PURPOSE: We devised a single-step posterior reconstruction (PR) technique, which opposes the median dorsal raphe solely to the posterior counterpart of the detrusor apron, rather than to the Denonvilliers' fascia.
We previously found that during robot-assisted laparoscopic prostatectomy (RALP) this new technique could significantly shortens continence recovery time through a retrospective study. We designed a prospective clinical trial to confirm it.
MATERIALS AND METHODS: We designed a single-blind, parallel group, randomized controlled trial. One hundred men who underwent RALP by a single surgeon at a referral center were randomly allocated to intervention group (n=50) or control group (n=50) from October 2012 through August 2013. The intervention group underwent PR with this new technique before +vesicourethral anastomosis. All patients in both groups received anterior reconstruction. The primary endpoint was duration to continence recovery, defined as no pad use. The secondary outcomes included social continence (0 or 1 pad per day) recovery time.
RESULTS: In the control group, one subject was excluded due to open conversion and four patients were excluded due to withdrew from participation. The median duration of complete continence recovery did not differ significantly between intervention (106 days) and control (119 days) (p=0.890). However, social continence recovery was significantly shorter in the intervention group (median 18 days) than control group (median 30 days, p=0.024).
CONCLUSIONS: Single-step PR did not significantly shorten the duration of complete continence recovery. However, it seems to have marginal benefit on early social continence recovery.
Written by:
Jeong CW, Lee JK, Oh JJ, Lee S, Jeong SJ, Hong SK, Byun SS, Lee SE. Are you the author?
Department of Urology, Seoul National University Hospital, Seoul, Korea; Department of Urology, College of Medicine, Seoul National University, Seoul, Korea; Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Reference: J Urol. 2014 Oct 11. pii: S0022-5347(14)04641-2.
doi: 10.1016/j.juro.2014.10.023
PubMed Abstract
PMID: 25315960