Prostate cancer represents a serious health problem worldwide. Radical prostatectomy is the gold standard for management of localized prostate cancer. Urinary incontinence is among the most common complications affecting RALP patients' post-operative quality of life.
Several surgical modifications were introduced to overcome this problem including the puboprostatic ligament reconstruction. In this study, we discuss our technique of anterior reconstruction of the puboprostatic ligament during RALP and its effect on the continence outcome postoperatively.
In this retrospective study, the data of 95 consecutive patients were analyzed and the patients were divided in two groups; the control group "Group A" (47 patients) and the anterior reconstruction group "Group B" (48 patients). The primary endpoint of this study was to compare both groups as regards the post-operative continence rates.
Complete continence (no pads) rates were reported at time of catheter removal (T0), 1 month (T1), 4 months (T4), 6 months (T6) and 12 months (T12) post-operatively. Moreover, the social continence (0-1 security pad) was reported at 12 months post-operatively. Complete continence was significantly different between both groups at T0 and T6 (p =0.022, and P=0.035 respectively). The social continence was not significantly different between both groups (85.1% Vs 89.6% in group A Vs group B).
Despite anterior reconstruction of the puboprostatic ligament showed no significant effect on the overall continence, it showed earlier return to continence up to 6 months, which supports the theory that anterior puboprostatic reconstruction may provide better immediate continence and shorten the time to continence for RALP patients. However, most of the published literature showed better continence rates with the total anatomical reconstruction (combined anterior and posterior). Therefore, we started to offer patients in our center total anatomical reconstruction during RALP.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2018 Dec 14 [Epub ahead of print]
Stefano Puliatti, Ahmed Elsherbiny, Ahmed Eissa, Giacomo Pirola, Elena Morini, Denise Squecco, Raffaele Inzillo, Ahmed Zoeir, Andrea Iseppi, Maria Chiara Sighinolfi, Salvatore Micali, Bernardo Rocco, Giampaolo Bianchi
Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy - ., Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/30547904
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