title: The powerful impact of double-layered posterior rhabdosphincter reconstruction on early recovery of urinary continence after robot-assisted radical prostatectomy.
abstract: OBJECTIVE
  The usefulness of posterior rhabdosphincter reconstruction (PR) during robot-assisted radical prostatectomy (RARP) has still been controversial. We investigated the association of several factors, including the Rocco original double-layered PR, with early recovery of urinary continence after RARP.
  
  
  METHODS
  Between August 2006 and April 2011, a single surgeon at Tokyo Medical University Hospital performed 206 RARPs. Of these 206 patients, 199 eligible patients were enrolled in this study. We retrospectively analyzed the correlation of several perioperative factors, including surgical techniques, with early recovery of urinary continence 1 month after catheter removal. Continence was defined as no use or the use of only one safety pad.
  
  
  RESULTS
  Univariate analysis showed that surgeon experience, lateral approach of bladder neck preservation, bladder neck reconstruction, anterior reconstruction, and the Rocco double-layered PR were significantly associated with early recovery of urinary continence 1 month after catheter removal. Preoperative prostate-specific antigen level, body mass index, and attempted nerve-sparing (NS) procedures, however, were not significantly associated with early recovery of urinary continence. Multivariate logistic regression analysis showed that the Rocco PR and attempted NS were the only independent predictive factors of urinary continence recovery 1 month after catheter removal (odds ratio [OR], 15.01; 95% confidence interval [CI], 3.413-66.67; P=0.0003 and OR, 2.248; 95% CI, 1.048-4.975; P=0.0402, respectively). When we applied NS as well as the Rocco PR, the recovery rates of continence at 1 month after catheter removal was 85.3%.
  
  
  CONCLUSIONS
  The Rocco double-layered PR and attempted NS and not surgeon experience were the significant independent predictive factors of early recovery of urinary continence after RARP. NS procedures positively influenced early recovery of urinary continence only when they were applied with the PR technique.
authors.affiliation: Department of Urology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakagami
authors.forename: Riu
authors.initials: R
authors.lastname: Hamada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kashima
authors.forename: Kenji
authors.initials: K
authors.lastname: Shimodaira
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Naoya
authors.initials: N
authors.lastname: Satake
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011468:Prostatectomy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012371:Robotics; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology*; D013520:Urologic Surgical Procedures