title: Urinary incontinence after robot-assisted radical prostatectomy: pathophysiology and intraoperative techniques to improve surgical outcome.
abstract: Robot-assisted radical prostatectomy has been shown to have comparable and possibly improved postoperative continent rates compared with retropubic and laparoscopic radical prostatectomy. However, postoperative urinary incontinence has remained one of the most bothersome postoperative complications. The basic concept of the intraoperative technique to improve postoperative urinary continence is to maintain as normal anatomical and functional structure in the pelvis as possible. Therefore, improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of urinary continence. It might be necessary to carry out three steps to realize improvement of the early return of urinary continence after robot-assisted radical prostatectomy: (i) preservation (bladder neck, neurovascular bundle, puboprostatic ligament, pubovesical complex, and/or urethral length, etc.); (ii) reconstruction (posterior and/or anterior reconstruction, and/or reattachment of the arcus tendineus to the bladder neck, etc.); and (iii) reinforcement (bladder neck plication and/or sling suspension, etc.). On the basis of these steps, further modifications during robot-assisted radical prostatectomy should be developed to improve urinary continence and quality of life after robot-assisted radical prostatectomy.
authors.affiliation: Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kojima
authors.forename: Norio
authors.initials: N
authors.lastname: Takahashi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Haga
authors.forename: Masanori
authors.initials: M
authors.lastname: Nomiya
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Yanagida
authors.forename: Kei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Ken
authors.initials: K
authors.lastname: Aikawa
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
mesh_terms: D006801:Humans; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control
keywords: anatomy; prostate cancer; prostatectomy; robotic surgery; urinary incontinence