Robot-assisted radical prostatectomy using a novel urethral reconstruction technique vs standard vesicourethral anastomosis. A retrospective cohort study.

BACKGROUND

Urinary incontinence is a common postoperative complication of radical prostatectomy (RP). In order to improve postoperative urinary continence rate, we proposed a urethral reconstruction technique which can prevent functional urethra retracting and maintain urethral stability. This study aims to describe the novel technique of robotic-assisted radical prostatectomy (RARP) and compare it with standard vesicourethral anastomosis (VUA) in the early postoperative urinary continence.

METHODS

Based on the anatomy study, we proposed our novel urethral reconstruction technique. The technique is a continuous suture of the outer urethral rhabdosphincter and the levator ani muscle, the medial dorsal raphe and Denonvilliers fascia. A retrospective, single-center cohort of 75 patients undergoing RARP between August 2020 and February 2022 was analyzed, including 38 patients in the study group undergoing the novel urethral reconstruction technique and 37 patients in the control group undergoing the standard VUA.

RESULTS

The two groups were comparable in all baseline characteristics. The continence rates in the study group were significantly higher than that in the control group at the day catheter was removed, 1st month and 3rd month after the catheter removal (71.1% vs 37.8%, p = 0.004; 76.3% vs 43.2%, p = 0.003; and 94.7% vs 78.4%, p = 0.037; respectively). No significant difference was observed in operation time (p = 0.241). Meantime, no increase in complications rate was observed in the study group.

CONCLUSIONS

Our novel urethral reconstruction technique contributes to the early urinary continence after RARP effectively and safely.