Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatectomy: anatomic basis and preliminary outcomes.
OBJECTIVE
The aims of the present study are to prove the hypothesis that the preservation of the puboprostatic collar and puboperineoplasty contribute to the early recovery of urinary continence after robotic radical prostatectomy. We reconfirm the anatomy of the periurethral supporting tissue and show the preliminary result on the early continence of patients undergoing this modification.


METHODS
Using 10, male, fresh cadavers, we traced the endopelvic fascia, the fascia of levator ani, puboprostatic ligaments, rhabdosphincter, and puboperinealis muscle to devise strategies in preserving this complex. The modifications were then attempted by a single surgeon (A.K.T.) in 19 patients undergoing robotic prostatectomy during September 2005.


RESULTS
After incision of the endopelvic fascia within the fascial tendinous arch of the pelvis, the puboprostatic collar and the levator ani could be separated laterally. The puboperinealis muscle attached to part of the pubic symphysis behind the puboprostatic ligament and terminated at the perineal body. We were able to preserve the puboprostatic collar in all attempted cases. Furthermore, puboperineoplasty took 5min to complete. The total continence rate was 63.2% at median follow-up of 38.1 d. Immediate continence rate just after catheter removal was 42.1%. The rate at 1 and 4 wk was 52.6% and 71.4%, respectively. The margins of the examined specimens were all negative for malignancy.


CONCLUSIONS
This modification should preserve or allow for early recovery of urinary continence from an anatomic perspective. Further studies are necessary to elucidate the clinical impact on a patient's early continence.
Takenaka
Atsushi
A
Department of Urology, Weill Medical College of Cornell University, New York City, New York, USA. atake@med.kobe-u.ac.jp <atake@med.kobe-u.ac.jp>
Tewari
Ashutosh K
AK
Leung
Robert A
RA
Bigelow
Kevin
K
El-Tabey
Nasr
N
Murakami
Gen
G
Fujisawa
Masato
M
D000328:Adult; D002102:Cadaver; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects*; D020127:Recovery of Function; D012371:Robotics; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology* / Q000517:prevention & control*