title: Technique and outcomes of bladder neck intussusception during robot-assisted laparoscopic prostatectomy: A parallel comparative trial.
abstract: Postprostatectomy incontinence significantly impairs quality of life. Although bladder neck intussusception has been reported to accelerate urinary recovery after open radical retropubic prostatectomy, its adaption to robotic surgery has not been assessed. Accordingly, we describe our technique and compare outcomes between men treated with and without bladder neck intussusception during robot-assisted laparoscopic prostatectomy.
  
  
  
  We performed a comparative trial of 48 men undergoing robot-assisted laparoscopic prostatectomy alternating between bladder neck intussusception (n = 24) and nonintussusception (n = 24). Intussusception was completed using 3-0 polyglycolic acid horizontal mattress sutures anterior and posterior to the bladder neck. We assessed baseline characteristics and clinicopathologic outcomes. Adjusting for age, body mass index, race, and D׳Amico risk classification, we prospectively compared urinary function at 2 days, 2 weeks, 2 months, and last follow-up using the urinary domain of the Expanded Prostate Cancer Index-Short Form.
  
  
  
  Baseline patient characteristics and clinicopathologic outcomes were similar between treatment groups (P>0.05). Median catheter duration (8 vs. 8d, P = 0.125) and rates of major postoperative complications (4.2% vs. 4.2%, P = 1.000) did not differ. In adjusted analyses, Expanded Prostate Cancer Index-Short Form urinary scores were significantly higher for the intussusception arm at 2 weeks (65.4 vs. 46.6, P = 0.019) before converging at 2 months (69.1 vs. 68.3, P = 0.929) after catheter removal and at last follow-up (median = 7mo, 80.5 vs. 77.0; P = 0.665).
  
  
  
  Bladder neck intussusception during robot-assisted laparoscopic prostatectomy is feasible and safe. Although the long-term effects appear limited, intussusception may improve urinary function during the early recovery period.
authors.affiliation: VA/UCLA Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA; Department of Urology, University of California, Los Angeles, CA.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Department of Urology, University of California, Los Angeles, CA.
authors.forename: Siwei
authors.initials: S
authors.lastname: Xiong
authors.affiliation: Department of Urology, University of California, Los Angeles, CA.
authors.forename: Aaron A
authors.initials: AA
authors.lastname: Laviana
authors.affiliation: Department of Urology, University of California, Los Angeles, CA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Chuang
authors.affiliation: Department of Urology, University of California, Los Angeles, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Treat
authors.affiliation: Brady Department of Urology, Johns Hopkins Medical Institute, Baltimore, MD.
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Walsh
authors.affiliation: Department of Urology, University of California, Los Angeles, CA; Brady Department of Urology, Weill Cornell Medicine New York, New York. Electronic address: jch9011@med.cornell.edu.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000368:Aged; D015992:Body Mass Index; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D012371:Robotics / Q000379:methods*; D013536:Suture Techniques; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000209:etiology / Q000517:prevention & control*
keywords: Comparative study; Incontinence; Prostate neoplasm; Prostatectomy