Clinical
Male Stress Urinary Incontinence (Post Prostatectomy Incontinence)
Jeremy Fallot
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Abstract Centre
Urinary incontinence remains a major concern for patients when undergoing a radical prostatectomy. Although long-term continence rates exceed 90%, early continence rates are much lower, ranging between 28% to 74% at 3 months. We describe a novel technique to improve urinary function by using an autologous vascularized fascial sling (RoboSling) placed underneath the urethrovesical anastomosis at the time of robot-assisted radical prostatectomy (RARP).
We provide a step-by-step description of our RoboSling technique. Also included are the results of a prospective, non-randomised cohort study comparing continence rates between patients who underwent a standard RARP and those who in addition to RARP had a RoboSling procedure performed concurrently. In our hospital, between December 2016 and October 2019, 176 patients underwent RARP done by 5 different surgeons. The RoboSling procedures were performed by one surgeon. We compared pad usage and continence rates using the EPIC-urinary domain questionnaire, as well as clinical and oncological outcomes in 146 patients without a RoboSling and 30 with a RoboSling.
One hundred and seventeen patients (response rate 80%) filled in their 3 months postoperative questionnaires. Baseline characteristics did not differ between the two groups (see table). At three months, zero pad usage (p=0,010) was significantly higher in the RoboSling group. At 3 months, zero pad usage and continence rates remained higher in the RoboSling group. Zero pad use was 47% with and 17% without a RoboSling. Length of stay and complication rate did not differ between the two groups. Blood loss was significantly lower in the RoboSling group (P=0.015).
Patients undergoing a RoboSling procedure at the time of robotic radical prostatectomy experienced an earlier return to continence compared to the control arm without a higher complication or positive surgical margin rate. A randomized controlled trial with multiple surgeons performing the RoboSling procedure is now underway to further assess the merits of this novel technique.