Proper 6-branch suburethral autologous sling tensioning during robotic assisted radical prostatectomy with the intraopea
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ORIGINAL ARTICLE
Proper 6‑branch suburethral autologous sling tensioning during robotic assisted radical prostatectomy with the intraopeartive use of retrograde perfusion sphincterometry: the technique Andrea Cestari1 · Giuseppe Zanni1 · Fabio Fabbri1 · Francesco Sozzi1 · Massimo Ghezzi1 · Patrizio Rigatti1 Received: 24 June 2020 / Accepted: 22 September 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The aim of this paper is to describe our surgical technique and results of proper 6-branch autologous sling tensioning during RALP employing intraoperatively the Retrograde Perfusion Sphincterometry (RPS). Between May 2016 and February 2020, 374 patients underwent RALP with the 6-branch suburethral autologous sling tensioned under intraoperative guidance of RPS. Surgical procedure: Retrograde Leak Point pressure (RLPP) was evaluated by means of RPS after pneumoperitoneum induction (RLPPp), after urethrovescical anastomosis (RLPPa) and during proper sling tensioning (RLPPs). The goal of the sling tensioning was to obtain at the end of the procedure similar pressures as after pneumoperitoneum induction (RLPPs ≅ RLPPp). Intraoperative variables, postoperative complications, and continence recovery outcomes were assessed. A descriptive statistical analysis was performed. Sling positioning and tensioning was feasible in all patients. Mean operative time was 215 min. Proper sling tensioning allowed for the possibility to restore sphincteric efficacy to preoperative value (RLPPs vs. RLPPp (42.5 vs. 42.6) cmH2O). Urinary continence was achieved, respectively, in 58%, 67%, 74%, 88% and 92% of patients after 24 h, 10 days, 1 month, 6 months and 1 year after catheter removal. In conclusion, RPS revealed a valid option for proper autologous 6-branch sling tensioning during RALP, offering the possibility to restore sphincteric apparatus efficiency to its preoperative status to improve EUC. Keywords Robotic prostatectomy · Urinary continence · Prostate neoplasm · Urodynamics · Suburethral sling
Introduction Early urinary continence (EUC) recovery is one of the main goal of modern radical prostate surgery. Several techniques have been reported [1, 2] with the aim to improve overall continence recovery rate and to reduce the time of post operative incontinence in patients submitted to robotic assisted radical prostatectomy (RALP). Recently, the use of autologous sling during RALP, to better sustain the sphincteric apparatus and restore proper functional anatomy, has been reported with encouraging results [3–5]. Nevertheless, proper autologous sling tensioning remains one of the major drawback of this surgical step, mainly related to surgeon’s experience. * Andrea Cestari [email protected] 1
Department of Urology – Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
We recently reported the feasibility of intraoperative urodynamic evaluation of the sphincteric apparatus during RALP employing Retrograde Perfusion Sphincterometry (RPS) [6] In this paper we describe in
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