Urinary continence outcomes after peri-urethral suspension according to Patel during Robot Assisted Laparoscopic Radical Prostatectomy (RALP). Results from a case-control study
Technical variations of RALP have been proposed by different authors to improve urinary continence with conflicting results, due to the persistence of multiple adjunctive factors such as bladder neck sparing and the patient or disease characteristics. The aim of the present study was to determine the effects of peri-urethral suspension according to Patel on a cohort of consecutive patients who underwent RALP for clinically localized prostate cancer.
Materials and Methods
Two-hundred and thirty patients who previously underwent RALP were recalled by telephone and subsequently investigated by PSA testing , ultrasound post-voiding residual urine measurement and specifically designed questionnaire to investigate their quality of life and the effects of surgery on urinary continence. 174 of them responded to the telephone recall and were eligible for the study while 56 were considered as drop out (2 deceased for unrelated diseases, 51 refused to respond the questionnaire). 81 out 174 received PUS with polyglecaprone 3-0 suture prior of Van Velthoven vesico-urethral anastomosis ( Group 1) while 93 out 174 received a standard vesico-urethral polyglecaprone 3-0 suture according to Van Velthoven (Group 2). Statistical analysis was performed by Fisher Exact test.
Patients presented comparable preoperative characteristics in both groups except for prostate volume, which had a median value greater than 40 cc in 95.3% of Group 1 in comparison to 80.8% in the Group 2 (p<0.001). Pathological analysis demonstrated comparable distribution of progression risk in both groups but a significantly higher number of T3 patients in the control group ( 13.3% vs. 25.6%) (p=0.02). Positive surgical margin rate was comparable between the two groups. Sixty-nine percent of patients in the Group 1 were immediately and totally continent after the urethral catheter removal as well as after a median follow up of 23±17.4 months (period 2011-2016) while only 48.3% in the Group 2 were continent with a median follow up of 30±22.1 months (period 2009-2016). Socially acceptable continence (no pads or a single safety pad a day) was found in 92.58% of the Group 1 and 79.56 of the Group 2 patients respectively (p=0.003). Severe incontinence was found in 4.9% and 15% of the Group 1 and 2 respectively.
Periurethral suspension according to Patel during RALP resulted in a statistically significant shorter interval to continence recovery and higher continence rate at a median 23 months follow up time.Argomenti: cancro della prostata