title: Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis.
abstract: To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP); an updated systematic review of the literature. A systematic review of the literature was performed in June 2015, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and searching Medline, Embase, Scopus and Web of Science databases. We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the 'Title' and 'Abstract' fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed. In all, 21 studies were identified, including three randomised controlled trials. The overall analysis of comparative studies showed that PR improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after PR. There were no significant differences for positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture. The analysis confirms the benefits at 30 days after catheter removal already discussed in the review published in 2012, but also shows a significant advantage in terms of urinary continence recovery in the first 90 days. A multicentre prospective randomised controlled trial is currently being conducted in several institutions around the world to better assess the effectiveness of PR in facilitating an earlier recovery of postoperative urinary continence.
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Angelica A C
authors.initials: AA
authors.lastname: Grasso
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Mistretta
authors.affiliation: DMS StatLab, Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sandri
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Cozzi
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: De Lorenzis
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Rosso
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Albo
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Palmisano
authors.affiliation: OLV Robotic Surgery Institute, Aalst, Belgium.
authors.forename: Alex
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.affiliation: Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Coelho
authors.affiliation: Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA.
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.|Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
mesh_terms: D006801:Humans; D008297:Male; D054792:Muscle, Striated / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D014549:Urinary Incontinence / Q000517:prevention & control*; D013521:Urologic Surgical Procedures, Male / Q000379:methods
keywords: early continence; posterior musculofascial reconstruction; posterior rhabdosphincter reconstruction; radical prostatectomy; urinary continence; urinary incontinence