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Combined bladder neck preservation and posterior musculofascial reconstruction during robotic assisted radical prostatectomy: effects on early and long term urinary continence recovery.
BMC Urol. 2017 Dec 15; 17(1):119.BU

Abstract

BACKGROUND

To evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP).

METHODS

Two-hundred ninety-two patients who previously underwent radical prostatectomy were retrospectively selected for a case-control study, excluding those with anastomotic strictures and significant perioperative complications and re-called for a medical follow-up visit after their consent to participate the study. They were divided in 3 different groups according to the surgical technique previously received: radical retropubic prostatectomy (RRP) combined with bladder neck preservation (BNP), RARP with bladder neck resection, and RARP combined with BNP and posterior musculofascial reconstruction (PRec). Functional and oncologic outcomes evaluation were integrated by a questionnaire on urinary continence status, abdominal ultrasound scan, uroflowmetry and post-void urine volume measurement. Urinary continence definition included the terms "no pad" or "safety pad".

RESULTS

Two hundred thirty-two patients responded to the phone call interview and were enrolled in the study. They presented comparable age, prostate volume and BMI. Differences in comorbidities, ASA score and medications, did not influence the postoperative functional results, focused on continence outcome. Early urinary continence was achieved in 49.38% and 24.73% of patients who previously underwent RARP + BNP + PRec and simple RARP respectively (p = 0.000)as well as late 12-months urinary continence was obtained in 92.59% and 79.56% of patients.(p = 0.01). Late urinary continence in the RRP + BNP group was comparable to the result obtained in the simple RARP group. The potential effects of nerve sparing technique on urinary continence have not been evaluated.

CONCLUSIONS

The combined technique of RARP + BNP + PRec seems to be effective to determine early and long term significant effects on urinary continence of patients with comparable body mass index, age and prostate volume. No statistically significant differences were found between the simple RARP and the RRP + BNP groups.

Authors+Show Affiliations

Urology Unit University of Pisa, Pisa, Italy. riccardo.bartoletti@hotmail.com. Urology University Unit, Cisanello Hospital, Via Paradisa 2, 56124, Pisa, Italy. riccardo.bartoletti@hotmail.com.Urology Unit University of Pisa, Pisa, Italy.Urology Unit AOUP, Pisa, Italy.Urology Unit AOUP, Pisa, Italy.Urology Unit University of Pisa, Pisa, Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

29246146

Citation

Bartoletti, Riccardo, et al. "Combined Bladder Neck Preservation and Posterior Musculofascial Reconstruction During Robotic Assisted Radical Prostatectomy: Effects On Early and Long Term Urinary Continence Recovery." BMC Urology, vol. 17, no. 1, 2017, p. 119.
Bartoletti R, Mogorovich A, Francesca F, et al. Combined bladder neck preservation and posterior musculofascial reconstruction during robotic assisted radical prostatectomy: effects on early and long term urinary continence recovery. BMC Urol. 2017;17(1):119.
Bartoletti, R., Mogorovich, A., Francesca, F., Pomara, G., & Selli, C. (2017). Combined bladder neck preservation and posterior musculofascial reconstruction during robotic assisted radical prostatectomy: effects on early and long term urinary continence recovery. BMC Urology, 17(1), 119. https://doi.org/10.1186/s12894-017-0308-1
Bartoletti R, et al. Combined Bladder Neck Preservation and Posterior Musculofascial Reconstruction During Robotic Assisted Radical Prostatectomy: Effects On Early and Long Term Urinary Continence Recovery. BMC Urol. 2017 Dec 15;17(1):119. PubMed PMID: 29246146.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined bladder neck preservation and posterior musculofascial reconstruction during robotic assisted radical prostatectomy: effects on early and long term urinary continence recovery. AU - Bartoletti,Riccardo, AU - Mogorovich,Andrea, AU - Francesca,Francesco, AU - Pomara,Giorgio, AU - Selli,Cesare, Y1 - 2017/12/15/ PY - 2017/07/13/received PY - 2017/11/28/accepted PY - 2017/12/17/entrez PY - 2017/12/17/pubmed PY - 2018/10/6/medline KW - Bladder neck preservation KW - Posterior musculofascial reconstruction KW - Prostate cancer surgery KW - Robot assisted radical prostatectomy KW - Urinary continence SP - 119 EP - 119 JF - BMC urology JO - BMC Urol VL - 17 IS - 1 N2 - BACKGROUND: To evaluate the effects of combined bladder neck preservation and posterior reconstruction techniques on early and long term urinary continence in patients treated by robotic assisted radical prostatectomy (RARP). METHODS: Two-hundred ninety-two patients who previously underwent radical prostatectomy were retrospectively selected for a case-control study, excluding those with anastomotic strictures and significant perioperative complications and re-called for a medical follow-up visit after their consent to participate the study. They were divided in 3 different groups according to the surgical technique previously received: radical retropubic prostatectomy (RRP) combined with bladder neck preservation (BNP), RARP with bladder neck resection, and RARP combined with BNP and posterior musculofascial reconstruction (PRec). Functional and oncologic outcomes evaluation were integrated by a questionnaire on urinary continence status, abdominal ultrasound scan, uroflowmetry and post-void urine volume measurement. Urinary continence definition included the terms "no pad" or "safety pad". RESULTS: Two hundred thirty-two patients responded to the phone call interview and were enrolled in the study. They presented comparable age, prostate volume and BMI. Differences in comorbidities, ASA score and medications, did not influence the postoperative functional results, focused on continence outcome. Early urinary continence was achieved in 49.38% and 24.73% of patients who previously underwent RARP + BNP + PRec and simple RARP respectively (p = 0.000)as well as late 12-months urinary continence was obtained in 92.59% and 79.56% of patients.(p = 0.01). Late urinary continence in the RRP + BNP group was comparable to the result obtained in the simple RARP group. The potential effects of nerve sparing technique on urinary continence have not been evaluated. CONCLUSIONS: The combined technique of RARP + BNP + PRec seems to be effective to determine early and long term significant effects on urinary continence of patients with comparable body mass index, age and prostate volume. No statistically significant differences were found between the simple RARP and the RRP + BNP groups. SN - 1471-2490 UR - https://www.unboundmedicine.com/medline/citation/29246146/Combined_bladder_neck_preservation_and_posterior_musculofascial_reconstruction_during_robotic_assisted_radical_prostatectomy:_effects_on_early_and_long_term_urinary_continence_recovery_ L2 - https://bmcurol.biomedcentral.com/articles/10.1186/s12894-017-0308-1 DB - PRIME DP - Unbound Medicine ER -