Posterior muscolofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis.

OBJECTIVE - To evaluate the influence of posterior musculofascial plate reconstruction (PR) on early return of continence after radical prostatectomy (RP). An updated systematic review of the literature.

MATERIALS AND METHODS - A systematic review of the literature was performed in June 2015, following the PRISMA statement and searching Medline, Embase, Scopus and Web of Science databases.

We searched the terms posterior reconstruction prostatectomy, double layer anastomosis prostatectomy across the Title and Abstract fields of the records, with the following limits: humans, gender (male), and language (English). The authors reviewed the records to identify studies comparing cohorts of patients who underwent RP with or without restoration of the posterior aspect of the rhabdosphincter. A meta-analysis of the risk ratios estimated using data from the selected studies was performed.

RESULTS - Twenty-one studies were identified in the literature search, including three randomized controlled trials. The overall analysis of comparative studies showed that PR improves the early continence recovery at 3-7, 30 and 90 days after catheter removal, while continence rate at 6 months is statistically but not clinically affected. Statistically significant lower anastomotic leakage rates were described after PR. No significant differences were found in terms of positive surgical margins rates or for complications such as acute urinary retention and bladder neck stricture.

CONCLUSIONS - The analysis confirms the benefits at 30 days post catheter removal already discussed in the review published in 2012 but also shows a significant advantage in terms of urinary continence recovery in the first 3 months. A multicenter prospective randomized controlled trial is currently conducted in several institutions all over the world to better assess the effectiveness of the PR in facilitating an earlier recovery of postoperative urinary continence. This article is protected by copyright. All rights reserved.

BJU international. 2016 Mar 14 [Epub ahead of print]

A A C Grasso, F A Mistretta, M Sandri, G Cozzi, E De Lorenzis, M Rosso, G Albo, F Palmisano, A Mottrie, A Haese, M Graefen, R Coelho, V R Patel, B Rocco

Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., DMS StatLab, Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy., OLV Robotic Surgery Institute, Aalst, Belgium., Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany., Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany., University of Central Florida School of Medicine and Global Robotics Institute Florida Hospital-Celebration Health Celebration, FL, USA., University of Central Florida School of Medicine and Global Robotics Institute Florida Hospital-Celebration Health Celebration, FL, USA., Department of Urology, University of Milan Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.