Reconstruction of the Denonvillier's fascia and posterior ligament of the external urethral sphincter: Assessment of its effect on urinary continence after laparoscopic radical prostatectomy
https://doi.org/10.4081/aiua.2021.3.274
Accepted: July 9, 2021
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Objectives: Some studies have shown that rhabdosphincter reconstruction provides an earlier return to continence after radical prostatectomy. We aim to study the impact of this procedure in urinary continence along with comparing two specific surgical techniques for posterior reconstruction.
Materials and methods: We studied a group of patients who were submitted to LRP with No Rhabdosphincter Reconstruction (NRR) and another group with Posterior Reconstruction of the Rhabdosphincter (PRR). The latter was further divided into two groups: "Rocco type stitch" group and "Bollens type stitch" group. We used three questionnaires (IIEF-5, ICIQ-SF and IPSS) to assess urinary continence and erectile function 90 days after surgery.
Results: Patients of PRR group had a better full continence rate than patients of NRR group at 90 days (96.6% vs 33.3%, p < 0.001). Concerning urinary incontinence (p = 0.116), lower urinary tract symptoms (p = 0.543) and postoperative complication rates (p = 0.738), our results suggested that there were no differences between the techniques studied.
Conclusions: Posterior reconstruction of the rhabdosphincter has significant benefits for urinary continence recovery on patients undergoing radical prostatectomy. No differences were observed in continence recovery between the two techniques analyzed. Additionally, reconstruction of the rhabdosphincter appears to be a safe procedure with no increased risk of postoperative complications.
Wein AJ, Kavoussi LR, Partin AW, et al. Campbell-Walsh Urology. 12th ed. Elsevier. 2020; 153:3529-3532.
Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localised prostate cancer. Medicine (Baltimore). 2019; 98:e15770. DOI: https://doi.org/10.1097/MD.0000000000015770
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008; 358:1250-61. DOI: https://doi.org/10.1056/NEJMoa074311
Miller DC, Saigal CS, Litwin MS. The demographic burden of urologic diseases in America. Urol Clin North Am. 2009; 36:11-27. DOI: https://doi.org/10.1016/j.ucl.2008.08.004
Trost L, Elliott DS. Male stress urinary incontinence: A review of surgical treatment options and outcomes. Adv Urol. 2012; 8:1-13. DOI: https://doi.org/10.1155/2012/287489
Alivizatos G, Skolarikos A. Incontinence and erectile dysfunction following radical prostatectomy: a review. Scientific World Journal. 2005; 5:747-58. DOI: https://doi.org/10.1100/tsw.2005.94
Topaktas R, Urkmez A, Kutluhan MA, et al. Vesicourethral anastomosis including rhabdosphincter in retropubic radical prostatectomy: Technique and results. Arch Ital Urol Androl. 2019; 90:249-253. DOI: https://doi.org/10.4081/aiua.2018.4.249
Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG Guidelines on prostate cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol. 2017; 71:618-29. DOI: https://doi.org/10.1016/j.eururo.2016.08.003
Bollens R, Vanden Bossche M, Roumeguere T, et al. Extraperitoneal laparoscopic radical prostatectomy. Eur Urol. 2001; 40:65-9. DOI: https://doi.org/10.1159/000049750
Rocco B, Cozzi G, Spinelli MG, et al. Posterior musculofascial reconstruction after radical prostatectomy: A systematic review of the literature. Eur Urol. 2012; 62:779-90. DOI: https://doi.org/10.1016/j.eururo.2012.05.041
Grasso AAC, Mistretta FA, Sandri M, et al. Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis. BJU Int. 2016; 118:20-34. DOI: https://doi.org/10.1111/bju.13480
Salazar A, Regis L, Planas J, et al. Early continence after radical prostatectomy: A systematic review. Actas Urologicas Espanolas. 2019;43:526-535. DOI: https://doi.org/10.1016/j.acuroe.2019.06.003
Tamanini TNJ, Dambros M, Levi ACD, et al. Validation of the “International Consultation on Incontinence Questionnaire-Short Form” (ICIQ-SF) for Portuguese. Rev Saude Publica. 2004; 38:438-44. DOI: https://doi.org/10.1590/S0034-89102004000300015
Mineo Bianchi F, Romagnoli D, D’Agostino D, et al. Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of technique and its impacto n urinary continence. Arch Ital Urol Androl. 2019; 91:5-10. DOI: https://doi.org/10.4081/aiua.2019.1.5
Berger M, Luz Junior PN, Brasil SN, Koff WJ. Statistical validation of the international prostatic symptom score (I-PSS) in portuguese. J Bras Urol. 1999; 25:225-34.
