title: Effects of new 1-step posterior reconstruction method on recovery of continence after robot-assisted laparoscopic prostatectomy: results of a prospective, single-blind, parallel group, randomized, controlled trial.
abstract: OBJECTIVE
  We devised a 1-step posterior reconstruction technique that opposes the median dorsal raphe only to the posterior counterpart of the detrusor apron rather than to Denonvilliers' fascia. In a retrospective study we previously found that during robot-assisted laparoscopic prostatectomy this new technique could significantly shorten continence recovery time. We designed a prospective clinical trial to confirm this.
  
  
  METHODS
  We designed a single-blind, parallel group, randomized, controlled trial. A total of 100 men who underwent robot-assisted laparoscopic prostatectomy performed by a single surgeon at a referral center were randomly allocated to the intervention group (50) or the control group (50) from October 2012 through August 2013. The intervention group underwent posterior reconstruction with this new technique before vesicourethral anastomosis. All patients in each group were treated with anterior reconstruction. The study primary end point was time to continence recovery, defined as no pad use. Secondary outcomes were time to recovery of social continence, defined as 0 or 1 pad used per day.
  
  
  RESULTS
  One control was excluded from analysis due to open conversion and 4 patients were excluded since they withdrew from participation. Median time to complete continence recovery did not differ significantly between the intervention and control groups (106 and 119 days, respectively, p = 0.890). However, time to social continence recovery was significantly shorter in the intervention group than in controls (median 18 vs 30 days, p = 0.024).
  
  
  CONCLUSIONS
  One-step posterior reconstruction did not significantly shorten time to complete continence recovery. However, it seemed to have a marginal benefit on early recovery of social continence.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Oh
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Sangchul
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Jeong
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Republic of Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: selee@snubh.org.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function; D065287:Robotic Surgical Procedures; D016037:Single-Blind Method; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*
keywords: prostatectomy; prostatic neoplasms; robotics; treatment outcome; urinary incontinence