Elsevier

Urology

Volume 83, Issue 3, March 2014, Pages 632-640
Urology

Prostate Cancer
Radical Prostatectomy
Bladder Neck Sling Suspension During Robot-assisted Radical Prostatectomy to Improve Early Return of Urinary Continence: A Comparative Analysis

https://doi.org/10.1016/j.urology.2013.09.059Get rights and content

Objective

To present our experience of a novel technique, bladder neck sling suspension technique, in patients undergoing robot-assisted radical prostatectomy (RARP) and evaluate its efficacy for improving early continence outcomes after RARP in comparison with that of the standard technique.

Methods

Fifty-seven consecutive patients underwent RARP between August 2011 and April 2012. We performed RARP with and without bladder neck sling suspension technique for 27 (sling group) and 30 (nonsling group) patients, respectively, and compared the urinary outcome between the groups. Both subjective and objective assessments of urinary incontinence were performed before and after RARP.

Results

The International Prostate Symptom Score (P <.05) and International Consultation on Incontinence Questionnaire-Short Form (P <.05) in the sling group were significantly lower, and Expanded Prostate Cancer Index Composite urinary incontinence score (P <.05) in the sling group was higher than those in nonsling group, 4 weeks after RARP. In addition, mean pad weight gain on 1-hour pad test in the sling group was significantly smaller than that in the nonsling group, 4 weeks after RARP (P <.05). Both patient perception and objective data of urinary incontinence 4 weeks after RARP were better in the sling group than in the nonsling group. Valsalva maneuver during cystography demonstrated that the mean posterior urethrovesical angle in the sling group was smaller than that in the nonsling group (P <.001).

Conclusion

Bladder neck sling suspension technique is a simple and feasible procedure in RARP and can improve the early return of continence after RARP, although additional larger studies are required to confirm this finding.

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.

References (27)

  • P.C. Walsh

    Anatomic radical prostatectomy: evolution of the surgical technique

    J Urol

    (1998)
  • J.A. Eastham et al.

    Risk factors for urinary incontinence after radical prostatectomy

    J Urol

    (1996)
  • X. Hurtes et al.

    Anterior suspension combined with posterior reconstruction during robot-assisted laparoscopic prostatectomy improves early return of urinary continence: a prospective randomized multicentre trial

    BJU Int

    (2012)
  • Cited by (35)

    • European Association of Urology Guidelines on Male Urinary Incontinence

      2022, European Urology
      Citation 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.

    • Dysuria: An Uncommon Presentation in Emergency Department Following Bladder Neck Disruption

      2017, Urology Case Reports
      Citation 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 Science
      Citation 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.

    View all citing articles on Scopus

    Financial Disclosure: The authors declare that they have no relevant financial interests.

    View full text