Early continence outcomes of posterior musculofascial plate reconstruction during robotic and laparoscopic prostatectomy

Authors

  • Mike M. Nguyen,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Kazumi Kamoi,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Robert J. Stein,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Monish Aron,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Jason M. Hafron,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Burak Turna,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Robert P. Myers,

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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  • Inderbir S. Gill

    1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, and Department of Urology, Mayo Clinic, Rochester, MN, USA
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Inderbir S. Gill, Glickman Urological Institute, 9500 Euclid Ave, Desk A100, Cleveland, OH 44195, USA.
e-mail: gilli@ccf.org

Abstract

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.

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