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Early continence outcomes of posterior musculofascial plate reconstruction during robotic and laparoscopic prostatectomy
Author(s) -
Nguyen Mike M.,
Kamoi Kazumi,
Stein Robert J.,
Aron Monish,
Hafron Jason M.,
Turna Burak,
Myers Robert P.,
Gill Inderbir S.
Publication year - 2008
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2007.07425.x
Subject(s) - urethra , medicine , laparoscopic radical prostatectomy , prostatectomy , urology , transrectal ultrasonography , catheter , surgery , laparoscopy , prostate , cancer
Associate Editor Ash Tewari Editorial Board Ralph Clayman, USA Inderbir Gill, USA Roger Kirby, UK Mani Menon, USA OBJECTIVES To detail the technique and evaluate in a preliminary study the effectiveness of posterior reconstruction of Denonvilliers’ musculofascial plate (PRDMP) in enhancing early continence after robotic and laparoscopic radical prostatectomy (RP). PATIENTS AND METHODS Thirty‐two consecutive patients having robotic or laparoscopic RP with PRDMP (group 1). Thirty previous patients not having PRDMP were compared as historical controls (group 2). Continence, as measured by patient self‐reporting of the number of pads used/24 h, was assessed at 3 days and 6 weeks after catheter removal, by telephone interview. ‘Continent’ was defined as the use of none or one pads, ‘moderate incontinence’ as two pads, and ‘severe incontinence’ as more than two pads. Intraoperative transrectal ultrasonography (TRUS) was used to measure the membranous urethral length before and after PRDMP. RESULTS At 3 days after catheter removal, more patients in group 1 were continent than in group 2 (34% vs 3%, P = 0.007). At 6 weeks continence was again better in group 1 (56% vs 17%, P = 0.006). The mean length of the membranous urethra on TRUS measured before RP, after RP but before the musculofascial suture, and afterward, was 15.6, 12 and 14 mm, respectively. Thus, reconstruction restored the length of the transected membranous urethra by a mean of 2 mm. CONCLUSIONS PRDMP during robotic and laparoscopic RP leads to improved maintenance of membranous urethral length and significantly higher early continence rates.