title: Posterior reconstruction and outcomes of laparoscopic radical prostatectomy in a high-risk setting.
abstract: OBJECTIVE
  To detail the technique and evaluate the impact of a personal modified posterior reconstruction technique (PDR) on the outcomes of extrafascial laparoscopic radical prostatectomy (eLRP) in a consecutive series of 52 patients affected by high-risk prostate cancer (HRPCa).
  
  
  METHODS
  From October 2007 to March 2012, 52 patients underwent PDR during eLRP for HRPCa. Fifty-four patients who underwent eLRP for HRPCa with no PDR were considered as historical controls. Mean operative time (MOT), mean catheterization time (MCT), % continence and quality of life (QoL) at a scheduled follow-up, % anastomotic leakage, % adjuvant therapy were compared between the groups. Percentage of continence and QoL were prospectively assessed by self-administered validated questionnaires (ICI-Q-SF; SF-36) at 1, 3, 6, and 12 months.
  
  
  RESULTS
  PDR was associated wither higher continence rates at 1 and 3 mo (P = .028, P = .006), a lower incidence of cystographic leakage (P = .002), and an increased adjuvant radiotherapy rate (P = .008). At 1- and 3-mo interval, in the PDR group, we found a higher number of patients reporting better general health, (P = .01, P = .03) reduced role limitations due to physical health, (P = .02, P = .001), and emotional problems (P = .001, P = .02).
  
  
  CONCLUSIONS
  PDR is associated with a lower degree of anastomotic leakage, and it significantly enhances urinary continence at 1 and 3 mo. The increased adjuvant radiotherapy rate and quality of life after surgery observed with our technique suggest that in the high-risk setting an early functional recovery may substantially influence the oncologic outcome of eLRP.
authors.affiliation: Department of Urology, Viale dei Colli Portuensi 579 - CAP 00151 Rome (Italy). Policlinico Tor Vergata, Viale Oxford 81 00133- Rome - Italy. umberto.anceschi@alice.it.
authors.forename: U
authors.initials: U
authors.lastname: Anceschi
authors.affiliation: S. Camillo-Forlanini Hospital, Department of Urology, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gaffi
authors.affiliation: S. Camillo-Forlanini Hospital, Department of Urology, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Molinari
authors.affiliation: S. Camillo-Forlanini Hospital, Department of Urology, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Anceschi
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome; D014554:Urination