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Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes



Anterior and posterior reconstructions of pelvic structures are used during a robot-assisted radical prostatectomy to obtain better continence outcomes. This study was conducted to evaluate the Advanced Reconstruction of Vesicourethral Support (ARVUS), a novel postprostatectomy reconstruction technique.


The study was designed as a prospective, controlled, partially randomized and blinded experiment. The statistical analysis was based on the generalized linear modeling (GLM) framework with random effects: the logit link was used to model the probability of achieving continence and the logarithmic link was used to evaluate the overall score of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The significance of the fixed effects and all possible two-way interactions was tested using the critical level of 0.05.


The probability of achieving the continence significantly depends on the neurovascular bundle sparing (p < 0.001) and the time after the surgery (p < 0.001). Analogously, the expected ICIQ-SF score significantly depends on the nerve-sparing status (p = 0.035) and the time after the surgery (p < 0.001). No statistically significant difference between the unilateral or bilateral nerve sparing was found. The ARVUS technique seems to perform slightly worse with respect to the expected continence, but this difference is within the margins of random fluctuations (p = 0.715).


The study demonstrates a significant positive association between the nerve-sparing approach and the patient’s continence, however, regardless of the unilateral or bilateral approach. In terms of the continence rate, no statistically significant benefits of ARVUS were observed.

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  1. Sooriakumaran P, Nyberg T, Akre O, Haendler L, Heus I, Olsson M, Carlsson S, Roobol MJ, Steineck G, Wiklund P (2014) Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 348:g1502

    PubMed  PubMed Central  Article  Google Scholar 

  2. Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, Menon M, Mottrie A, Myers RP, Patel V, Tewari A, Villers A, Artibani W (2016) A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 970(2):301–311

    Article  Google Scholar 

  3. Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E et al (2016) ProtecT Study Group. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375(15):1425–1437

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  4. Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H, Wilson TG, Zattoni F, Mottrie A (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62:405–417

    PubMed  Article  Google Scholar 

  5. Dev HS, Sooriakumaran P, Srivastava A, Tewari AK (2012) Optimizing radical prostatectomy for the early recovery of urinary continence. Nat Rev Urol 9(4):189–195

    PubMed  Article  Google Scholar 

  6. Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944

    PubMed  Article  Google Scholar 

  7. Student V, Vidlar A, Grepl M, Hartmann I, Buresova E, Student V (2017) Advanced reconstruction of vesicourethral support (ARVUS) during robot-assisted radical prostatectomy: 1-year functional outcomes in a two-group randomised controlled trial. Eur Urol 71(5):822–830

    PubMed  Article  Google Scholar 

  8. Mottrie A, Van Migem P, De Naeyer G, Schatteman P, Carpentier P, Fonteyne E (2007) Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases. Eur Urol 52:746–751

    PubMed  Article  Google Scholar 

  9. Rocco B, Gregori A, Stener S, Santoro L, Bozzola A, Galli S, Knez R, Scieri F, Scaburri A, Gaboardi F (2007) Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal video laparoscopic radical prostatectomy. Eur Urol 51:996–1003

    PubMed  Article  Google Scholar 

  10. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    PubMed  PubMed Central  Article  Google Scholar 

  11. Tholomier C, Bienz M, Hueber PA, Trinh QD, Hakim AE, Alhathal N, Lebeau T, Benayoun S, Valdivieso R, Liberman D, Saad F, Lattouf JB, Widmer H, Begin L, Latour M, Zorn KC (2014) Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: the largest Canadian 5-year experience. Can Urol Assoc J 8:195–201

    PubMed  PubMed Central  Article  Google Scholar 

  12. Michl U, Tennstedt P, Feldmeier L, Mandel P, Oh SJ, Ahyai S, Budäus L, Chun FKH, Haese A, Heinzer H, Salomon G, Schlomm T, Steuber T, Huland H, Graefen M, Tilki D (2016) Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy. Eur Urol 69(4):584–589.

