title: Early return of continence in patients undergoing robot-assisted laparoscopic prostatectomy using modified maximal urethral length preservation technique.
abstract: OBJECTIVE
  To evaluate the impact of maximal urethral length preservation (MULP) technique in comparison with posterior urethral reconstruction and anterior bladder suspension (PRAS) technique on the continence rates (CR), time to achieve continence among patients with prostate cancer (PCa) undergoing robot-assisted laparoscopic prostatectomy (RALP).
  
  
  METHODS
  We prospectively analyzed the CR, time to achieve continence, pre- and postoperative prostate-specific antigen (PSA) levels, rates of positive margins among three groups of continent men with PCa undergoing RALP from whom consent was obtained. Each group consisted of 30 patients: PRAS was performed in group A, combined MULP and PRAS in group B, and MULP in group C. Continence was measured by patient self-reporting of the number of pads/24 h.
  
  
  RESULTS
  No differences were detected in the age, preoperative PSA levels, biochemical recurrence, prostate volume, and positive margins for the three groups. Men in groups B and C had marked improvement in CR 1, 3, and 6 months after catheter removal vs group A (50% and 70% vs 10%, 90% and 96.66% vs 23.3% and 100%, 100% vs 53.3%, respectively, P<0.0001). The average and median times to continence were significantly shorter in group B (5.4 and 4 weeks) and C (3.8 and 3 weeks) vs group A (27.4 and 22.5 weeks), P<0.00001. Using Cox regression analysis, only MULP and MULP+PRAS techniques were significantly correlated with continence outcomes 1, 3, and 6 months after catheter removal.
  
  
  CONCLUSIONS
  MULP rather than PRAS confers higher postoperative CR and shorter time to achieve continence among patients with PCa who underwent RALP without increasing risk of positive margin.
authors.affiliation: 1 Department of Urology, Jackson South Hospital , Miami, Florida.
authors.forename: Alaa
authors.initials: A
authors.lastname: Hamada
authors.forename: Shirin
authors.initials: S
authors.lastname: Razdan
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Etafy
authors.forename: Randy
authors.initials: R
authors.lastname: Fagin
authors.forename: Sanjay
authors.initials: S
authors.lastname: Razdan
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D020127:Recovery of Function / Q000502:physiology*; D012044:Regression Analysis; D012371:Robotics / Q000379:methods*; D014521:Urethra / Q000033:anatomy & histology / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*
chemical_list: D017430:Prostate-Specific Antigen