ACS 2018: Modified Marshall-Marchetti-Krantz Urethral Suspension During Robot Assisted Laparoscopic Prostatectomy: Is Postoperative Urinary Continence Affected?

Boston, Massachusetts ( Lukas Hockman, studied the effect of modified MMK vesico-urethral suspension into  Robot Assisted Laparoscopic Prostatectomy (RALP) . This study compared patients who had MMK suspension and those who did not to determine whether postoperative urinary continence was affected. No other changes in technique were incorporated during this time period assessed.

A retrospective review was performed on all patients who underwent RALP at a single institution by a single surgeon from 2010 to 2017. Patients were excluded due to lack of follow up or characteristics that would affect ability to determine continence (neurological disorders, operative complications, etc.). Patients were considered continent if they used ≤1 pad per day or reported minimal to no urine leakage.

After exclusions, 88 patients remained and were separated into a MMK group (n=58) and non-MMK group (n=30). There was no statistically significant difference in age, BMI, PSA, Gleason score, prostate size, length of operation or rate of nerve-sparing surgery between groups (Table 1). Operative blood loss was higher in the non-MMK group (p<0.0001). Continence rates at 6-week, 6-month and 12-month postoperative intervals were 59.3%, 75% and 75.9% in the MMK group; and 38.1%, 74.1% and 73.7% in the non-MMK group. The 6-week continence rate was significantly higher in the MMK group (p=0.04947). The 6-month and 12-month rates were not significantly different. No standardized instruments were used.

In conclusion, the overall continence rate in patients who had modified MMK vesico-urethral suspension during RALP was higher at 6 weeks post operation. While single institution and limited numbers of patients with lack of standardized instruments, these data suggest the utility of MMK procedure in RALP as useful tool to decrease time to continence after RALP.

Presented by: Lukas Hockman, University of Missouri, Columbia, Columbia, MO

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts