Anterior Sphincter-sparing Suturing of the Vesicourethral Anastomosis During Robotic-assisted Laparoscopic Radical Prostatectomy.
Continence
Early recovery
Minimally invasive surgery
Prostate cancer
Robotic surgery
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
accepted:
05
04
2023
medline:
22
5
2023
pubmed:
22
5
2023
entrez:
22
5
2023
Statut:
epublish
Résumé
Continence is an important functional outcome after robotic-assisted laparoscopic radical prostatectomy (RARP), and modifications of the surgical technique may improve outcomes. To illustrate a novel RARP technique and to describe the observed continence outcomes. A retrospective study of men treated with RARP between 2017 and 2021 was conducted. During RARP, periprostatic structures are preserved, the intraprostatic urethra is partially spared, and the anterior anastomosis stitches involve the plexus structures but not the anterior urethra. A descriptive analysis of the pathological, functional, and short-term oncological outcomes was performed. Of 640 men, 448 (70%) with at least 1 yr of follow-up and a median age of 66 yr were included. The median operative time was 270 min and the prostatic volume 52 ml. The transurethral catheter was removed after a median of 3 d, and leakage of urine in the first 24 h after catheter removal was observed in 66/448 patients (15%). Positive surgical margins were reported in 104/448 (23%). Prostate-specific antigen persistence after prostatectomy was observed in 26/448 (6%). During a median follow-up of 2 yr (interquartile range 1-3 yr), the biochemical recurrence after prostatectomy was observed in 19/448 patients (4%). One year after prostatectomy, 406/448 patients (91%) were continent and required no pad at all, while 42/448 (9%) required at least one pad per day. Not stitching the anterior urethra is a novel technical modification and may improve continence outcomes. We describe a novel way to stitch the bladder neck to the urethra after removal of the prostate using a surgical robotic system. Our technique appeared safe, with promising urinary continence results.
Sections du résumé
Background
UNASSIGNED
Continence is an important functional outcome after robotic-assisted laparoscopic radical prostatectomy (RARP), and modifications of the surgical technique may improve outcomes.
Objective
UNASSIGNED
To illustrate a novel RARP technique and to describe the observed continence outcomes.
Design setting and participants
UNASSIGNED
A retrospective study of men treated with RARP between 2017 and 2021 was conducted.
Surgical procedure
UNASSIGNED
During RARP, periprostatic structures are preserved, the intraprostatic urethra is partially spared, and the anterior anastomosis stitches involve the plexus structures but not the anterior urethra.
Measurements
UNASSIGNED
A descriptive analysis of the pathological, functional, and short-term oncological outcomes was performed.
Results and limitations
UNASSIGNED
Of 640 men, 448 (70%) with at least 1 yr of follow-up and a median age of 66 yr were included. The median operative time was 270 min and the prostatic volume 52 ml. The transurethral catheter was removed after a median of 3 d, and leakage of urine in the first 24 h after catheter removal was observed in 66/448 patients (15%). Positive surgical margins were reported in 104/448 (23%). Prostate-specific antigen persistence after prostatectomy was observed in 26/448 (6%). During a median follow-up of 2 yr (interquartile range 1-3 yr), the biochemical recurrence after prostatectomy was observed in 19/448 patients (4%). One year after prostatectomy, 406/448 patients (91%) were continent and required no pad at all, while 42/448 (9%) required at least one pad per day.
Conclusions
UNASSIGNED
Not stitching the anterior urethra is a novel technical modification and may improve continence outcomes.
Patient summary
UNASSIGNED
We describe a novel way to stitch the bladder neck to the urethra after removal of the prostate using a surgical robotic system. Our technique appeared safe, with promising urinary continence results.
Identifiants
pubmed: 37213237
doi: 10.1016/j.euros.2023.04.007
pii: S2666-1683(23)00181-7
pmc: PMC10192927
doi:
Types de publication
Journal Article
Langues
eng
Pagination
109-114Informations de copyright
© 2023 The Authors.
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