Prostate CancerRadical ProstatectomyBladder Neck Sling Suspension During Robot-assisted Radical Prostatectomy to Improve Early Return of Urinary Continence: A Comparative Analysis
Section snippets
Materials and Methods
Between August 2011 and April 2012, 57 consecutive patients (median age, 65.6; range, 40-75 years) underwent RARP at Nagoya City University Hospital. Inclusion criteria were (1) clinically localized prostate cancer (T1c or T2), (2) younger than 75 years, and (3) Eastern Cooperative Oncology Group 0 performance status. Exclusion criteria were a previous history of neurogenic bladder caused by diabetes mellitus or other neurologic disorders, urethral stricture, previous prostatic surgery,
Results
The baseline and perioperative characteristics of the patients in the nonsling and sling groups are shown in Table 1. There were no statistically significant differences in patient characteristics, including patient age, BMI, prostate-specific antigen, the distribution of Gleason score, and clinical stage between the 2 groups. No significant difference was also observed in the preoperative IPSS, IPSS voiding, and storage subscale scores, ICIQ-SF, MFR, and PVR between the 2 groups (Table 2). In
Comment
A wide range of rates of postprostatectomy incontinence has been reported because of the lack of homogeneity in the definition of continence and differences in the methods used to evaluate it.9 In addition, there are discrepancies in the perception of urinary incontinence between doctor and patient after prostatectomy.11, 16 Only 14.7% of patients who were considered to be continent by their doctor also considered themselves to be continent, suggesting that the nonuse of pads is not equivalent
Conclusion
The outcome of this study has demonstrated that the bladder neck sling suspension technique is a simple and feasible procedure in RARP and can improve the early return of continence after RARP; however, the number of patients in this study was small, and this study was based on experiences at a single institution. Additional larger randomized control studies are required to confirm these encouraging findings.
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Cited by (35)
European Association of Urology Guidelines on Male Urinary Incontinence
2022, European UrologyCitation Excerpt :The concept of autologous slings has recently been introduced. Only a few RCTs have assessed the effect of autologous vas deferens sling versus no sling and reported that continence rates were similar [94–96]. The most widely marketed nonadjustable male slings are the AdVance, the AdVance XP, and the transobturator compressive I-Stop TOMS.
Early continence after radical prostatectomy: A systematic review
2019, Actas Urologicas EspanolasDysuria: An Uncommon Presentation in Emergency Department Following Bladder Neck Disruption
2017, Urology Case ReportsCitation Excerpt :One suggestion is the patient may have benefitted from a bladder neck sling, which is indicated in patients who present with urinary incontinence. The sling uses reconstructed fascia to suspend the bladder and urethra above the pubic ramus into the abdomen, reinforces the sub-urethral tissue and provides more support to the bladder neck and urethra during moments of increased intraabdominal pressure (cough or sneeze).5 A bladder neck sling has been found to expedite the healing process after RALP and improve continence.
The value of cystography in the prediction of early urinary continence after radical prostatectomy
2016, Urological ScienceCitation Excerpt :Intraoperative surgical techniques have also been reported to play a role in the early recovery of continence. Procedures including peri-urethral suspension, lateral prostatic fascia preservation,16 bladder neck preservation, posterior urethral reconstruction,5 and bladder neck suspension17 have shown encouraging outcomes in improving urinary continence after RP. A stable compliant detrusor muscle and a competent bladder outlet are factors in maintaining continence.
Improved early continence following laparoscopic radical prostatectomy: the urethral hammock technique
2024, World Journal of Urology
Financial Disclosure: The authors declare that they have no relevant financial interests.