title: Robotic-assisted laparoscopic prostatectomy: a critical analysis of its impact on urinary continence.
abstract: OBJECTIVE
  Over 90% of all prostate cancer patients are diagnosed at a stage when the disease is organ-confined and potentially curable. Currently, more than 60% of all prostate cancer surgeries in the USA are performed using the robotic approach. We review the current literature evaluating the technical advances to optimize continence recovery following robotic prostatectomy.
  
  
  RESULTS
  Recent studies suggest that the several technical nuances during robotic prostatectomy can result in earlier continence recovery in patients without compromising the oncologic outcome. The key is in delicate handling of tissues, reducing trauma, preserving support structures, and restoring postoperative anatomy as close as possible to preoperative anatomy. There should also be standardization in assessment of continence recovery.
  
  
  CONCLUSIONS
  Much progress has been achieved in elucidating the anatomic, physiologic, and neural basis of the male continence mechanism, resulting in novel adaptations of the conventional approach to radical prostatectomy with the aim of preserving continence and accelerating its return. Various principles for augmenting continence return have been proposed which have been evaluated in series of open, laparoscopic, and robotic-assisted radical prostatectomy. Going forward, we foresee a paradigm shift from individual techniques toward a unified approach of interwoven principles aimed at preserving and augmenting the functional and innervative anatomy of the continence mechanism.
authors.affiliation: Lefrak Center of Robotic Surgery and Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, NewYork, NewYork, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Srivastava
authors.forename: Sonal
authors.initials: S
authors.lastname: Grover
authors.forename: Prasanna
authors.initials: P
authors.lastname: Sooriakumaran
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Joneja
authors.forename: Ashutosh K
authors.initials: AK
authors.lastname: Tewari
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000517:prevention & control*