title: Endopelvic fascia preservation during robot-assisted laparoscopic radical prostatectomy: does it affect urinary incontinence?
abstract: OBJECTIVE
  Urinary incontinence has a significant impact on the quality of life after radical prostatectomy. This study aimed to determine whether preserving the endopelvic fascia influences subsequent urinary incontinence.
  
  
  METHODS
  Consecutive patients (n = 138) who underwent robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer between October 2010 and June 2012 with a minimum of 1 year follow-up were retrospectively analysed. The subjects were divided into two groups: the non-preserved endopelvic fascia group (nPE group) and the preserved endopelvic fascia group (PE group). Continence was defined as not using any pads and having no urine leakages. Continence rates at set time-points after RALP were compared using the chi-squared test. Continence recovery rates were analysed with the Kaplan-Meier method and the log-rank test. Prognostic factors of incontinence were identified using the Cox proportional hazards model.
  
  
  RESULTS
  The age, body mass index, preoperative prostate-specific antigen levels, prostate volume, estimated blood loss, mean operative time, Gleason score and pathological stage were not significantly different between the two study groups. The continence rate of the nPE group and PE group was 88.4% and 97.1%, respectively, at 12 months after surgery (p = 0.049), which was also significant according to the Kaplan-Meier analysis (p < 0.001). Preservation of endopelvic fascia was the only significant prognostic factor for urinary incontinence (p = 0.002, hazard ratio = 1.867) according to the multivariate analysis.
  
  
  CONCLUSIONS
  Endopelvic fascia preservation during RALP significantly enhances postoperative continence and is related to the speed of recovery of continence.
authors.affiliation: Departments of Urology.
authors.forename: Se Yun
authors.initials: SY
authors.lastname: Kwon
authors.forename: Jun Nyung
authors.initials: JN
authors.lastname: Lee
authors.forename: Hyun Tae
authors.initials: HT
authors.lastname: Kim
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Kim
authors.forename: Bup Wan
authors.initials: BW
authors.lastname: Kim
authors.forename: Gyu-Seog
authors.initials: GS
authors.lastname: Choi
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000071938:Fasciotomy; D005500:Follow-Up Studies; D006801:Humans; D016496:Incontinence Pads; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010388:Pelvis; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology* / Q000517:prevention & control
keywords: incontinence; prostate cancer; robot