title: Bladder neck plication stitch: a novel technique during robot-assisted radical prostatectomy to improve recovery of urinary continence.
abstract: OBJECTIVE
  Efforts to improve postprostatectomy incontinence have led to many modifications in surgical technique. We present our experience with a novel technique to improve continence outcomes in patients who are undergoing robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  A consecutive series of 159 patients after initiation of a bladder neck plication stitch was compared with the most recent group before the change. After completion of the vesicourethral anastomosis, a single suture was used to plicate the distal bladder neck. A structured questionnaire was used for follow-up. Continence criteria used were 1 pad per day for social continence and 0 pad per day for total continence.
  
  
  RESULTS
  A total of 334 patients were included in the study: 159 in the plication stitch group vs 175 in the control group. Average age was 59.1 vs 59.6 years, average body mass index was 27.9 vs 28.3 kg/m(2), and average prostate volume was 58.1 vs 60.9 cc, respectively. The mean time to reach social continence was 3.63±3.01 vs 5.33±4.89 weeks (P=0.004), and total continence was 5.10±3.80 vs 8.49±6.32 weeks (P=0.002), respectively. Chance of total continence improved with the bladder plication stitch: Odds ratio of 1.95±0.72 (P<0.001) at 1 month, 1.25±0.56 (P=0.113) at 3 months, and 2.07±0.66 (P=0.005) at 12 months. There were no bladder neck contractures or other urinary complications noted in either group.
  
  
  CONCLUSIONS
  The bladder plication stitch is a simple and effective technical modification for shortening the period of recovery of urinary continence in RARP patients. Randomized controlled trials are under way to further evaluate this technique.
authors.affiliation: Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. David.Lee@uphs.upenn.edu
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Alexei
authors.initials: A
authors.lastname: Wedmid
authors.forename: Pierre
authors.initials: P
authors.lastname: Mendoza
authors.forename: Saurabh
authors.initials: S
authors.lastname: Sharma
authors.forename: Mary
authors.initials: M
authors.lastname: Walicki
authors.forename: Rachel
authors.initials: R
authors.lastname: Hastings
authors.forename: Kelly
authors.initials: K
authors.lastname: Monahan
authors.forename: Daniel
authors.initials: D
authors.lastname: Eun
mesh_terms: D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011468:Prostatectomy / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology*; D012371:Robotics; D013537:Sutures; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000503:physiopathology*