Long-term impact of posterior reconstruction urethrovesical anastomosis during robot-assisted prostatectomy
A secondary analysis of a randomized cohort
DOI:
https://doi.org/10.5489/cuaj.9121Keywords:
Robot-assisted radical prostatectomy, posterior-reconstruction urethrovesical anastomosis, Rocco stitch, urinary incontinenceAbstract
INTRODUCTION: We aimed to assess early and late continence rates post-robot-assisted radical prostatectomy (RARP), comparing posterior reconstruction (PR) urethrovesical anastomosis (UVA) to conventional urethrovesical anastomosis (C-UVA).
METHODS: Consecutive patients with clinically localized prostate cancer undergoing RARP underwent simple randomization to PR-UVA or C-UVA. Return to continence outcomes were assessed using a validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC] Short Form-26) at baseline, two-, three-, four-, six-, eight-, and 12-month followups. Five-year outcomes were assessed by frequency of undergoing continence-improving procedures.
RESULTS: A total of 163 patients were randomized 1:1 to PR-UVA or C-UVA from April 2014 to July 2015, and 140 patients completed followup. There were no significant clinical or functional differences between groups preoperatively. Using a continence definition of 0-1 pads/day, the continence rates for PR-UVA vs. C-UVA were 39% vs. 38% at two months, respectively (p=1.0), and 93% vs. 86%, respectively, at 12 months (p=0.3). Frequency of urine leak, quantity of pad use, subjective urinary control, and overall bother improved significantly in all patients during the 12-month study period (p<0.001); however, no difference was demonstrated between groups. Five-year results showed no statistically significant difference in the number of patients undergoing a continence-improving procedure (hazard ratio 1.21, 95% confidence interval 0.40-3.65, p=0.7).
CONCLUSIONS: PR-UVA failed to show a benefit in short-term return to urinary continence or need for an incontinence-improving procedure five years post-RARP.
Downloads
Downloads
Published
How to Cite
Issue
Section
License
You, the Author(s), assign your copyright in and to the Article to the Canadian Urological Association. This means that you may not, without the prior written permission of the CUA:
- Post the Article on any Web site
- Translate or authorize a translation of the Article
- Copy or otherwise reproduce the Article, in any format, beyond what is permitted under Canadian copyright law, or authorize others to do so
- Copy or otherwise reproduce portions of the Article, including tables and figures, beyond what is permitted under Canadian copyright law, or authorize others to do so.
The CUA encourages use for non-commercial educational purposes and will not unreasonably deny any such permission request.
You retain your moral rights in and to the Article. This means that the CUA may not assert its copyright in such a way that would negatively reflect on your reputation or your right to be associated with the Article.
The CUA also requires you to warrant the following:
- That you are the Author(s) and sole owner(s), that the Article is original and unpublished and that you have not previously assigned copyright or granted a licence to any other third party;
- That all individuals who have made a substantive contribution to the article are acknowledged;
- That the Article does not infringe any proprietary right of any third party and that you have received the permissions necessary to include the work of others in the Article; and
- That the Article does not libel or violate the privacy rights of any third party.
