Tips to Preserve Continence During Robotic Radical Prostatectomy
While incontinence and impotence are the two major drawbacks of radical prostatectomy, incontinence seems to be the problem that troubles patients most, even if it occurs less frequently than impotence. The prevalence of urinary incontinence after radical prostatectomy can be influenced by preoperative patient characteristics, surgeon experience, surgical techniques and methods used to collect and report data. In this chapter we will focus on surgical tips to improve continence recovery during robot assisted radical prostatectomy (RARP), analyzing the procedures step by step.
KeywordsRadical prostatectomy Robotic surgery Robotic prostatectomy Urinary continence Prostate cancer Surgery technique Continence
- 1.Guideline for the management of clinically localized prostate cancer (2007). Reviewed and validity confirmed 2011. Available from: https://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Cancer.pdf.
- 4.Hakimi AA, Faleck DM, Agalliu I, Rozenblit AM, Chernyak V, Ghavamian R, et al. Preoperative and intraoperative measurements of urethral length as predictors of continence after robot-assisted radical prostatectomy. J Endourol. 2011;25:1025–30.Google Scholar
- 6.Lei Y, Alemozaffar M, Williams SB, Hevelone N, Lipsitz SR, Plaster BA, et al. Athermal division and selective suture ligation of the dorsal vein complex during robot-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol. 2011;59:235–43.CrossRefPubMedGoogle Scholar
- 10.Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial. J Urol. 2013;189(3):891–8.CrossRefPubMedGoogle Scholar
- 21.Tewari AK, Srivastava A, Mudaliar K, Tan GY, Grover S, El Douaihy Y, et al. Anatomical retro-apical technique of synchronous (posterior and anterior) urethral transaction: a novel approach for ameliorating apical margin positivity during robotic radical prostatectomy. BJU Int. 2010;106:1364–73.Google Scholar
- 23.Coughlin G, Dangle PP, Patil NN, Palmer KJ, Woolard J, Jensen C, et al. Surgery illustrated – focus on details. Modified posterior reconstruction of the rhabdosphincter: application to robotic-assisted laparoscopic prostatectomy. BJU Int. 2008;102(10):1482–5.Google Scholar
- 24.Coelho RF, Chauhan S, Orvieto MA, Sivaraman A, Palmer KJ, Coughlin G, 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(1):72–80.CrossRefPubMedGoogle Scholar