Sustainable functional urethral reconstruction: Maximizing early continence recovery in robotic-assisted radical prostatectomy

doi:10.1016/j.ajur.2020.01.003

Asian Journal of Urology, 2021, 8 (1): 126-133 doi: 10.1016/j.ajur.2020.01.003

Original Article

Sustainable functional urethral reconstruction: Maximizing early continence recovery in robotic-assisted radical prostatectomy

Zepeng Jia¹,Yifan Chang¹,Yan Wang¹,Jing Li,Min Qu,Feng Zhu,Huan Chen,Bijun Lian,Meimian Hua,Yinghao Sun(

),Xu Gao(

)

Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China

Abstract
Related Citation (15)

Download:

HTML

PDF (2129KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: To evaluate the safety profile and short-term functional outcome of sustainable functional urethral reconstruction (SFUR) in robotic-assisted radical prostatectomy (RARP).

Methods: One hundred and sixty-two consecutive prostate cancer patients who underwent RARP were retrospectively analyzed, in which 53 had undergone SFUR while the other 109 had undergone conventional RARP procedures. Immediate, 2-week, 1-month and 3-month continence recovery and other perioperative data were compared to evaluate short-term surgical and functional outcome.

Results: The median age was 68 and 67 years in the experimental group and control group, respectively (p=0.206), with a median prostate-specific antigen (PSA) of 13.6 ng/mL (interquartile range [IQR], 8.46-27.32 ng/mL) in the experimental group and 13.84 ng/mL (IQR, 9.12-26.80 ng/mL) in control group (p=0.846). Immediate, 2-week, 1-month and 3-month continence recovery rates between the groups were 34.0% vs. 3.7%, 50.9% vs. 14.7%, 62.3% vs. 27.5%, and 79.2% vs. 63.3% (all p<0.05). The morphological changes made by the new reconstruction technique were maintained on magnetic resonance imaging (MRI) 3 months postoperatively. Nerve-sparing procedures and adoption of the new reconstruction technique were significantly relevant to continence recovery on logistics regression model (p<0.001).

Conclusion: SFUR is a safe and easy-to-handle modification that may contribute to early continence return for RARP. Long-term follow-up and prospective studies are required to further evaluate its value in postoperative quality-of-life improvement.

Key words： Prostate cancer Prostatectomy Robotic surgery Urinary incontinence Sustainable functional urethral reconstruction

Received: 18 October 2019 Available online: 20 January 2021

Corresponding Authors: Yinghao Sun,Xu Gao E-mail: sunyhsmmu@126.com;gaoxu.changhai@foxmail.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Zepeng Jia
	Yifan Chang
	Yan Wang
	Jing Li
	Min Qu
	Feng Zhu
	Huan Chen
	Bijun Lian
	Meimian Hua
	Yinghao Sun
	Xu Gao

TRENDMD:

Cite this article:

Zepeng Jia,Yifan Chang,Yan Wang, et al. Sustainable functional urethral reconstruction: Maximizing early continence recovery in robotic-assisted radical prostatectomy[J]. Asian Journal of Urology, 2021, 8(1): 126-133.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2020.01.003 OR http://www.ajurology.com/EN/Y2021/V8/I1/126

Illustration of the surgical technique. (A) Intra-abdominal view before vesicourethral anastomosis. (B) A muscular flap sized approximately 3 cm×2.5 cm being formed before creating a new bladder opening. (C) Tubularized bladder neck before anastomosis, with design of lateral umbilical ligament reshaping for periurethral reinforcement. Red and green dots represent the location where the lateral umbilical ligament and the periurethral tissue were approximated on both sides. (D) the anastomosed bladder neck before lateral umbilical ligament reinforcement, lateral view. (E) Intra-abdominal view after periurethral reinforcement with lateral umbilical ligament. BN, bladder neck; DVC, dorsal venous complex; LAF, levator ani fascia; P, pubic symphysis; SPF, supravesical peritoneal flap; U, urethra.

Preoperative variables.

Intraoperative variables.

The Clavien-Dindo classification system for patients undergoing RALP with tubularized bladder neck reconstruction.

Histopathological data.

Postoperative pelvic MRI 3 months after RARP. (A) Sagittal T2 image; (B) The same patient on axial T2 image. Blue arrows indicate the tubular bladder neck that mimics natural anatomy of the bladder neck. A steris indicates the supporting structure around the periurethral muscular complex created by the supravesical peritoneal flap. U, urethra; R, rectum.

Logistic regression model.

