title: Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: impact on early recovery of urinary continence.
abstract: OBJECTIVE
  To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes.
  
  
  METHODS
  A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction.
  
  
  RESULTS
  There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P < 0.05). The mean interval to achieve continence was significantly shorter in the total pelvic floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003).
  
  
  CONCLUSIONS
  The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical reinforcement of the pelvic floor. Therefore, this technique is likely to improve urinary continence outcomes after laparoscopic radical prostatectomy.
authors: Department of Urology, Tokai University School of Medicine, Isehara, Japan.
authors: Akio
authors: A
authors: Hoshi
authors: Masahiro
authors: M
authors: Nitta
authors: Yuuki
authors: Y
authors: Shimizu
authors: Taro
authors: T
authors: Higure
authors: Masayoshi
authors: M
authors: Kawakami
authors: Nobuyuki
authors: N
authors: Nakajima
authors: Kazuya
authors: K
authors: Hanai
authors: Takeshi
authors: T
authors: Nomoto
authors: Yukio
authors: Y
authors: Usui
authors: Toshiro
authors: T
authors: Terachi
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery*; D011467:Prostate / Q000473:pathology; D011468:Prostatectomy / Q000379:methods* / Q000534:rehabilitation; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000534:rehabilitation*
keywords: anterior reconstruction; laparoscopic surgery; posterior reconstruction; prostate cancer; urinary incontinence