Pechorro PS, Calvinho AM, Pereira NM, Vieira RX. Validação da versão portuguesa do Índice Internacional de Função Eréctil-5 (IIEF-5). Rev Int Andrología. 2011; 9:3-9. DOI: https://doi.org/10.1016/S1698-031X(11)70002-4
Razali NM, Wah YB. Power comparisons of Shapiro-Wilk, Kolmogorov-Smirnov, Lilliefors and Anderson-Darling tests. J Stat Model Anal. 2011; 2:21-33.
Kim HY. Statistical notes for clinical researchers: assessing normal distribution using skewness and kurtosis. Restor Dent Endod. 2013; 38:52. DOI: https://doi.org/10.5395/rde.2013.38.1.52
Cohen J. Statistical power analysis for the behavioral sciences. 2nd edition. New York: Lawrence Erlbaum Associates; 1988, Chapt 2, pp 20-52.
Chan YH. Biostatistics 102: Quantitative data-parametric & non-parametric tests. Singapore Med J. 2003;44:391-396.
Chan YH. Biostatistics 103: Qualitative data-tests of independence. Singapore Med J. 2003; 44:498-503.
Liao X, Qiao P, Tan Z, et al. "Total reconstruction" of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy. Int Braz J Urol. 2016; 42:215-22. DOI: https://doi.org/10.1590/S1677-5538.IBJU.2014.0666
Wu YP, Xu N, Wang ST, et al. The efficacy and feasibility of total reconstruction versus non total reconstruction of the pelvic floor on short-term and long-term urinary continence rates after radical prostatectomy: a meta-analysis. World J Surg Oncol. 2017; 20;15:228. DOI: https://doi.org/10.1186/s12957-017-1296-z
Coelho RF, Chauhan S, Orvieto MA, 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; 59:72-80. DOI: https://doi.org/10.1016/j.eururo.2010.08.025
Rocco B, Gregori A, Stener S, et al. Posterior Reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal videolaparoscopic radical prostatectomy. Eur Urol. 2007; 51:996-1003. DOI: https://doi.org/10.1016/j.eururo.2006.10.014
Machioka K, Kadono Y, Naito R, et al. Evaluating urinary incontinence before and after radical prostatectomy using the international consultation on incontinence questionnaire-short form. Neurourol Urodyn. 2019; 38:726-33 DOI: https://doi.org/10.1002/nau.23907
Barry MJ, Fowler FJ, O'Leary MP, et al. The American urological association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol. 1992; 148:1549-57. DOI: https://doi.org/10.1016/S0022-5347(17)36966-5
Rocco F, Carmignani L, Acquati P, et al. Restoration of Posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006; 175:2201-6. DOI: https://doi.org/10.1016/S0022-5347(06)00262-X
Tewari A, Jhaveri J, Rao S, et al. Total reconstruction of the vesico-urethral junction. BJU Int. 2008; 101:871-7. DOI: https://doi.org/10.1111/j.1464-410X.2008.07424.x
Gershman B, Psutka SP, McGovern FJ, et al. Patient- reported functional outcomes following open, laparoscopic, and robotic assisted radical prostatectomy performed by high-volume surgeons at high-volume hospitals. Eur Urol Focus. 2016; 2:172-179. DOI: https://doi.org/10.1016/j.euf.2015.06.011
Fujimoto M, Higuchi T, Kouichi H, Takada M. Association of statin use with storage lower urinary tract symptoms: Data mining of claims database. J Pharmacovigil. 2014; 2:5. DOI: https://doi.org/10.5414/CP202113
Heesakkers J, Farag F, Bauer RM, et al. Pathophysiology and contributing factors in postprostatectomy incontinence: A review. Eur Urol. 2017; 71: 936-44. DOI: https://doi.org/10.1016/j.eururo.2016.09.031
Kretschmer A, Hübner W, Sandhu JS, Bauer RM. Evaluation and management of postprostatectomy incontinence: a systematic review of current literature. Eur Urol Focus. 2016; 2:245-59. DOI: https://doi.org/10.1016/j.euf.2016.01.002
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