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31-01-2012 | Surgery | Article

Prostatectomy modifications improve return of continence after surgery


Free abstract

MedWire News: Anterior suspension (AS) combined with posterior reconstruction (PR) during robotic-assisted laparoscopic prostatectomy (RALP) significantly improves the early return of continence in patients after surgery, report researchers.

The two techniques are easy to perform, safe, and do not compromise oncologic control, say Xavier Hurtes (University Hospital of Tours, France) and team.

"Results reported with these two technical modifications have been inconsistent," say the researchers. "We therefore decided to combine AS and PR during RALP and to assess outcomes in a randomized, multicentre control study."

The team studied 72 patients with localized prostate cancer (clinical stage cT0-cT2, by tumor, nodes, metastasis [TNM] classification) who were randomly allocated to undergo either a standard RALP procedure (group A, n=33) or RALP with both AS and PR (group B, n=39).

The primary outcome of interest was continence measured at 15 days and 1, 3, and 6 months after surgery using the University of California Los Angeles Prostate Cancer Index. The team also recorded procedural complication rate (using the Clavien-Dindo classification), postoperative pain, and positive surgical margin (PSM) rate (the visible normal tissue or skin margin that is removed during tumor/growth excision).

The researchers report that RALP with AS and PR resulted in significantly higher continence rates at 1 and 3 months after surgery than standard RALP did (26.5 vs 7.1% and 45.2 vs 15.4%, respectively), although there was no significant improvement in very early (15 days) and late (6 months) continence (5.9 vs 3.6% and 65.4 vs 57.9%, respectively).

"We consider that AS provides an anatomical support for the urethra, allowing improvement of the urethral length during the apex dissection, and stabilization of the urethra and the striated sphincter in the anatomical position," write Hurtes et al in the British Journal of Urology International.

"Moreover, adding PR enables the surgeon to perform a tension-free anastomosis and recreate a posterior support for the sphincter," they explain.

Hurtes and team also found that the overall PSM rate in the present study was 16.9% with no significant differences in PSM rate found between group A and group B.

Furthermore, no significant between-group differences were found in complication rates, severity of complications, or postoperative pain.

"The present multicenter randomized study shows that anterior suspension combined with posterior reconstruction is a safe and easy-to-perform technique for improving continence after RALP," concludes the team.

By Sally Robertson

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