title: Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence.
abstract: BACKGROUND
  The introduction of robotics revolutionized prostate cancer surgery because the magnified three-dimensional vision system and wristed instruments allow microsurgery to be performed. The advantages of robotic surgery could lead to improved continence outcomes in terms of early recovery compared with the traditional surgical methods.
  
  
  OBJECTIVE
  To describe the total anatomical reconstruction (TAR) technique during robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  evaluation of the continence rate at different time points. Secondary endpoint: evaluation of urine leakage and anastomosis stenosis rates related to the technique.
  
  
  METHODS
  June, 2013 to November, 2014; prospective consecutive series of patients with localized prostate cancer (cT1-3, cN0, cM0).
  
  
  METHODS
  RARP with TAR was performed in all cases. Lymph node dissection was performed if the risk of lymph nodal metastasis was over 5%, according to the Briganti updated nomogram.
  
  
  METHODS
  Preoperative, intraoperative, postoperative, and pathological variables were analyzed. Enrolled patients were arbitrarily divided into three groups according to a time criterion. The relationships between the learning curve and the trend of the above-mentioned variables were analyzed using LOESS analysis. Continence was rigorously analyzed preoperatively and at 24h, 1 wk, 4 wk, 12 wk, and 24 wk after catheter removal.
  
  
  CONCLUSIONS
  In total, 252 patients were analyzed. The continence rates immediately after catheter removal and at 1 wk, 4 wk, 12 wk, and 24 wk after RARP were 71.8%, 77.8%, 89.3%, 94.4%, and 98.0%, respectively. Multivariate analysis revealed that the nerve sparing technique, D'Amico risk groups, lymph node dissection, and prostate volume were involved in the early recovery of urinary continence. One ileal perforation requiring reoperation was recorded. The transfusion rate was 0.8%. Thirty-one (12.3%) postoperative complications were recorded up to 6 mo after surgery. Among these, eight acute urinary retentions (3.2%) and three urine leakages (1.2%) were recorded. There was a lack of randomization and comparison with other techniques. Both anatomical dissection of the prostatic apex and TAR were used. The results may not be generalized to low-volume centers.
  
  
  CONCLUSIONS
  The TAR technique showed promising results in the early recovery of urinary continence, as well as watertight anastomosis and a low rate of urine leakage. The oncologic results were not affected. Comparative studies are needed to support the quality of reported results.
  
  
  RESULTS
  On the basis of our findings, it seems that the risk of urinary incontinence following radical prostatectomy can be lowered via meticulous anatomical reconstruction using a robotic system. Comparative studies are required to support the reported results.
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy. Electronic address: porpiglia@libero.it.
authors: Francesco
authors: F
authors: Porpiglia
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
authors: Riccardo
authors: R
authors: Bertolo
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
authors: Matteo
authors: M
authors: Manfredi
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
authors: Stefano
authors: S
authors: De Luca
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
authors: Enrico
authors: E
authors: Checcucci
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
authors: Ivano
authors: I
authors: Morra
authors: Division of Nuclear Medicine, San Giovanni Battista Hospital, University of Torino, Turin, Italy.
authors: Roberto
authors: R
authors: Passera
authors: Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy.
authors: Cristian
authors: C
authors: Fiori
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D020127:Recovery of Function; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*
keywords: Anatomical reconstruction; Apex dissection; Continence; Continence recovery; Posterior reconstruction; Prostate cancer; Robot-assisted radical prostatectomy