title: Autologous retro-pubic urethral sling: a novel, quick, intra-operative technique to improve continence after robotic-assisted radical prostatectomy.
abstract: After radical prostatectomy, many men may suffer from urinary incontinence, which can have detrimental effects on quality of life. We describe a novel technique using an autologous retro-pubic urethral sling placed at the time of robotic-assisted laparoscopic prostatectomy (RALP) and evaluate its impact on post-operative urinary continence. During 2011, 153 men who underwent sling placement at the time of RALP at a high-volume academic institution were compared to 78 men who did not undergo sling placement. The primary outcomes were time to one and no pads per day. The association between these outcomes and placement of a sling was assessed using Cox proportional hazards regression. Median follow-up was 26 weeks in those who had slings and 32.5 weeks in those who did not. Clinical and pathological characteristics were similar between the groups, with the exception that sling patients were older (p < 0.01) and underwent less nerve sparing (p < 0.01). Multivariate analysis showed that sling placement did not appear to have an effect on time to one (p = 0.24) or no pads per day (p = 0.20). Although the association between sling placement and early return of urinary continence did not reach statistical significance, there was a selection bias against the sling, since it was placed in men who were expected to have more difficulty regaining their continence. A randomized trial is needed to assess the true benefit of sling placement on urinary continence.
authors.affiliation: Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St, Box 1695, San Francisco, 94143-1695, CA, USA. sanoj.punnen@gmail.com.
authors.forename: Sanoj
authors.initials: S
authors.lastname: Punnen
authors.affiliation: Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St, Box 1695, San Francisco, 94143-1695, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Clint Cary
authors.affiliation: Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St, Box 1695, San Francisco, 94143-1695, CA, USA.
authors.forename: Allison S
authors.initials: AS
authors.lastname: Glass
authors.affiliation: Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St, Box 1695, San Francisco, 94143-1695, CA, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Cowan
authors.affiliation: Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 1600 Divisadero St, Box 1695, San Francisco, 94143-1695, CA, USA.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
keywords: Autologous; Incontinence; Retro-pubic sling; Robotic-assisted radical prostatectomy