Two-layer posterior reconstruction of the vesicourethral anastomosis during robotic-assisted radical prostatectomy


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Aim. To study the influence of the technique of posterior reconstruction of the vesicourethral anastomosis (VUA) on the prevention of urinary incontinence after robotic-assisted radical prostatectomy (RARP). Material and methods. A total of 67 patients (mean age 63 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n=32) the standard technique of the VUA was used, while in the group 2 (n=35) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7, all patients underwent cystography to assess the tightness of the VUA. Results. One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 4.57 in group 2 (p=0.04). After 3 and 6 months the respective values were 3.8 vs. 2.3 (p=0.09) and 1.94 vs. 1.2 (p=0.23), respectively. Cystography revealed no extravasation of the contrast. Conclusion. The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.

Full Text

Restricted Access

About the authors

M. A Kodzokov

I.M. Sechenov First Moscow State Medical University

Email: kodzokov-m@mail.ru
3-year Ph.D. student, Institute for Urology and Human Reproductive Health

E. V Spot

I.M. Sechenov First Moscow State Medical University

Email: shpot@inbox.ru
professor, Head of the Department of Oncourology, Institute for Urology and Human Reproductive Health

A. V Proskura

I.M. Sechenov First Moscow State Medical University

Email: proskura777@yandex.ru
physician of the Department of Oncourology, Institute for Urology and Human Reproductive Health

E. S Gazimiev

I.M. Sechenov First Moscow State Medical University

6-year student

A. D Damiev

I.M. Sechenov First Moscow State Medical University

Email: damievakhmed@mail.ru

M. A Gazimiev

I.M. Sechenov First Moscow State Medical University

Email: gazimiev@yandex.ru
Ph.D., MD, professor, Deputy Director on Science of the Institute for Urology and Human Reproductive Health; Director of National Medical Research Center of Urology

