Korean J Urol.  2009 Dec;50(12):1203-1207.

Effect of Posterior Urethral Reconstruction (PUR) in Early Recovery of Urinary Continence after Robotic-Assisted Radical Prostatectomy

• Kim SD
• Kim TH
• Cho JW
• You YC
• Sung GT

Abstract

PURPOSE
Prolonged urinary incontinence is one of the greatest concerns for patients undergoing radical prostatectomy. One of the possible causes for this urinary incontinence is a postoperative deficiency of the external striated urethral sphincter (EUS) complex and continence nerves. We evaluated the effect of posterior urethral reconstruction (PUR) in the early recovery of urinary continence after robotic-assisted radical prostatectomy.
MATERIALS AND METHODS
Between January 2008 and March 2009 we performed robotic-assisted radical prostatectomy with PUR in 30 patients (PUR group) and without PUR in 30 patients (non-PUR group). We compared perioperative parameters and postoperative continence rates between the two groups. Continence was defined as no pads or one diaper per 24 hours and was assessed 1 month, 3 months, and 6 months after the procedure.
RESULTS
Patients in the PUR group achieved better continence rates at 1 month (43% vs. 35%) and 3 months of follow-up (89% vs. 64%). At 6 months of follow-up, the continence rate was similar between the two groups (96% vs. 90%). No major complications were observed in the PUR group. However, 2 cases of anastomotic site leakage and 1 case of delayed bleeding were observed in the non-PUR group.
CONCLUSIONS
Posterior urethral reconstruction appears to be an easy and reproducible technique in robotic-assisted radical prostatectomy. Our early experience demonstrates that PUR in robotic-assisted radical prostatectomy appears to confer early continence recovery and reduce intraoperative complications.

Keyword

Robotics; Prostatectomy; Urinary incontinence

MeSH Terms

Follow-Up Studies
Hemorrhage
Humans
Intraoperative Complications
Prostatectomy
Robotics
Urethra
Urinary Incontinence

Figure

• 

  Fig. 1 Schematic diagram of posterior urethral reconstruction during robot-assisted radical prostatectomy. (A) Denonvillier's fascia is approximated to the posterior aspect of the rhabdosphincter and the posterior median raphe by using one arm of the continuous suture. (B) The running suture takes three "bites" of each, the urethra and the bladder neck are approximated, and the suture is tied.

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