Articles

Impact of Posterior Musculofascial Reconstruction on Early Continence After Robot-Assisted Laparoscopic Radical Prostatectomy: Results of a Prospective Parallel Group Trial

By: Neil Joshia b, Willem de Bloka, Erik van Muilekoma and Henk van der Poela lowast

Published online: 01 July 2010

Keywords: Prostatectomy, Laparoscopic surgery, Robotic surgery, Urinary incontinence

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Abstract

Background

A significant proportion of patients develop urinary incontinence early after radical prostatectomy. Posterior reconstruction of supporting tissues has been found to reduce incontinence in open and conventional laparoscopic prostatectomy series.

Objective

To investigate whether our version of a posterior musculofascial reconstruction will reduce early incontinence and have a beneficial effect on patients’ quality of life (QoL).

Design, setting, and participants

One hundred seven consecutive patients undergoing primary robot-assisted radical laparoscopic prostatectomy (RALP) performed by a single surgeon at one tertiary referral oncology institution were alternately assigned (not randomised) to intervention (n=53) or control groups (n=54).

Surgical procedure

RALP with median fibrous raphe reconstruction (MFRR) followed by formation of the urethrovesical anastomosis (intervention group) versus standard anastomosis without posterior reconstruction (control group).

Measurements

Measurements included incontinence at baseline and 3-mo intervals; QoL as measured by a simple questionnaire, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life–Core 30 (QLQ-C30), and Prostate Cancer Module (PR25) questionnaires preoperatively and at 6 mo postprocedure; tumour characteristics; operative time; fascial preservation score; duration of catheterisation; and anastomotic leakage on cystogram.

Results and limitations

For intervention and control groups respectively, mean catheter duration was 11.74 d and 12.74 d (p=0.451); leakage on cystogram was present in six and eight cases (p=0.28); and incontinence (any involuntary urine loss) at 3 mo was 75% and 69% (p=0.391) and at 6 mo was 51% and 43% (p=0.686). Urinary retention occurred only in one case (control group). The percentage of cases returning to baseline in all QoL domains (except insomnia) was similar at 6 mo between the two groups. Short follow-up, lack of blinding, and probable small differences in our method of MFRR performed compared with other studies were identified as significant limitations.

Conclusions

No significant difference in any of the analysed outcome measures was observed. Posterior reconstruction of the musculofascial complex does not appear to improve early urinary incontinence after RALP.

Take Home Message

Posterior reconstruction of the musculofascial complex does not appear to improve early urinary incontinence following robot-assisted radical laparoscopic prostatectomy (RALP). More randomised controlled trials are needed, perhaps with an alternative technique, to prove the benefit of adding this type of step to standard RALP.

Keywords: Prostatectomy, Laparoscopic surgery, Robotic surgery, Urinary incontinence.

Footnotes

a Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands

b North Coast Area Health Service, New South Wales, Australia

lowast Corresponding author. Afdeling Urologie, AvL-NKI, Plesmanlaan 121, Amsterdam 1066CX, The Netherlands. Tel. +31 20 512 2000.