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Re: Anterior Suspension Combined with Posterior Reconstruction During Robot-Assisted Laparoscopic Prostatectomy Improves Early Return of Urinary Continence: A Prospective Randomized Multicentre Trial
LAPAROSCOPY/NEW TECHNOLOGY
1717
Laparoscopy/New Technology Re: Anterior Suspension Combined with Posterior Reconstruction During Robot-Assisted Laparoscopic Prostatectomy Improves Early Return of Urinary Continence: A Prospective Randomized Multicentre Trial X. Hurtes, M. Rouprêt, C. Vaessen, H. Pereira, B. Faivre d’Arcier, L. Cormier and F. Bruyère Urology Department, University Hospital of Tours, Tours, France BJU Int 2012; 110: 875– 883.
Objective: To assess the impact on urinary continence of anterior retropubic suspension with posterior reconstruction during robot-assisted laparoscopic prostatectomy (RALP). Patients and Methods: In total, 72 patients who were due to undergo prostatectomy between July 2009 and July 2010 were prospectively randomized into two groups: group A underwent a standard RALP procedure and group B had anterior suspension and posterior reconstruction during RALP. The primary outcome measure was urinary continence, assessed using the University of California Los Angeles Prostate Cancer Index questionnaire at 15 days, and at 1, 3 and 6 months, after surgery. Other data recorded were operation duration, blood loss, length of hospital stay, duration of bladder catheterization, complications and positive margin rate. Results: The continence rates at 15 days, and at 1, 3 and 6 months, after surgery were 3.6%, 7.1%, 15.4% and 57.9%, respectively, in group A, and 5.9%, 26.5%, 45.2% and 65.4%, respectively, in group B. The continence rates differed statistically between groups at 1 and 3 months (P ⫽ 0.047 and P ⫽ 0.016, respectively). There was no significant difference between groups regarding complications (P ⫽ 0.8) or positive margin rate (P ⫽ 0.46). Conclusion: Anterior suspension associated with posterior reconstruction during RALP improved the early return of continence, without increasing complications. Editorial Comment: This study contradicts 2 other randomized studies in which there was no demonstrable advantage of posterior reconstruction (Rocco stitch) regarding early return of urinary continence. In this appropriately powered multicenter study posterior reconstruction, when combined with an anterior suspension of the dorsal venous complex, significantly improved urinary control at 1 and 3 months. With no adverse effects attributable to these maneuvers reported in any series, I agree with the authors that when technically feasible, these maneuvers are simple to perform and should add minimally to the operative time of robotic radical prostatectomy. Jeffrey A. Cadeddu, M.D.
Re: Extended Nodal Dissection Reduces Sexual Function Recovery After Robot-Assisted Laparoscopic Prostatectomy H. G. van der Poel, C. Tillier, W. de Blok and E. van Muilekom Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands J Endourol 2012; 26: 1192–1198.
Background and Purpose: Considering the anatomic proximity of the internal iliac lymph nodes and the pelvic plexus, it may be expected that more extensive pelvic nodal dissection is associated with an increased risk of damage to the small pelvis neural and vascular structures. We evaluate whether nodal dissection is associated with functional outcome after robot-assisted radical prostatectomy (RARP). Patients and Methods: In a series of 798 RARP procedures, 325 (40.7%) patients underwent a lymph node dissection. Continence, sexual function, and lower urinary tract symptoms (LUTS) were assessed using the International Consultation of Incontinence Questionnaire short form (ICIQ)-SF),
1717
Laparoscopy/New Technology Re: Anterior Suspension Combined with Posterior Reconstruction During Robot-Assisted Laparoscopic Prostatectomy Improves Early Return of Urinary Continence: A Prospective Randomized Multicentre Trial X. Hurtes, M. Rouprêt, C. Vaessen, H. Pereira, B. Faivre d’Arcier, L. Cormier and F. Bruyère Urology Department, University Hospital of Tours, Tours, France BJU Int 2012; 110: 875– 883.
Objective: To assess the impact on urinary continence of anterior retropubic suspension with posterior reconstruction during robot-assisted laparoscopic prostatectomy (RALP). Patients and Methods: In total, 72 patients who were due to undergo prostatectomy between July 2009 and July 2010 were prospectively randomized into two groups: group A underwent a standard RALP procedure and group B had anterior suspension and posterior reconstruction during RALP. The primary outcome measure was urinary continence, assessed using the University of California Los Angeles Prostate Cancer Index questionnaire at 15 days, and at 1, 3 and 6 months, after surgery. Other data recorded were operation duration, blood loss, length of hospital stay, duration of bladder catheterization, complications and positive margin rate. Results: The continence rates at 15 days, and at 1, 3 and 6 months, after surgery were 3.6%, 7.1%, 15.4% and 57.9%, respectively, in group A, and 5.9%, 26.5%, 45.2% and 65.4%, respectively, in group B. The continence rates differed statistically between groups at 1 and 3 months (P ⫽ 0.047 and P ⫽ 0.016, respectively). There was no significant difference between groups regarding complications (P ⫽ 0.8) or positive margin rate (P ⫽ 0.46). Conclusion: Anterior suspension associated with posterior reconstruction during RALP improved the early return of continence, without increasing complications. Editorial Comment: This study contradicts 2 other randomized studies in which there was no demonstrable advantage of posterior reconstruction (Rocco stitch) regarding early return of urinary continence. In this appropriately powered multicenter study posterior reconstruction, when combined with an anterior suspension of the dorsal venous complex, significantly improved urinary control at 1 and 3 months. With no adverse effects attributable to these maneuvers reported in any series, I agree with the authors that when technically feasible, these maneuvers are simple to perform and should add minimally to the operative time of robotic radical prostatectomy. Jeffrey A. Cadeddu, M.D.
Re: Extended Nodal Dissection Reduces Sexual Function Recovery After Robot-Assisted Laparoscopic Prostatectomy H. G. van der Poel, C. Tillier, W. de Blok and E. van Muilekom Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands J Endourol 2012; 26: 1192–1198.
Background and Purpose: Considering the anatomic proximity of the internal iliac lymph nodes and the pelvic plexus, it may be expected that more extensive pelvic nodal dissection is associated with an increased risk of damage to the small pelvis neural and vascular structures. We evaluate whether nodal dissection is associated with functional outcome after robot-assisted radical prostatectomy (RARP). Patients and Methods: In a series of 798 RARP procedures, 325 (40.7%) patients underwent a lymph node dissection. Continence, sexual function, and lower urinary tract symptoms (LUTS) were assessed using the International Consultation of Incontinence Questionnaire short form (ICIQ)-SF),