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Effect of Puboprostatic Ligament Reconstruction on Continence Recovery after Robot-assisted Laparoscopic Prostatectomy: Our Initial Experience. - Beyond the Abstract

Incontinence is one of the major problems after radical prostatectomy (RP) that might affects the patients’ decision regarding the available treatment options; however, the actual magnitude of this problem is still unclear. This can be explained by the absence of a standardized definition of continence after RP and the highly variable methodology for assessment of incontinence between subjective and objective means.  Furthermore, there is a high discrepancy between patient- and physician-reported continence outcomes following RP. On the other hand, several techniques have been introduced to improve the continence rates after RP but their outcomes are still debatable due to the lack of standardization of these techniques application between different centers.

We believe that the ideal technique for improving the post-operative continence outcomes should be characterized by simplicity and short learning curve, low cost (no need for special type stitches or using two needle holders during RARP and not time-consuming), and higher patient satisfaction. In these settings, we presented our experience with a simple technique of anterior reconstruction of the puboprostatic ligament. We compared 48 patients who underwent RARP with anterior reconstruction versus 47 patients who underwent RARP without any reconstruction showing that our technique provided better continence (complete continence with no pads per day) at the time of catheter removal (p=0.022) and at 6 months (p=0.035).

Pubo-Prostatic Ligaments Reconstruction



Our study was not devoid of limitations including the retrospective nature of the study and the small sample size; however, it can still support that our simple technique of anterior reconstruction might provide better immediate continence rate and shorten the time to continence. Since posterior reconstruction is the most studied technique in the literature with a described benefit on early continence recovery, we believe that adding our technique to it, may improve the continence rates in patients undergoing RARP, thus, we started to offer our patients a combined anterior and posterior reconstruction.

Written by: Stefano Puliatti1, Ahmed Eissa1,2, Ahmed Zoeir1,2, Maria Chiara Sighinolfi1, Salvatore Micali1, Bernardo Rocco1, Giampaolo Bianchi1
1. Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
2. Urology Department Faculty of Medicine, Tanta University, Egypt

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