Retrotrigonal muscular layer sling associated with total anatomical reconstruction in robot-assisted radical prostatecto

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ORIGINAL ARTICLE

Retrotrigonal muscular layer sling associated with total anatomical reconstruction in robot‑assisted radical prostatectomy and early continence Matteo Luigi Zanoni1 · Fabio Grizzi2 · Davide Maffei2 · Paolo Vota1 · Nicola Frego2 · Giovanni Toia1 · Cinzia Mazzieri1 · Massimo Lazzeri3 · Nicolò Buffi2 · Giovanni Lughezzani2 · Paolo Casale3 · Alberto Saita3 · Giorgio Guazzoni2 · Alberto Mandressi1 · Gianluigi Taverna1,2,3  Received: 9 June 2020 / Accepted: 13 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Background and purpose  Urinary continence (UC) represents the main non-oncological goal in patients undergoing roboticassisted radical prostatectomy (RARP). To evaluate the efficacy in early UC achievement, we described a new sling technique using the retrotrigonal muscular layer (TZ sling) combined with total anatomical reconstruction (TAR). Patients and methods  We prospectively enrolled 407 consecutive prostate cancer (PC) patients undergoing RARP between May 2017 and January 2020. The first 250 patients underwent only TAR, while the following 157 patients TAR + TZ sling, by isolating and anchoring the retrotrigonal muscular layer to the pubic bone with 2 bilateral sutures. We defined UC as ≤ 1 pad/die, which was assessed after catheter removal at 1, 4 and 12wk using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. Sling-related operative time and post-operative complications were analyzed. Results  In the TAR group, the UC rates at the 1, 4 and 12wk were 58%, 66% and 86%; in the TAR + TZ sling group 72%, 76% and 88%, respectively. A statistically significant difference was observed in the two groups at 1wk (p = 0.0049) and 4wk (p = 0.035) favoring the TZ sling surgical strategy. This difference in UC rates was lost at 12wk (p ≥ 0.05). No statistically significant differences in operative time, acute urinary retentions and other complication rates were observed between the two groups (p = NS). Conclusions  We have described a new, safe, feasible modification of RARP using a sling with the retrotrigonal muscular layer associated with TAR. We have demonstrated a statistically significant improvement in early UC rate in patients who are undergoing TAR and TZ sling compared to undergoing only TAR. Keywords  Robotic-assisted radical prostatectomy · Early urinary continence · Retrotrigonal muscular layer · Prostate cancer

Introduction Electronic supplementary material  The online version of this article (https​://doi.org/10.1007/s0034​5-020-03500​-9) contains supplementary material, which is available to authorized users. * Gianluigi Taverna [email protected] 1



Department of Urology, Humanitas Mater Domini, Via Gerenzano 2, 21053 Varese, Castellanza, Italy

2



Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Milan, Pieve Emanuele, Italy

3

Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089 Rozzano, Italy



RARP represents the primary choice of t