title: Modified posterior musculofascial plate reconstruction decreases the posterior vesicourethral angle and improves urinary continence recovery in patients undergoing laparoscopic radical prostatectomy.
abstract: The aim of this study was to evaluate the efficacy of our modified posterior musculofascial plate reconstruction (PMPR) procedure in laparoscopic radical prostatectomy (LRP). Prior to 2010, four operative procedures were used to expedite continence recovery: preserving the fascia covering the levator ani muscle, preserving the bladder neck, securing a functional urethral length by using a lateral-view dissection technique and suspending the vesicourethral anastomosis from the puboprostatic ligaments. Since February, 2010, a running suture between Denonvilliers' fascia (DF) and the median fibrous raphe (MFR, the fibrous tissue that lies immediately underneath the urethra) has also been used. In vesicourethral anastomosis, a double-armed running suture was performed. At the beginning of the anastomosis, the first stitches (at 1 and 11 o'clock positions on the bladder neck) were placed 1-2 cm dorsocephalad to the bladder neck (first through the seromuscular layer and then through the full thickness of the bladder neck). At the 5 and 7 o'clock positions of the urethra, the stitches were placed through the urethral mucosa as well as the the reconstructed musculofascial plate. The bladder shape was evaluated by postoperative cystography and the clinical results were compared between patients undergoing LRP without PMPR (group A) and those undergoing LRP with PMPR (group B). The cystograms demonstrated that the PMPR significantly shortened the vertical length of the bladder and significantly decreased the posterior vesicourethral angle. At 1, 3 and 6 months after LRP, the number of daily used pads was significantly lower in group B compared to that in group A and the time to achieve a pad-free status was significantly shorter in group B. Our modified PMPR procedure significantly improved the recovery of urinary continence following LRP and this improvement may be due in part to changes of the bladder shape.
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Seguchi
authors.initials: S
authors.lastname: Kenji
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshii
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hamada
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Asakuma
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Tasaki
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroda
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sato
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Horiguchi
authors.affiliation: Department of Urology, National Defense Medical College, Tokorozawa, Saitama 359-8513, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Asano
keywords: laparoscopic radical prostatectomy; posterior musculofascial plate reconstruction; urinary incontinence; vesicourethral angle