Abstract
Urinary incontinence following radical prostatectomy (RP) is still a major source of morbidity and significant concern for patients facing with surgery. The advent of robotics has facilitated new surgical techniques for this operation. Robotic assistance has allowed adjustment of pelvic anatomical and functional relationships after removal of the prostate to ameliorate postprostatectomy incontinence and reduce the time to complete continence. There have been various different kinds of surgical procedures used in an attempt to make urinary continence recovery earlier post Robot-Assisted RP (RARP). Surgical reconstruction of pelvic floor structures aims to enhance anatomical support, returning to the presurgical state. Among them, urethral stitch suspension is one of the most popular and simple method to deliver because of the robotic articulation.
Urethral suspension during RARP are mainly comprised of stitch suspension with sutures or sling suspension using various materials and combination of these. The concept of urethral suspension is mainly associated with the stabilization of the vesicourethral anastomosis. Almost all urethral suspension showed similar short-term continence recovery and excellent outcomes post RARP. There are only a few randomized clinical trials comparing a reconstructive technique with “no additional reconstruction” or a different reconstructive technique. The outcomes of clinical trials are conflicting partly due to the differences on continence criterion among the studies. Although many of the procedures reported a benefit with respect to early continence, benefits seem to diminish with longer follow-up. There seemed no global consensus which of the reconstructive techniques is the best for continence recovery post RARP.
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Shiroki, R., Takahara, K., Zennami, K., Takenaka, M., Sumitomo, M., Kusaka, M. (2022). Urethral Suspension. In: Ren, S., Nathan, S., Pavan, N., Gu, D., Sridhar, A., Autorino, R. (eds) Robot-Assisted Radical Prostatectomy. Springer, Cham. https://doi.org/10.1007/978-3-031-05855-4_16
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