Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy.
OBJECTIVE
Urinary incontinence is one of the major drawbacks of radical retropubic prostatectomy (RRP). One of the possible reasons for this urinary incontinence is a postoperative deficiency of the rhabdosphincter (RS). It has been recently demonstrated that reconstruction of the posterior aspects of the RS allows a rapid recovery of continence after RRP. This study evaluated the application of this technique in videolaparoscopic radical prostatectomy (VLRP), assessing the percentage of continent patients at 3, 30, and 90 d after catheter removal.


METHODS
A two-arm prospective comparative trial was carried out with 31 patients recruited for each arm. Group A underwent standard VLRP and group B underwent VLRP with RS reconstruction (VLRP-R). Continence was defined as no pads or one diaper/24h and was assessed 3, 30, and 90 d after the procedure.


RESULTS
At catheter removal, 74.2% versus 25% (p=0.0004) of patients were continent with the VLRP-R technique versus VLRP, respectively. A statistically significant difference was present at 30 d (83.8% vs. 32.3%; p=0.0001) At 90 d the difference, although still present, was not statistically significant (92.3% vs. 76.9%; p=0.25).


CONCLUSIONS
In this preliminary report, the posterior reconstruction of the RS appears to be an easy and feasible technique even in a laparoscopic setting. Time to continence recovery was significantly shortened.
Rocco
Bernardo
B
Division of Urology, European Institute of Oncology, Milan, Italy.
Gregori
Andrea
A
Stener
Silvio
S
Santoro
Luigi
L
Bozzola
Andrea
A
Galli
Stefano
S
Knez
Roberto
R
Scieri
Francesco
F
Scaburri
Alessandra
A
Gaboardi
Franco
F
D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D013997:Time Factors; D014521:Urethra / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control; D020535:Video-Assisted Surgery