A better way to preserve continence? A new technique for prostatectomy

This study examined the effects of total anatomical reconstruction (TAR) during robot-assisted radical prostatectomy on recovery of urinary continence. 

Urinary incontinence is a potential side effect of radical prostatectomy (removal of the prostate gland) that can impair a patient’s quality of life following surgery.  The TAR technique involves full restoration of the structures surrounding the urethra (tube that urine is excreted through). Hence this technique could improve continence outcomes.

The use of robotics allows surgeons to keep delicate structures, like nerves, intact. Therefore, robotic surgery may also lead to improved recovery of continence. Anastomosis is a new surgical connection made, in this case, between the bladder and the urethra.  Stenosis is a narrowing of this connection. This is a possible complication of this type of surgery.

The current study examined whether the TAR method improved urinary incontinence and decreased the risk of stenosis in patients undergoing radical prostatectomy.

This study included 252 patients with localized prostate cancer (had not spread beyond the prostate). All patients underwent robotic-assisted prostatectomy using the TAR technique. Continence rates were examined at 24 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter (a tube from the bladder through the urethra that removes urine following surgery) removal. Patients were said to be continent if they used zero pads/adult diapers, or one ‘safety pad’ per day to control leakage.

At the time of catheter removal 71.8% of patients were continent. Continence rates gradually improved. 77.8% of patients were continent at 1 week, 89.3% at 4 weeks, 94.4% at 12 weeks, and 98.0% at 24 weeks after catheter removal.

Early recovery of incontinence was influenced by the nerve sparing technique, prostate volume (size), D’Amico risk groups (a score indicating how likely the cancer is to return), and eventual extended pelvic lymph node dissection A low rate of urine leakage (1.2%) and no stenosis of the anastomosis was recorded.

This study concluded that the TAR technique may be effective in the early recovery of urinary continence.

This study lacked randomization and comparison with other techniques. Aside from smoking and diabetes, other preexisting conditions that could affect continence recovery were not examined.

Discuss surgical options with your physician.