Surgical strategies to promote early continence recovery after robotic radical prostatectomy.
OBJECTIVE
Over 90% of all prostate cancer patients are diagnosed at a stage when the disease is organ-confined and potentially curable.  Currently >60% of all  prostate cancer surgeries in the United States are performed using the robotic approach. We review the current literature evaluating the technical  advances to  optimize continence recovery following robotic prostatectomy.


METHODS
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  post-operative  anatomy as close as possible to pre-operative 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.
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, USA.
Abhishek
A
Srivastava
Alexandra
A
Peyser
Siobhan
S
Gruschow
Niyati
N
Harneja
Katerina
K
Jiskrova
Ashutosh K
AK
Tewari
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D006801:Humans; D007036:Hypothermia, Induced; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000503:physiopathology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*