Robot-assisted radical prostatectomy was proposed to improve functional outcomes in comparison with retropubic
radical prostatectomy or laparoscopic radical prostatectomy. We comprehensively review the anatomic and
functional changes occurring post prostatectomy along with the reconstructive techniques. The rationale of
posterior musculofascial plate reconstruction during radical prostatectomy is to shorten the time to reach urinary
continence recovery and to reduce the risk of bleeding and anastomosis leakage.

A total of 100 patients (mean age 67 years) with localized prostate cancer were included in the study. All patients
were divided into two groups. In the group 1 (n=50) the standard technique of the VUA was used, while in the
group 2 (n=50) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality
of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7,
all patients underwent cystography to assess the tightness of the VUA.

One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 1.7 in group
2 (p=0.01). After 3 and 6 months the respective values were 4.1 vs. 1.3 (p=0.03) and 2.1 vs. 1.0 (p=0.05),
respectively. Cystography revealed no extravasation of the contrast.

1. One Month Post-Operation: 

   • Group 1 (traditional posterior reconstruction) had a mean ICIQ-SF score of 6.72, indicating a higher level of urinary incontinence compared to Group 2 (novel technique), which had a mean score of 1.7. The p-value of 0.01 suggests that this difference is statistically significant, meaning it is unlikely to have occurred by chance.

2. Three Months Post-Operation: 

   • The mean scores were 4.1 for Group 1 and 1.3 for Group 2, with a p-value of 0.03. This also indicates a statistically significant difference, showing that the novel technique continues to result in better outcomes regarding urinary incontinence.

3. Six Months Post-Operation: 

   • The scores were 2.1 for Group 1 and 1.0 for Group 2, with a p-value of 0.05. This is still statistically significant, although the difference in scores is less pronounced than at earlier time points.

Overall, these results suggest that the novel technique used in Group 2 is associated with significantly lower levels of urinary incontinence at all measured time points compared to the traditional method used in Group 1. The improvement in ICIQ-SF scores over time in both groups indicates some degree of recovery, but the novel technique appears to provide superior outcomes in terms of urinary function post-surgery.

...The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA
during RARP, being a simple method, provides better continence rate one month postoperatively compared to
standard technique, although larger randomized clinical trials are needed