Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy

• Published in: Journal of robotic surgery 2023-02, Vol.17 (1), p.177-184
• Main Authors: Hoeh, Benedikt, Hohenhorst, Jan L., Wenzel, Mike, Humke, Clara, Preisser, Felix, Wittler, Clarissa, Brand, Marie, Köllermann, Jens, Steuber, Thomas, Graefen, Markus, Tilki, Derya, Karakiewicz, Pierre I., Becker, Andreas, Kluth, Luis A., Chun, Felix K. H., Mandel, Philipp
• Format: Article
• Language: English
• Subjects: Body mass index; Body size; Catheters; Humans; Male; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Original; Original Article; Patients; Prostate - surgery; Prostate cancer; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - surgery; Recovery of Function; Regression models; Robotic Surgical Procedures - methods; Robotics; Robustness (mathematics); Standard of care; Surgeons; Surgery; Treatment Outcome; Tumors; Urethra - surgery; Urinary incontinence; Urological surgery; Urology
• ISSN: 1863-2491; 1863-2483; 1863-2491
• DOI: 10.1007/s11701-022-01408-7

The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP ( p   5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51–27.36; p