Bladder and Prostate Research

No AccessJournal of UrologyAdult urology1 Jun 2006Restoration of Posterior Aspect of Rhabdosphincter Shortens Continence Time After Radical Retropubic Prostatectomy F. Rocco, L. Carmignani, P. Acquati, F. Gadda, P. Dell'Orto, B. Rocco, G. Bozzini, G. Gazzano, and A. Morabito F. RoccoF. Rocco Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy , L. CarmignaniL. Carmignani Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy , P. AcquatiP. Acquati Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy , F. GaddaF. Gadda Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy , P. Dell'OrtoP. Dell'Orto Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy , B. RoccoB. Rocco Divisione di Urologia, Istituto Europeo di Oncologia Ricovero e Cura a Carattere Scientifico, Milano, Italy , G. BozziniG. Bozzini Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy , G. GazzanoG. Gazzano Servizio di Anatomia Patologica, Azienda Ospedale San Paolo e Ospedale Maggiore Ricovero e Cura a Carattere Scientifico, Milano, Italy , and A. MorabitoA. Morabito Servizio di Biostatistica, Università degli studi, Azienda Ospedale San Paolo, Milano, Italy View All Author Informationhttps://doi.org/10.1016/S0022-5347(06)00262-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Prolonged postoperative incontinence is a major drawback of RRP. Age, scars in the rhabdosphincter, nonnerve sparing surgery and postoperative sphincter insufficiency can cause temporary or definitive urinary incontinence. We believe that sphincter deficiency is the main cause of early incontinence. Urinary leakage results from the shortening of anatomical and functional sphincter length due to caudal retraction of the urethral sphincteric complex and disruption of the median posterior fibrous raphe. We describe a modification of the Walsh RRP that overcomes caudal retraction, reconstructs the posterior fibrous raphe and decreases time to continence. The primary study end point was early continence rate assessment. Long-term continence (1 year) and erectile function assessment were secondary end points. Materials and Methods: To avoid caudal retraction of the urethrosphincteric complex, before completing the vesicourethral anastomosis the posterior semicircumference of the sphincter is joined to the residuum of Denonvilliers' fascia and fixed to the posterior bladder wall 1 to 2 cm cranial and dorsal to the new bladder neck. Vesicourethral anastomosis is subsequently performed with care taken not to involve the neurovascular bundles. A total of 161 patients with clinically confined disease underwent modified RRP (group 1). They were compared with a historical series of 50 patients who underwent standard RRP (group 2). Early continence was defined as no pad use but patients using 1 diaper were also considered continent. Continence, assessed prospectively as the number of pads daily, was evaluated 3, 30 and 90 days, and 1 year after catheter removal. The continence state was assessed by a multivariate logistic model. Erectile function was evaluated using the International Index of Erectile Function questionnaire preoperatively and after 18 months in patients younger than 65 years who underwent nerve sparing surgery. Results: In group 1, 116 (72%), 127 (78.8%) and 139 patients (86.3%) were continent 3, 30 and 90 days after catheter removal compared with 7 (14%), 15 (30%) and 23 (46%), respectively, in group 2. One-year continence rates were 96% and 90%, respectively. Erectile function was similar in groups 1 and 2 (46% and 42%, respectively). Multivariate analysis showed that continence was significantly influenced by operation type, stage and patient age. Conclusions: Careful reconstruction of the posterior aspect of the rhabdosphincter markedly shortens time to continence. 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Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byJeong C, Lee J, Oh J, Lee S, Jeong S, Hong S, Byun S and Lee S (2018) Effects of New 1-Step Posterior Reconstruction Method on Recovery of Continence after Robot-Assisted Laparoscopic Prostatectomy: Results of a Prospective, Single-Blind, Parallel Group, Randomized, Controlled TrialJournal of Urology, VOL. 193, NO. 3, (935-942), Online publication date: 1-Mar-2015.Abd-El-Barr A, Sukumar S, Trinh Q, Roghmann F and Sun M (2018) Re: Surgeon Variation in Patient Quality of Life after Radical ProstatectomyJournal of Urology, VOL. 190, NO. 4, (1441-1442), Online publication date: 1-Oct-2013.Ko Y, Coelho R, Chauhan S, Sivaraman A, Schatloff O, Cheon J and Patel V (2018) Factors Affecting Return of Continence 3 Months After Robot-Assisted Radical Prostatectomy: Analysis From a Large, Prospective Data by a Single SurgeonJournal of Urology, VOL. 187, NO. 1, (190-195), Online publication date: 1-Jan-2012.Sutherland D, Linder B, Guzman A, Hong M, Frazier H, Engel J and Bianco F (2018) Posterior Rhabdosphincter Reconstruction During Robotic Assisted Radical Prostatectomy: Results From a Phase II Randomized Clinical TrialJournal of Urology, VOL. 185, NO. 4, (1262-1267), Online publication date: 1-Apr-2011.Loughlin K and Prasad M (2018) Post-Prostatectomy Urinary Incontinence: A Confluence of 3 FactorsJournal of Urology, VOL. 183, NO. 3, (871-877), Online publication date: 1-Mar-2010.Rocco B and Rocco F (2018) Re: Assessment of Early Continence After Reconstruction of the Periprostatic Tissues in Patients Undergoing Computer Assisted (Robotic) Prostatectomy: Results of a 2 Group Parallel Randomized Controlled TrialJournal of Urology, VOL. 181, NO. 3, (1500-1501), Online publication date: 1-Mar-2009.Nguyen L, Jhaveri J and Tewari A (2018) Surgical Technique to Overcome Anatomical Shortcoming: Balancing Post-Prostatectomy Continence Outcomes of Urethral Sphincter Lengths on Preoperative Magnetic Resonance ImagingJournal of Urology, VOL. 179, NO. 5, (1907-1911), Online publication date: 1-May-2008.Song C, Doo C, Hong J, Choo M, Kim C and Ahn H (2018) Relationship Between the Integrity of the Pelvic Floor Muscles and Early Recovery of Continence After Radical ProstatectomyJournal of Urology, VOL. 178, NO. 1, (208-211), Online publication date: 1-Jul-2007. Volume 175Issue 6June 2006Page: 2201-2206 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsprostatectomyurinary incontinenceprostateprostatic neoplasmsbladderMetricsAuthor Information F. Rocco Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author L. Carmignani Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author P. Acquati Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author F. Gadda Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author P. Dell'Orto Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author B. Rocco Divisione di Urologia, Istituto Europeo di Oncologia Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author G. Bozzini Clinica Urologica I, Università degli Studi, Fondazione Ospedale Maggiore Policlinico, Mangiagalli Regina Elena Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author G. Gazzano Servizio di Anatomia Patologica, Azienda Ospedale San Paolo e Ospedale Maggiore Ricovero e Cura a Carattere Scientifico, Milano, Italy More articles by this author A. Morabito Servizio di Biostatistica, Università degli studi, Azienda Ospedale San Paolo, Milano, Italy More articles by this author Expand All Advertisement PDF downloadLoading ...