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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

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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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Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Viktor Kováčik.

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The authors declare that they have no conflict of interest.

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). https://doi.org/10.1007/s00345-019-02975-5

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  • DOI: https://doi.org/10.1007/s00345-019-02975-5

Keywords

  • Radical prostatectomy
  • Continence
  • ARVUS
  • Nerve sparing