References

  1. Аляев Ю.Г., Безруков Е.А., Крупинов Г.Е. Выбор метода лечения при локализованном и местнораспространенном раке предстательной железы. Врачебное сословие. 2007;5:45-49
  2. Нестеров С.Н., Страт А.А. Робот-ассистированная радикальная простатэктомия в лечении клинически локализованного рака предстательной железы (обзор литературы). Онкоурология. 2012;8(3):80-87
  3. Алексеев Б.Я. Лечение локализованного и местно распространенного рака предстательной железы: диссертация докт. мед. наук. М., 2006. 259 с.
  4. Sandoval Salinas C., Gonzalez Rangel A.L., Catano Catano J.G., Fuentes Pachon J.C., Castillo Londono J.S. Efficacy of robotic-assisted prostatectomy in localized prostate cancer: a systematic review of clinical trials. Adv Urol. 2013;2013:105651-105656.
  5. Голубцова Е.Н., Томилов А.А., Велиев Е.И. Влияние вариантов реконструкции уретровезикального анастомоза при выполнении радикальной простатэктомии на восстановление функции удержания мочи. Consilium Medicum. 2018;20(7):26-29
  6. Перепечай В.А., Димитриади С.Н., Алексеев Б.Я. Способ раннего восстановления континенции при радикальной простатэктомии. Клиническая практика. 2011;2(1):35-40
  7. Freire M.P., Weinberg A.C., Lei Y., et al. Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol 2009; 56:972-980.
  8. Tewari A., Jhaveri J., Rao S., et al. Total reconstruction of the vesicourethral junction. BJU Int 2008; 101:871-877.
  9. Asimakopoulos A.D., Annino F., D’Orazio A., et al. Complete periprostatic anatomy preservation during robot-assisted laparoscopic radical prostatectomy (RALP): the new pubovesical complex-sparing technique. Eur Urol 2010; 58:407-417.
  10. Stolzenburg J.U., Liatsikos E.N., Rabenalt R., et al. Nerve sparing endoscopic extraperitoneal radical prostatectomy - effect of puboprostatic ligament preservation on early continence and positive margins. Eur Urol 2006; 49:103-111.
  11. Rocco B., Gregori A., Stener S., et al. Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol 2007; 51:996-1003.
  12. Ko Y.H., Coelho R.F., Chauhan.S., et al. Factors affecting return of continence 3 months after robot-assisted radical prostatectomy: analysis from a large, prospective data by a single surgeon. J. Urol 2012; 187:190-194.
  13. Kojima Y., Hamakawa T., Kubota Y., et al. Bladder neck sling suspension during robotassisted radical prostatectomy to improve early return of urinary continence: a comparative analysis. Urology 2014;83:632-639.
  14. Patel V.R., Coelho R.F., Palmer K.J., et al. Periurethral suspension stitch during robotassisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 2009; 56:472-478.
  15. Student V.Jr., Vidlar A., Grepl M., et al. Advanced reconstruction of vesicourethral support (ARVUS) during robot-assisted radical prostatectomy: One-year functional outcomes in a two-group randomised controlled trial. Eur Urol 2017;71:822-830.
  16. Lee D.I., Wedmid A., Mendoza.P., et al. Bladder neck plication stitch: a novel technique during robot-assisted radical prostatectomy to improve recovery of urinary continence. J. Endourol 2011; 25:1873-1877.
  17. Menon M., Muhletaler F., Campos M., et al. Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a 2 group parallel randomized controlled trial. J. Urol 2008;180:1018-1023.
  18. Coelho R.F., Chauhan S., Orvieto M.A., et al. Influence of modified posterior reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol 2011;59:72-80.
  19. Gondo T., Yoshioka K., Hashimoto T., et al. The powerful impact of doublelayered posterior rhabdosphincter reconstruction on early recovery of urinary continence after robot-assisted radical prostatectomy. J. Endourol 2012;26:1159-1164.
  20. Joshi N., de Blok W., van Muilekom E., et al. Impact of posterior musculofascial reconstruction on early continence after robot-assisted laparoscopic radical prostatectomy: results of a prospective parallel group trial. Eur Urol 2010;58:84-89.
  21. Sutherland D.E., Linder B., Guzman A.M., et al. Posterior rhabdosphincter reconstruction during robotic assisted radical prostatectomy: results from a phase II randomized clinical trial. J. Urol 2011;185:1262-1267.
  22. Jeong C.W., Lee J.K., Oh J.J., et al. Effects of new 1-step posterior reconstruction method on recovery of continence after robot-assisted laparoscopic prostatectomy: results of a prospective, single-blind, parallel group, randomized, controlled trial. J. Urol 2015;193:935-942.
  23. Brien J.C., Barone B., Fabrizio M., et al. Posterior reconstruction before vesicourethral anastomosis in patients undergoing robot-assisted laparoscopic prostatectomy leads to earlier return to baseline continence. J. Endourol 2011;25:441-445.
  24. Grasso A.A., Mistretta F.A., Sandri M., et al. Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis. BJU Int 2016;118:20-34.
  25. Guillonneau B., Vallancien G. Laparoscopic radical prostatectomy: the Montsouris experience. J. Urol 2000;163:418-422.
  26. Kojima Y., Takahashi N., Haga N., et al. Urinary incontinence after robot-assisted radical prostatectomy: pathophysiology and intraoperative techniques to improve surgical outcome. Int J. Urol 2013;20:1052-1063.
  27. Rocco F., Carmignani L., Acquati P. et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J. Urol 2006; 175:2201-2206.
  28. Seckiner I., Yesilli C., Mungan N.A., Aykanat A., Akduman B. Correlations between the ICIQ-SF score and urodynamic findings. Neurourol Urodyn. 2007;26(4):492-494.
  29. Haga N., Ogawa S., Yabe M., et al. Factors Contributing to early recovery of urinary continence analyzed by pre- and postoperative pelvic anatomical features at robotassisted laparoscopic radical prostatectomy. J. Endourol 2015; 29:683-690.
  30. Rocco F., Gadda F., Acquati P., et al. Personal research: reconstruction of the urethral striated sphincter. Arch Ital Urol Androl 2001;73:127-137.
  31. Rocco F., Rocco B. Anatomical reconstruction of the rhabdosphincter after radical prostatectomy. BJU Int 2009;104:274-281.
  32. Burnett A.L., Mostwin J.L. In situ anatomical study of the male urethral sphincteric complex: relevance to continence preservation following major pelvic surgery. J. Urol 1998; 160:1301-1306.
  33. Rocco B., Cozzi G., Spinelli M.G., et al. Posterior musculofascial reconstruction after radical prostatectomy: a systematic review of the literature. Eur Urol 2012; 62:779-790.
  34. Porpiglia F., Bertolo R., Manfredi M., De Luca S., Checcucci E., Morra I., Passera R., Fiori C. Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence. Eur Urol. 2016 Mar; 69(3):485-495.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies