CUA 2018: Impact Of The Rocco Stitch On Early Return To Continence Following Robot-Assisted Radical Prostatectomy: Results Of A Prospective, Longitudinal, Randomized Controlled Trial

Halifax, Nova Scotia ( It is extremely well known in the urologic field that prostate cancer is one of the most detrimental cancers that affect males worldwide. One of the most common treatments for this particular disease, robot-assisted radical prostatectomy (RARP), is particularly effective as a cancer management modality, but it is linked with certain postoperative complications such as urinary incontinence (UI). UI has been characterized as having a significant negative impact on patient-reported, health-related quality of life. It has been previously shown that UI is caused by the insufficiency of the urethral sphincter’s structural integrity, which is greatly reduced following RARP. Currently, there have been several surgical techniques described for urethrovesical anastomosis (UVA) following ablation of the prostate. One of the more popular techniques, the posterior reconstruction of the Denonvilliers’ musculofascial plate, often known as the “Rocco stitch”, has received mixed reviews from practicing urologists on the effect of urinary continence rates. Therefore, Jen Hoogenes, PhD, and her team of urologists at McMaster University set out to determine the short- and long-term return to urinary continence following RARP by comparing conventional UVA with UVA with the additional Rocco stitch.  

In order to investigate this question, a single surgeon was randomized to perform a conventional anastomosis or an anastomosis with the Rocco stitch, pictured below. Patients were blinded to the allocation status and the surgeon was notified immediately prior to the case. Following the surgery, patients completed the Expanded Prostate Cancer Index Composite Short Form (EPIC-26) questionnaire at baseline, 2, 3, 4, 6, 8, and 12-months postoperatively. All data was analyzed in IBM SPSS v25. Continence was defined as 0 pads/day and ≤ 1 pad/day.
Following the completion of the study, 73 patients were enrolled in the interventional, Rocco stitch cohort while 67 patients underwent the control, standard of care procedure. Mean BMI, PSA, and clinical stage were not significantly different. Additionally, there was no significant difference between either of the two cohorts in regard frequency of urine leak, quantity of pad use, and “overall bother” improved significantly in all patients from 2-12 months. Although not statistically significant, 93% of the patients in the experimental, Rocco stitch group stated that they were continent (≤ 1 pad per day) compared to 85.7% in the control group at the 12-month mark.

As she completed her presentation, Dr. Hoogenes explained to the audience that this study was the largest randomized controlled trial of the Rocco stitch technique to date. At the time of presentation, however, the study had not been fully evaluated as there are still data points from the EPIC-26 questionnaire that need to be reviewed as well as other perioperative characteristics. 

Presented by: Jen Hoogenes, MSc, PhD
Co-Authors: Derek Bos, Lisa Patterson, Yuding (Ding) Wang, Christopher Wu, Forough Farrokhyar, Bobby Shayegan
Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada

Written by: Zachary Valley, MD, Twitter: @ZacharyAValley, Department of Urology, University of California-Irvine