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Surgical techniques to optimise early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer
14th Meeting of the EAU Robotic Urology Section
VE09
Surgical techniques to optimise early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer Eur Urol Suppl 2017; 16(6);e2379
Sridhar A.N. , Mohammed A. , Mazzon G. , Busuttil G. , Thompson J. , Kelly J.D , Nathan S. , Shaw G. , Rajan P. , Sooriakumaran P. , Briggs T.P University College London Nhs Trust, Dept. of Urology, London, United Kingdom Introduction & Objectives: A variety of different surgical techniques are thought to impact on early urinary continence (UC) recovery in patients undergoing robotic prostatectomy (RARP) for prostate cancer. Here, we have reviewed the current evidence and demonstrated in the video, a composite evidence-based technique to optimize UC recovery after RARP Material & Methods: A literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. These were incorporated into the surgical procedure. Baseline, 6 weeks and 3 months UC rates were collected using the validated ICIQ-SF questionnaire. Results: The available data from studies ranging from randomized control trials to retrospective cohort studies suggest surgical techniques that look to minimize damage to the internal and external urinary sphincters and their neural supply, promote maximal sparing of urethral length, create a secure vesicourethral anastomosis, provide an anterior and posterior myo- fascio-ligamentous support to the anastomosis in order to improve early UC recovery post RARP. The video demonstrates a composite technique incorporating all of these steps. UC recovery rates to baseline levels using this composite technique were 52.7% and 69.4% at 6 weeks and 3 months respectively. Conclusions: A composite evidence-based surgical technique incorporating the above principles could optimize early UC recovery post RARP. Most studies are limited by the differences in surgical technique, absence of an objective measure and differences in outcome definitions. Unless there is an RCT comparing RARP incorporating all the above steps to RARP without these steps, it is difficult to draw concrete conclusions. In the meantime a consensus of surgical technique conducted using good qualitative methodology and experts might suffice to guide surgeons on their learning curve looking to improve the UC outcomes in their patients.
Eur Urol Suppl 2017; 16(6);e2379
VE09
Surgical techniques to optimise early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer Eur Urol Suppl 2017; 16(6);e2379
Sridhar A.N. , Mohammed A. , Mazzon G. , Busuttil G. , Thompson J. , Kelly J.D , Nathan S. , Shaw G. , Rajan P. , Sooriakumaran P. , Briggs T.P University College London Nhs Trust, Dept. of Urology, London, United Kingdom Introduction & Objectives: A variety of different surgical techniques are thought to impact on early urinary continence (UC) recovery in patients undergoing robotic prostatectomy (RARP) for prostate cancer. Here, we have reviewed the current evidence and demonstrated in the video, a composite evidence-based technique to optimize UC recovery after RARP Material & Methods: A literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. These were incorporated into the surgical procedure. Baseline, 6 weeks and 3 months UC rates were collected using the validated ICIQ-SF questionnaire. Results: The available data from studies ranging from randomized control trials to retrospective cohort studies suggest surgical techniques that look to minimize damage to the internal and external urinary sphincters and their neural supply, promote maximal sparing of urethral length, create a secure vesicourethral anastomosis, provide an anterior and posterior myo- fascio-ligamentous support to the anastomosis in order to improve early UC recovery post RARP. The video demonstrates a composite technique incorporating all of these steps. UC recovery rates to baseline levels using this composite technique were 52.7% and 69.4% at 6 weeks and 3 months respectively. Conclusions: A composite evidence-based surgical technique incorporating the above principles could optimize early UC recovery post RARP. Most studies are limited by the differences in surgical technique, absence of an objective measure and differences in outcome definitions. Unless there is an RCT comparing RARP incorporating all the above steps to RARP without these steps, it is difficult to draw concrete conclusions. In the meantime a consensus of surgical technique conducted using good qualitative methodology and experts might suffice to guide surgeons on their learning curve looking to improve the UC outcomes in their patients.
Eur Urol Suppl 2017; 16(6);e2379