title: Improving time to continence after robot-assisted laparoscopic prostatectomy: augmentation of the total anatomic reconstruction technique by adding dynamic detrusor cuff trigonoplasty and suprapubic tube placement.
abstract: After robot-assisted laparoscopic prostatectomy, total anatomic reconstruction (TR) with the additions of a circumapical urethral dissection, a dynamic detrusor cuff trigonoplasty, and placement of a suprapubic catheter was performed in 49 patients from June to July 2012. Continence at 6 weeks after catheter removal was assessed for an initial group of 23 patients, and also at 2 weeks in an additional 26 patients who most recently had undergone surgery. Follow-up appointments and telephone interviews were used to assess pad use and continence. Of the initial 23 patients receiving the modified TR, 60.9% had 0 pad use at 6 weeks. By 2 weeks, 65.4% of the most recent 26 patients operated on achieved continence with 0-1 pad use. Preservation and reconstruction of the pelvic floor and supporting bladder structures leads to an earlier return of continence. These key steps need to be validated and confirmed in larger and randomized trials.
authors.affiliation: Department of Urology, Weill Cornell Medical College of Cornell University, New York, NY, USA. akt2002@med.cornell.edu
authors.forename: Ashutosh K
authors.initials: AK
authors.lastname: Tewari
authors.forename: Adnan
authors.initials: A
authors.lastname: Ali
authors.forename: George
authors.initials: G
authors.lastname: Ghareeb
authors.forename: Wesley
authors.initials: W
authors.lastname: Ludwig
authors.forename: Sheela
authors.initials: S
authors.lastname: Metgud
authors.forename: Nithin
authors.initials: N
authors.lastname: Theckumparampil
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takenaka
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Abhishek
authors.initials: A
authors.lastname: Shrivastava
authors.forename: Steve A
authors.initials: SA
authors.lastname: Kaplan
authors.forename: Robert
authors.initials: R
authors.lastname: Leung
authors.forename: Rahul
authors.initials: R
authors.lastname: Paryani
authors.forename: Siobhan
authors.initials: S
authors.lastname: Grushow
authors.forename: Matthieu
authors.initials: M
authors.lastname: Durand
authors.forename: Alexandra
authors.initials: A
authors.lastname: Peyser
authors.forename: Sameer
authors.initials: S
authors.lastname: Chopra
authors.forename: Niyati
authors.initials: N
authors.lastname: Harneja
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Michael
authors.initials: M
authors.lastname: Herman
authors.forename: Brian
authors.initials: B
authors.lastname: Robinson
authors.forename: Maria M
authors.initials: MM
authors.lastname: Shevchuck
mesh_terms: D004210:Dissection; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D009132:Muscles / Q000601:surgery*; D010865:Pilot Projects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012371:Robotics; D013997:Time Factors; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000209:etiology*