Impact of Posterior Musculofascial Reconstruction on Early Continence After Robot-Assisted Laparoscopic Radical Prostatectomy: Results of a Prospective Parallel Group Trial

BackgroundA significant proportion of patients develop urinary incontinence early after radical prostatectomy. Posterior reconstruction of supporting tissues has been found to reduce incontinence in open and conventional laparoscopic prostatectomy series.ObjectiveTo investigate whether our version of a posterior musculofascial reconstruction will reduce early incontinence and have a beneficial effect on patients’ quality of life (QoL).Design, setting, and participantsOne hundred seven consecutive patients undergoing primary robot-assisted radical laparoscopic prostatectomy (RALP) performed by a single surgeon at one tertiary referral oncology institution were alternately assigned (not randomised) to intervention (n = 53) or control groups (n = 54).Surgical procedureRALP with median fibrous raphe reconstruction (MFRR) followed by formation of the urethrovesical anastomosis (intervention group) versus standard anastomosis without posterior reconstruction (control group).MeasurementsMeasurements included incontinence at baseline and 3-mo intervals; QoL as measured by a simple questionnaire, the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life–Core 30 (QLQ-C30), and Prostate Cancer Module (PR25) questionnaires preoperatively and at 6 mo postprocedure; tumour characteristics; operative time; fascial preservation score; duration of catheterisation; and anastomotic leakage on cystogram.Results and limitationsFor intervention and control groups respectively, mean catheter duration was 11.74 d and 12.74 d (p = 0.451); leakage on cystogram was present in six and eight cases (p = 0.28); and incontinence (any involuntary urine loss) at 3 mo was 75% and 69% (p = 0.391) and at 6 mo was 51% and 43% (p = 0.686). Urinary retention occurred only in one case (control group). The percentage of cases returning to baseline in all QoL domains (except insomnia) was similar at 6 mo between the two groups. Short follow-up, lack of blinding, and probable small differences in our method of MFRR performed compared with other studies were identified as significant limitations.ConclusionsNo significant difference in any of the analysed outcome measures was observed. Posterior reconstruction of the musculofascial complex does not appear to improve early urinary incontinence after RALP.