title: Anatomic restoration technique of continence mechanism and preservation of puboprostatic collar: a novel modification to achieve early urinary continence in men undergoing robotic prostatectomy.
abstract: OBJECTIVE
  The puboprostatic ligaments, puboperinealis muscle, and arcus tendineus are all recognized as important for continence in men and women. This complex of ligaments, muscles, and tendineus aponeurosis acts in unison to provide continence and can be disrupted during robotic prostatectomy. We propose that preservation of the puboprostatic collar during robotic surgery will help to restore early continence in men undergoing robotic prostatectomy.
  
  
  METHODS
  We performed cadaveric studies in 10 fresh cadavers to devise strategies to leave intact the puboprostatic ligaments, muscular collar, and arcus tendineus supporting the continence mechanism. We developed reconstructive strategies to reconnect the ligaments to the urethrovesical anastomosis, reapproximated the muscles, and fixed the distal bladder to the arcus tendineus. These modifications were then attempted in 50 consecutive patients who underwent robotic prostatectomy for clinically localized prostate cancer. The patient-reported outcomes were then used to assess the efficacy of this procedure.
  
  
  RESULTS
  The technique was reproducible, and the average additional time taken for the final reconstruction was only 2 to 5 minutes. The continence rate was 29% in the first week, 62% at 6 weeks, 88% at 12 weeks, and 95% in 16 weeks after catheter removal. No other differences were found in the operative, oncologic, or perioperative outcomes.
  
  
  CONCLUSIONS
  This modification helped in the early return of continence. It is unlikely that the long-term results will be any different, but shortening the recovery time will have psychological, financial, and health-related quality-of-life benefits for the patients.
authors: Department of Urology, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10021, USA. akt2002@med.cornell.edu
authors: Ashutosh K
authors: AK
authors: Tewari
authors: Kevin
authors: K
authors: Bigelow
authors: Sandhya
authors: S
authors: Rao
authors: Atsushi
authors: A
authors: Takenaka
authors: Nasr
authors: N
authors: El-Tabi
authors: Alex
authors: A
authors: Te
authors: E D
authors: ED
authors: Vaughan
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000033:anatomy & histology* / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D012371:Robotics; D013997:Time Factors; D014549:Urinary Incontinence / Q000517:prevention & control