[1]	Novara G, Ficarra V, Mocellin S, Ahlering TE, Carroll PR, Graefen M, et al. Systematic review and meta-analysis of studies reporting oncologic outcome after robot-assisted radical prostatectomy. Eur Urol 2012; 62:382-404.
[2]	Wallis CJ, Mahar A, Cheung P, Herschorn S, Klotz LH, Al- Matar A, et al. New rates of interventions to manage complications of modern prostate cancer treatment in older men. Eur Urol 2016; 69:933-41.
[3]	Srivatsa N, Nagaraja H, Shweta S, Raghunath S. Radical prostatectomy for locally advanced prostate cancersdreview of literature. Indian J Surg Oncol 2017; 8:175-8.
[4]	Veeratterapillay R, Goonewardene SS, Barclay J, Persad R, Bach C. Radical prostatectomy for locally advanced and metastatic prostate cancer. Ann R Coll Surg Engl 2017; 99:259-64.
[5]	Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robotassisted radical prostatectomy. Eur Urol 2012; 62:405-17.
[6]	Dev H, Sooriakumaran P, Srivastava A, Tewari A. Optimizing radical prostatectomy for the early recovery of urinary continence. Nat Rev Urol 2012; 9:189-95.
[7]	Bessede T, Sooriakumaran P, Takenaka A, Tewari A. Neural supply of the male urethral sphincter: comprehensive anatomical review and implications for continence recovery after radical prostatectomy. World J Urol 2017; 35:549-65.
[8]	Pavlovich CP, Rocco B, Druskin SC, Davis JW. Urinary continence recovery after radical prostatectomydanatomical/ reconstructive and nerve-sparing techniques to improve outcomes. BJU Int 2017; 120:185-96.
[9]	Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, et al. A Critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 2016; 70:301-11.
[10]	Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial. J Urol 2013; 189:891-8.
[11]	Bianchi L, Turri FM, Larcher A, De Groote R, De Bruyne P, De Coninck V, et al. A novel approach for apical dissection during robot-assisted radical prostatectomy: the "Collar" technique. Eur Urol Focus 2018; 4:677-85.
[12]	Grasso A, Mistretta F, Sandri M, Cozzi G, De Lorenzis E, Rosso M, et al. Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis. BJU Int 2016; 118:20-34.
[13]	Patel VR, Coelho RF, Palmer KJ, Rocco B. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 2009; 56:472-8.
[14]	Cestari A, Buffi NM, Scapaticci E, Lughezzani G, Salonia A, Briganti A, et al. Simplifying patient positioning and port placement during robotic-assisted laparoscopic prostatectomy. Eur Urol 2010; 57:530-3.
[15]	Ghani K, Trinh QD, Menon M. Vattikuti institute prostatectomydtechnique in 2012. J Endourol 2012; 26:1558-65.
[16]	Kadono Y, Nohara T, Kawaguchi S, Naito R, Urata S, Nakashima K, et al. Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence. BJU Int 2018; 122:456-62.
[17]	de Carvalho PA, Barbosa J, Guglielmetti GB, Cordeiro MD, Rocco B, Nahas WC, et al. Retrograde release of the neurovascular bundle with preservation of dorsal venous complex during robot-assisted radical prostatectomy: optimizing functional outcomes. Eur Urol 2020; 77:628-35.
[18]	Dalela D, Jeong W, Prasad MA, Sood A, Abdollah F, Diaz M, et al. A pragmatic randomized controlled trial examining the impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2017; 72:677-85.
[19]	Takenaka A, Tewari A, Hara R, Leung RA, Kurokawa K, Murakami G, et al. Pelvic autonomic nerve mapping around the prostate by intraoperative electrical stimulation with simultaneous measurement of intracavernous and intraurethral pressure. J Urol 2007; 177:225-9.
[20]	Ko YH, Coelho RF, Sivaraman A, Schatloff O, Chauhan S, Abdul-Muhsin HM, et al. Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: which is better for achieving early functional recovery? Eur Urol 2013; 63:169-77.
[21]	Stolzenburg JU, Kallidonis P, Do M, Dietel A, Hafner T, Rabenalt R, et al. A comparison of outcomes for interfascial and intrafascial nerve-sparing radical prostatectomy. Urology 2010; 76:743-8.
[22]	Bahler CD, Sundaram CP, Kella N, Lucas SM, Boger MA, Gardner TA, et al. A parallel randomized clinical trial examining the return of urinary continence after robot-assisted radical prostatectomy with or without a small intestinal submucosa bladder neck sling. J Urol 2016; 196:179-84.
[23]	Bauer RM, Grabbert MT, Klehr B, Gebhartl P, Gozzi C, Homberg R, et al. 36-month data for the AdVance XP? male sling: results of a prospective multicentre study. BJU Int 2017; 119:626-30.
[24]	Nguyen HG, Punnen S, Cowan JE, Leapman M, Cary C, Welty C, et al. A randomized study of intraoperative autologous retropubic urethral sling on urinary control after robotic assisted radical prostatectomy. J Urol 2017; 197:369-75.
[25]	Ficarra V, Crestani A, Rossanese M, Palumbo V, Calandriello M, Novara G, et al. Urethral-fixation technique improves early urinary continence recovery in patients who undergo retropubic radical prostatectomy. BJU Int 2017; 119:245-53.
[26]	Sun Y, Gao X, Gao X, Xu C, Wang L, Hou J, et al. [The surgical experience of 51 retropubic radical prostatectomy with complete continence]. J Clin Urol 2004; 8:449-51 [Article in Chinese].
[27]	Steiner MS, Burnett AL, Brooks JD, Brendler CB, Stutzman RE, Carter HB. Tubularized neourethra following radical retropubic prostatectomy. J Urol 1993; 150:407-10.
[28]	Hashimoto T, Yoshioka K, Gondo T, Hasama K, Hirasawa Y, Nakashima J, et al. The impact of lateral bladder neck preservation on urinary continence recovery after robot-assisted radical prostatectomy. J Endourol 2018; 32:40-5.
[29]	Tan P, Zhang C, Wei SY, Tang Z, Gao L, Yang L, et al. Effect of statins type on incident prostate cancer risk: a meta-analysis and systematic review. Asian J Androl 2017; 19:666-71.
[30]	Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)dincidence, management, and prevention. Eur Urol 2006; 50:969-80.