TY - JOUR
T1 - Anatomic Restoration Technique of Continence Mechanism and Preservation of Puboprostatic Collar
T2 - A Novel Modification to Achieve Early Urinary Continence in Men Undergoing Robotic Prostatectomy
AU - Tewari, Ashutosh K.
AU - Bigelow, Kevin
AU - Rao, Sandhya
AU - Takenaka, Atsushi
AU - El-Tabi, Nasr
AU - Te, Alex
AU - Vaughan, E. D.
N1 - Funding Information:
This study was supported by the Ronald P. Lynch Urologic Oncologic Endowment and Brady Urologic Research Foundation at Cornell University.
PY - 2007/4
Y1 - 2007/4
N2 - Objectives: The puboprostatic ligaments, puboperinealis muscle, and arcus tendineus are all recognized as important for continence in men and women. This complex of ligaments, muscles, and tendineus aponeurosis acts in unison to provide continence and can be disrupted during robotic prostatectomy. We propose that preservation of the puboprostatic collar during robotic surgery will help to restore early continence in men undergoing robotic prostatectomy. Methods: We performed cadaveric studies in 10 fresh cadavers to devise strategies to leave intact the puboprostatic ligaments, muscular collar, and arcus tendineus supporting the continence mechanism. We developed reconstructive strategies to reconnect the ligaments to the urethrovesical anastomosis, reapproximated the muscles, and fixed the distal bladder to the arcus tendineus. These modifications were then attempted in 50 consecutive patients who underwent robotic prostatectomy for clinically localized prostate cancer. The patient-reported outcomes were then used to assess the efficacy of this procedure. Results: The technique was reproducible, and the average additional time taken for the final reconstruction was only 2 to 5 minutes. The continence rate was 29% in the first week, 62% at 6 weeks, 88% at 12 weeks, and 95% in 16 weeks after catheter removal. No other differences were found in the operative, oncologic, or perioperative outcomes. Conclusions: This modification helped in the early return of continence. It is unlikely that the long-term results will be any different, but shortening the recovery time will have psychological, financial, and health-related quality-of-life benefits for the patients.
AB - Objectives: The puboprostatic ligaments, puboperinealis muscle, and arcus tendineus are all recognized as important for continence in men and women. This complex of ligaments, muscles, and tendineus aponeurosis acts in unison to provide continence and can be disrupted during robotic prostatectomy. We propose that preservation of the puboprostatic collar during robotic surgery will help to restore early continence in men undergoing robotic prostatectomy. Methods: We performed cadaveric studies in 10 fresh cadavers to devise strategies to leave intact the puboprostatic ligaments, muscular collar, and arcus tendineus supporting the continence mechanism. We developed reconstructive strategies to reconnect the ligaments to the urethrovesical anastomosis, reapproximated the muscles, and fixed the distal bladder to the arcus tendineus. These modifications were then attempted in 50 consecutive patients who underwent robotic prostatectomy for clinically localized prostate cancer. The patient-reported outcomes were then used to assess the efficacy of this procedure. Results: The technique was reproducible, and the average additional time taken for the final reconstruction was only 2 to 5 minutes. The continence rate was 29% in the first week, 62% at 6 weeks, 88% at 12 weeks, and 95% in 16 weeks after catheter removal. No other differences were found in the operative, oncologic, or perioperative outcomes. Conclusions: This modification helped in the early return of continence. It is unlikely that the long-term results will be any different, but shortening the recovery time will have psychological, financial, and health-related quality-of-life benefits for the patients.
UR - http://www.scopus.com/inward/record.url?scp=34147177746&partnerID=8YFLogxK
U2 - 10.1016/j.urology.2006.12.028
DO - 10.1016/j.urology.2006.12.028
M3 - Article
C2 - 17445659
AN - SCOPUS:34147177746
SN - 0090-4295
VL - 69
SP - 726
EP - 731
JO - Urology
JF - Urology
IS - 4
ER -