Early continence outcomes of posterior musculofascial plate reconstruction during robotic and laparoscopic prostatectomy.
OBJECTIVE
To detail the technique and evaluate in a preliminary study the effectiveness of posterior reconstruction of Denonvilliers' musculofascial plate (PRDMP) in enhancing early continence after robotic and laparoscopic radical prostatectomy (RP).


METHODS
Thirty-two consecutive patients having robotic or laparoscopic RP with PRDMP (group 1). Thirty previous patients not having PRDMP were compared as historical controls (group 2). Continence, as measured by patient self-reporting of the number of pads used/24 h, was assessed at 3 days and 6 weeks after catheter removal, by telephone interview. 'Continent' was defined as the use of none or one pads, 'moderate incontinence' as two pads, and 'severe incontinence' as more than two pads. Intraoperative transrectal ultrasonography (TRUS) was used to measure the membranous urethral length before and after PRDMP.


RESULTS
At 3 days after catheter removal, more patients in group 1 were continent than in group 2 (34% vs 3%, P = 0.007). At 6 weeks continence was again better in group 1 (56% vs 17%, P = 0.006). The mean length of the membranous urethra on TRUS measured before RP, after RP but before the musculofascial suture, and afterward, was 15.6, 12 and 14 mm, respectively. Thus, reconstruction restored the length of the transected membranous urethra by a mean of 2 mm.


CONCLUSIONS
PRDMP during robotic and laparoscopic RP leads to improved maintenance of membranous urethral length and significantly higher early continence rates.
Nguyen
Mike M
MM
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Kamoi
Kazumi
K
Stein
Robert J
RJ
Aron
Monish
M
Hafron
Jason M
JM
Turna
Burak
B
Myers
Robert P
RP
Gill
Inderbir S
IS
D016022:Case-Control Studies; D015331:Cohort Studies; D020878:Device Removal; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D011471:Prostatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000517:prevention & control*