Effect of puboprostatic ligament reconstruction on continence recovery after robot-assisted laparoscopic prostatectomy
Professor Jung Jun Kim (1), Professor Hyun Woo Kim, Professor Joon Chul Kim, Professor Jong Bo Choi, Professor Dong Hwan Lee
(1) Department Of Urology, Incheon St. Mary's Hospital, The Catholic University Of Korea, South Korea, (2) Department of Urology, Eun Pyeong St. Mary's Hospital, The Catholic University of Korea, (3) Department of Urology, Bucheon St. Mary’s Hospital, The Catholic University of Korea, (4) Department of Urology, Ajou University Hospital, Ajou University, (5) Department of Urology, Incheon St. Mary’s Hospital, The Catholic University of Korea
Urinary incontinence is among the most common complications affecting robot-assisted laparoscopic prostatectomy (RALP) patients' post-operative quality of life. Several surgical modifications have been introduced to improve continence including the puboprostatic ligament reconstruction. In this study, we introduce our novel technique of anterior reconstruction including the puboprostatic ligament reconstruction inspired by Burch Corposuspension as a last step of RALP and its effect on the continence recovery postoperatively.
In this retrospective study, the data of 288 consecutive patients of RALP from 2016 to 2018 were analyzed and the patients were divided into two groups; the control group "C Group" (144 patients) and the anterior reconstruction group "R Group" (144 patients). After radical prostatectomy with posterior reconstruction and anastomosis, additional novel anterior reconstruction step was performed only in R Group. The novel Burch suture was performed after conventional anterior reconstruction (figure). The primary endpoint of this study was to compare both groups regarding the post-operative continence rates. Urinary continence (0-1 security pad) rates were evaluated at time of 1 month (T1), 3 months (T3), 6 months (T6) and 12 months (T12) post-operatively. The multivariate logistic regression was performed to analyze the factors influence the recovery of continence. p<0.05 was considered as statistically significant
The median age was 68 years (48-80) and the rate of continence recovery was 36.5%, 63.2%, 84.0% and 92.7% at T1, T3, T6 and T12, respectively. The rate of continence at earlier period from T1 (46.5% vs 26.3%) to T3 (75.7% vs 50.7%) was significantly better in R group than C group. However, the continence recovery rate at T6 or T12 was not different between two groups. The absence of anterior reconstruction was independent risk factor after adjusting the influence of the other covariants including old age (>65 year), non-nerve sparing, bladder neck reconstruction and the short membranous urethra length (<12 mm), long operation time (>3 hour) at T1 and T3 according to multivariate logistic regression model.
Despite our novel anterior reconstruction including Burch suture showed no significant effect on continence after 6 months, it fastened the continence recovery up to 3 months. Our study supports the theory that our novel technique provides better immediate continence and shorten the time to continence for RALP patients