UroToday - Does resuspension of the urethra to reapproximate its anatomic position at the time of robotic assisted laparoscopic prostatectomy (RALP) for prostate cancer (CaP) improve continence? This question was studied by Dr. Vipul Patel and colleagues and is reported in the online edition of European Urology.

At the time of prostatectomy, ligation of the dorsal venous complex (DVC) and cutting the puboprostatic ligaments disrupts the normal anatomic position of the urethra. A group of 331 consecutive patients undergoing RALP were studied; 94 without the periurethral suspension stitch and 237 who had it performed. Data was prospectively collected and retrospectively analyzed. Continence rate was the primary endpoint and was assessed with a self-administered questionnaire (EPIC) at 1, 3, 6, and 12 months post-operatively. Continence was defined as the use of no pads and no leakage of urine.

All patients had suture ligation of the DVC. In the 237 who had the resuspension performed, a 12-inch monofilament polyglytone suture on a CT-1 needle was placed in the periurethral tissue from right to left between the urethra and DVC. It was then passed through the periostium on the pubic bone, and again through the DVC and then through the pubic bone in a figure-of-eight fashion. The knot was tied with a mild amount of tension. Following this the bladder neck dissection was performed and the prostatectomy performed as routinely described. The two groups of patients were compared for clinical, pathological and outcome variables.

There was no difference between the groups regarding age, BMI, PSA levels, prostate weight, AUA symptom score, and biopsy Gleason score. No significant difference was found regarding blood loss, operative time, blood transfusion rates and catheterization time. Just over 60% of patients in each group had bilateral nerve sparing performed. Both groups were similar with regard to pathologic stage and the incidence of positive surgical margins (9-12%). The continence rates at 1, 3, 6, and 12 months in the group without urethral resuspension performed were 33%, 83%, 94.7%, and 95.7%, respectively. The continence rates at 1, 3, 6, and 12 months in the group with urethral resuspension performed were 40%, 92.8%, 97.9%, and 97.9%, respectively. The urethral suspension was statistically significant for improved continence rates at 3 months post-RALP, but not at 6 or 12 months. The median return to continence was one week quicker (6 vs. 7 weeks) for patients in the suspension group.

Patel VR, Coelho RF, Palmer KJ, Rocco B
Eur Urol. 2009 Jun 16. Epub ahead of print.
doi:10.1016/j.eururo.2009.06.007

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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