SIU 2017: Lateral Bladder Neck Dissection Technique and Triple-Layer Posterior Bladder Wall Reconstruction Lead to Early Removal of Foley Catheter and Improved Urinary Continence after Robotic-Assisted Radical Prostatectomy

Lisbon, Portugal (UroToday.com) Recovery of urinary continence is an important functional outcome following prostatectomy, including robotic prostatectomy. Various techniques have been attempted to help improve return of urinary continence, including intra-operative vas deferens sling, rocco stitch, etc. Very little has been shown to improve continence except urethral length and sparing of the levator muscles.

In this study, the authors assess the ability of lateral bladder neck dissection (LBND) and triple layer posterior bladder wall reconstruction (TPWR) on the recovery of urine continence and early removal of foley catheter (FC). Described as the Ven velthoven technique, the authors assessed 485 patients who underwent robotic prostatectomy. It was unclear if this was a prospective or retrospective assessment and how patients were chosen for one technique or the other.

Regardless, 187 men underwent standard technique (Group 1) while 298 men (Group 2) underwent the Ven Velthoven technique. Pre-operative and postoperative urinary function (at 1 and 6 months) were evaluated and compared between the two groups.

In terms of results, the authors first focused on oncologic outcomes – even though this was not the primary outcome of the paper. The overall positive surgical margin rate was lower with group 2 than group 1 (11.2 and 15.6%, p = 0.045).

In terms of functional outcomes, early removal of foley catheter (earlier than POD #7) was successful in more patients in group 2 (73.8%) than in group 1 (16.2%) – though indication and decision making was not clear in the abstract. How were patients selected for early removal? Or do they do it in all patients?

EPIC was used to assess postoperative continence. At 1 month and at 6 months postoperatively, patients in Group 2 had much higher continence rates than group 1 – by 6 months, approximately 87.2% were continent.

Unfortunately, as the group did not post a poster, further details are not available – leaving many questions to be answered.

  • How was continence measured? Is EPIC an adequate questionnaire – what about pad usage?
  • They never addressed selection criteria – which patients got which operation?
  • They never account for baseline urinary function.
  • How much time did the extra procedure take?
  • Why was the margin rate better?
More rigorous testing of this technique is needed prior to adoption.

Speaker(s): Yang Gyu Bae, South Korea

Institution(s): Dong-A University Hospital, South Korea

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, twitter: @tchandra_uromd, at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal
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