Fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis: point of technique.

OBJECTIVES

Nerve-sparing radical prostatectomies provide excellent control of cancer, but the recovery of continence and sexual function are uncertain. We report the operative details and surgical techniques of a robot-assisted radical prostatectomy (RARP) experiences for organ confined prostate cancer.

METHODS

Between the years of 2009 and 2012, 68 patients with clinically localized prostate cancer underwent fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis. None of the patients were incontinent. 48 of them had an IIEF-5 potency score equal or greater than 22, without receiving phosphodiesterase-5 inhibitors. Our techniques included preservation of the bladder neck, preservation of the endopelvic fascia and puboprostatic ligaments, a nerve-sparing intrafascial approach, selective suturing of the dorsal venous complex, and anterior and posterior reconstruction. We evaluated the patients at the 1st, 3rd, 6th, and 12th postoperative months to determine if these techniques are correlated with early recovery of urinary continence and potency.

RESULTS

The mean operation time was 258.2±78.5 minutes, and the mean estimated blood loss was 111.2±22.9 cc during the operation. A nerve-sparing procedure was performed bilaterally in 62 (91.2 %) cases and unilaterally in 6 (8.8%) cases. The mean drain extraction time was 2.3±0.9 days, and the mean hospital stay was 3.4±1.1 days. The catheter was removed on postoperative day 9.9±0.9. The surgical margin was positive in 10 (14.7%) patients. The continence rates at 1, 3, 6, and 12 months were 74.2%, 76.9%, 80.6%, and 95.6%, respectively. During the same period, among the patients without ED, the potency rates were 29.4%, 38.2%, 54.1%, and 75%, respectively All operations were completed successfully, and there were no major complications.

CONCLUSIONS

A more comprehensive approach for reporting prostate cancer surgery outcomes is needed. Our study findings suggest that fascia-sparing techniques positively influence the early recovery of urinary continence. However, randomized controlled trials with large samples are needed.