Effect of New Posterior Reconstruction Method on Recovery of Continence After Robot-assisted Laparoscopic Prostatectomy
Incontinence is one of the most common complications of radical prostatectomy. The continence rate is not significantly improved even by robot-assisted laparoscopic prostatectomy (RALP). However, some reports suggested that posterior reconstruction (PR) behind vesicourethral anastomosis could improve early recovery of continence during open, laparoscopic or robot-assisted radical prostatectomy.
But, recent prospective studies reported no benefit of PR after RALP, which was the opposite result of those of previous studies. However the PR techniques used in these prospective studies seem to be quite different from the previous techniques. They seem to have used single-step PR, which opposes the median dorsal fibrous raphe (MDFR) only to the Denonvilliers' fascia (DF). By contrast, the original technique incorporated additional reconstruction between the MDFR and the posterior bladder wall 1-2 cm from the new bladder neck.
Our group identified this anatomic structure as the posterior counterpart of the detrusor apron (PDA). The PDA is a strong, thick functional tissue containing muscle that is more appropriate for pulling and fixing the MDFR than the DF. As such, we hypothesized that the key proximal structure for PR is not DF, but rather PDA. Furthermore, single-step reconstruction between MDFR and PDA could be enough for PR. We previously investigated whether our new PR technique, which entails opposition of the MDFR solely to the PDA, would improve continence recovery compared with the standard RALP technique without PR. And our retrospective study demonstrated that this new PR technique during RALP significantly shortens the time to the recovery of continence compared with the standard technique, which does not incorporate PR (Int J Urol, 2012;19:683-7).
Thus, we plan to validate this result by a well-designed, prospective, randomized controlled study.
Localized Prostate Cancer
Procedure: Posterior reconstruction
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Treatment
|Official Title:||Effect of New Posterior Reconstruction Method on Recovery of Continence After Robot-assisted Laparoscopic Prostatectomy: Prospective, Single-blinded, Randomized Controlled Trial|
- Complete recovery of urinary continence [ Time Frame: 6 months ] [ Designated as safety issue: No ]Duration of complete continence recovery defined as no pad use measured by question 5 of EPIC questionnaire.
- Duration of social continence recovery [ Time Frame: 6 months ] [ Designated as safety issue: No ]Defined as 0 or 1 measured by EPIC question 5.
- Continence score at 3 months [ Time Frame: 3 months ] [ Designated as safety issue: No ]
By EPIC question 5.
- 0 vs. 1-3
- mean value
- Urinary leak at 3 months [ Time Frame: 3 months ] [ Designated as safety issue: No ]
By EPIC question 1,
- 1-3 vs. 4-5
- mean value
- Self perception (QoL) of urinary function at 3 months [ Time Frame: 3 months ] [ Designated as safety issue: No ]
By EPIC question 7,
- 0-1 vs. 2-4
- mean value
- Total operative time [ Time Frame: At the day of surgery ] [ Designated as safety issue: No ]
- Total operative time
- Console time
- Estimated blood loss [ Time Frame: At the day of surgery ] [ Designated as safety issue: No ]
- Complication [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]Complication by modified Clavien-Dindo grade
|Study Start Date:||October 2012|
|Estimated Study Completion Date:||April 2014|
|Estimated Primary Completion Date:||April 2014 (Final data collection date for primary outcome measure)|
Experimental: Posterior reconstruction
||Procedure: Posterior reconstruction|
No Intervention: No posterior reconstruction
|Korea, Republic of|
|Seoul National University Bundang Hospital|
|Seongnam, Gyeonggi-do, Korea, Republic of, Gyeonggi-do|
|Principal Investigator:||Sang Eun Lee, M.D., Ph.D.||Seoul National University Bundang Hospital|