Introduction and objective
We have previously proposed a novel technique based on the concept of fixing the urethral stump laterally and posteriorly instead of supporting it, and have shown that urethral fixation was associated with a significant improvement in early urinary continence recovery compared to standard vesico-urethral anastomosis (VUA) after retropubic radical prostatectomy. In this study, we compared early urinary continence recovery and complications in patients undergoing robot-assisted radical prostatectomy (RARP) with urethral fixation versus standard VUA.
A prospective single-center, single-surgeon cohort of 70 consecutive patients undergoing RARP between January and December 2019 was analyzed. A study group of 35 patients operated on with the urethral fixation technique was compared with a control group of 35 patients receiving standard VUA. In the study group, the urethral stump was fixed to the dorsal median raphe posteriorly and to the medial portion of levator ani muscle postero-laterally, so as to avoid urethral retraction or deviation, and maintain the urethral sphincter in its natural position in the pelvic floor. The same posterior musculofascial reconstruction incorporating the VUA was performed in both groups. Urinary continence recovery, defined as 0-1 daily safety pads, within 3 months after catheter removal, and perioperative complications were compared between the two groups.
The two groups were comparable with regard to all demographic, clinical and pathological variables. Recovery of urinary continence at 3 months after catheter removal was reported by 34 (97.1%) patients in the study, and 28 (80%) patients in the control group (p=0.02). Patients in the study group reported significantly higher rates of urinary continence even at 1 week and 1 month after catheter removal compared to the control group (68.6% vs 45.7%, p=0.04, and 80% vs 54.3%, p=0.04, respectively). No intraoperative complications were observed in either group. Ninety-day postoperative complications were observed in 1 (2.9%) patient in the study, and in 4 (11.4%) in the control group (p=0.3).
We observed a significant improvement in early urinary continence recovery with no increase in perioperative complications using the novel urethral fixation technique versus standard VUA during RARP. These preliminary data seem to corroborate the hypothesis that maintaining the urethral stump in its correct position in the pelvic floor may improve the probability of an earlier urinary continence recovery after RARP.