title: Anterior suspension combined with posterior reconstruction during robot-assisted laparoscopic prostatectomy improves early return of urinary continence: a prospective randomized multicentre trial.
abstract: What's known on the subject? and What does the study add? Urinary incontinence is one of the major drawbacks of radical prostatectomy, regardless of the procedure used (i.e. open, laparoscopic or robotic-assisted). Several technical modifications have been described to improve postoperative continence, highlighting the role of puboprostatic ligaments and posterior reconstruction of the rhabdomyosphincter. The results obtained are inconsistent when applied to robotic surgery. The present multicentre randomized study shows that anterior suspension combined with posterior reconstruction is a safe and easy-to-perform technique for improving early continence after robotic-assisted laparoscopic prostatectomy.
  
  
  OBJECTIVE
  To assess the impact on urinary continence of anterior retropubic suspension with posterior reconstruction during robot-assisted laparoscopic prostatectomy (RALP).
  
  
  METHODS
  In total, 72 patients who were due to undergo prostatectomy between July 2009 and July 2010 were prospectively randomized into two groups: group A underwent a standard RALP procedure and group B had anterior suspension and posterior reconstruction during RALP. The primary outcome measure was urinary continence, assessed using the University of California Los Angeles Prostate Cancer Index questionnaire at 15 days, and at 1, 3 and 6 months, after surgery. Other data recorded were operation duration, blood loss, length of hospital stay, duration of bladder catheterization, complications and positive margin rate.
  
  
  RESULTS
  The continence rates at 15 days, and at 1, 3 and 6 months, after surgery were 3.6%, 7.1%, 15.4% and 57.9%, respectively, in group A, and 5.9%, 26.5%, 45.2% and 65.4%, respectively, in group B. The continence rates differed statistically between groups at 1 and 3 months (P = 0.047 and P = 0.016, respectively). There was no significant difference between groups regarding complications (P = 0.8) or positive margin rate (P = 0.46).
  
  
  CONCLUSIONS
  Anterior suspension associated with posterior reconstruction during RALP improved the early return of continence, without increasing complications.
authors.affiliation: Urology Department, University Hospital of Tours, Tours, France. hurtesx@gmail.com
authors.forename: Xavier
authors.initials: X
authors.lastname: Hurtes
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
authors.forename: Helder
authors.initials: H
authors.lastname: Pereira
authors.forename: Benjamin
authors.initials: B
authors.lastname: Faivre d'Arcier
authors.forename: Luc
authors.initials: L
authors.lastname: Cormier
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyère
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012371:Robotics; D016037:Single-Blind Method; D013997:Time Factors; D014554:Urination