    PubMed  Article  Google Scholar 

  13. Reeves F, Preece P, Kapoor J, Everaerts W, Murphy DG, Corcoran NM, Costello AJ (2015) Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta-analysis. Eur Urol 68(4):692–704

    PubMed  Article  Google Scholar 

  14. Steineck G, Bjartell A, Hugosson J, Axén E, Carlsson S, Stranne J, Wallerstedt A, Persson J, Wilderäng U, Thorsteinsdottir T, Gustafsson O, Lagerkvist M, Jiborn T, Haglind E, Wiklund P (2015) LAPPRO steering committee. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol 67(3):559–568

    PubMed  Article  Google Scholar 

  15. Hefermehl L, Bossert K, Ramakrishnan VM, Seifert B, Lehmann KA (2018) Prospective analysis of the effects of nerve-sparing radical prostatectomy on urinary continence based on expanded prostate cancer index composite and international index of erectile function scoring systems. Int Neurourol J 2(2):123–132

    Article  Google Scholar 

  16. Preisser F, Theissen L, Wild P, Bartelt K, Kluth L, Köllermann J, Graefen M, Steuber T, Huland H, Tilki D, Roos F, Becker A, Chun FK, Mandel P (2019) Implementation of intraoperative frozen section during radical prostatectomy: short-term results from a German Tertiary-Care Center. Eur Urol Focus.

    PubMed  Article  Google Scholar 

  17. Porpiglia F, Checcucci E, Amparore D, Manfredi M, Massa F, Piazzolla P, Manfrin D, Piana A, Tota D, Bollito E, Fiori C (2019) Three-dimensional elastic augmented-reality robot-assisted radical prostatectomy using hyperaccuracy three-dimensional reconstruction technology: a step further in the identification of capsular involvement. Eur Urol.

    PubMed  Article  Google Scholar 

  18. Sugimura Y, Hioki T, Yamada Y, Fumino M, Inoue T (2001) An anterior urethral stitch improves urinary incontinence following radical prostatectomy. Int J Urol 8:153–157

    CAS  PubMed  Article  Google Scholar 

  19. Noguchi M, Noda S, Nakashima O, Matsuoka K, Kojiro M (2004) Suspension technique improves rapid recovery of urinary continence following radical retropubic prostatectomy. Kurume Med J 51:245–251

    PubMed  Article  Google Scholar 

  20. Patel VR, Coelho RF, Palmer KJ, Rocco B (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56:472–478

    PubMed  Article  Google Scholar 

  21. Grasso AA, Mistretta FA, Sandri M, Cozzi G, De Lorenzis E, Rosso M, Albo G, Palmisano F, Mottrie A, Haese A, Graefen M, Coelho R, Patel VR, Rocco B (2016) Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis. BJU Int 118:20–34

    PubMed  Article  Google Scholar 

  22. Coelho RF, Chauhan S, Orvieto MA, Sivaraman A, Palmer KJ, Coughlin G, Patel VR (2011) Influence of modified posterior reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol 59:72–80

    PubMed  Article  Google Scholar 

  23. Sutherland DE, Linder B, Guzman AM, Hong M, Frazier HA 2nd, Engel JD, Bianco FJ Jr (2011) Posterior rhabdosphincter reconstruction during robotic assisted radical prostatectomy: results from a phase II randomized clinical trial. J Urol 185(4):1262–1267

    PubMed  Article  Google Scholar 

  24. Menon M, Muhletaler F, Campos M, Peabody JO (2008) Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a two group parallel randomized controlled trial. J Urol 180:1018–1023

    PubMed  Article  Google Scholar 

  25. Cui J, Guo H, Li Y, Chen S, Zhu Y, Wang S, Wang Y, Liu X, Wang W, Han J, Chen P, Nie S, Yin G, Shi B (2017) Pelvic floor reconstruction after radical prostatectomy: a systematic review and meta-analysis of different surgical techniques. Sci Rep 7(1):2737

    PubMed  PubMed Central  Article  Google Scholar 

  26. Tewari A, Jhaveri J, Rao S, Yadav R, Bartsch G, Te A, Ioffe E, Pineda M, Mudaliar S, Nguyen L, Libertino J, Vaughan D (2008) Total reconstruction of the vesico-urethral junction. BJU Int 101:871–877

    PubMed  Article  Google Scholar 

  27. Manfredi M, Checcucci E, Fiori C, Garrou D, Aimar R, Amparore D, De Luca S, Bombaci S, Stura I, Migliaretti G, Porpiglia F (2019) Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures. BJU Int.

    PubMed  Article  Google Scholar 

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Authors and Affiliations



VK: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. MM: protocol/project development, data analysis, and manuscript writing/editing. VB: protocol/project development and data collection or management. JB: protocol/project development and data collection or management. VK: protocol/project development and data collection or management. PB: manuscript writing/editing.

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Correspondence to Viktor Kováčik.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics committee of F.D. Roosevelt Hospital Banská Bystrica, 19/01/2016) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kováčik, V., Maciak, M., Baláž, V. et al. Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes. World J Urol 38, 1933–1941 (2020).

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  • Radical prostatectomy
  • Continence
  • Nerve sparing