Category: New Technology: Laparoscopy & Robotics
Introduction & Objective :
Urinary incontinence post radical prostatectomy is a well-recognized complication. 12-month continence rates typically range from 85-95%, yet few patients are continent in the early postoperative period. Posterior reconstruction of the Denonvilliers’ musculofascial plate, also known as the “Rocco stitch”, may improve early return to continence. We evaluated short and long-term return to urinary continence post robot-assisted radical prostatectomy (RARP) by comparing the Rocco stitch (intervention) versus conventional urethrovesical anastomosis (UVA) (control).
Patients undergoing RARP were prospectively recruited in clinic and randomly allocated to either the intervention or control group and blinded to allocation status. All cases were performed by a single high-volume surgeon at a tertiary academic healthcare centre. Outcomes were assessed using the EPIC-26 form at baseline and at 2, 3, 4, 6, 8, and 12-month follow-up. Pad use and continence scores were compared using the chi-square and Mann-Whitney U tests. An ordinal generalized estimating equation model assessed the treatment effect of the Rocco stitch on urinary continence over time.
A total of 140 patients were included in the analysis (Rocco n=73; control n=67). Mean age was 63.2±8. No differences were found between groups for preoperative clinical and functional variables. Using a continence definition of 0 pads/day, no significant differences were found between groups at any of the follow-up time points (Table 1). Frequency of urine leak, quantity of pad use, subjective urinary control, and overall bother improved significantly in all patients during the study period (p<0.001). When a continence definition of ≤1 pad/day was applied, the 12-month continence rate for the Rocco group was 93% and 85.7% for controls.
The use of the Rocco stitch showed no statistical significance in shortening time to urinary continence post-RARP when compared to conventional UVA. Larger, multi-centre randomized controlled trials are required to support these findings.
Jen Hoogenes– Clinical Research Coordinator, McMaster University, Hamilton, Ontario, Canada
Derek Bos– McMaster University, Hamilton, Ontario, Canada
Lisa Patterson– McMaster University, Hamilton, Ontario, Canada
Yuding Wang– Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
Christopher Wu– McMaster University, Hamilton, Ontario, Canada
Forough Farrokhyar– McMaster University, Hamilton, Ontario, Canada
Bobby Shayegan– McMaster University, Hamilton, Ontario, Canada
Clinical Research Coordinator
Hamilton, Ontario, Canada
Jen Hoogenes, MS, MSc, PhD; Clinical Research Coordinator, Department of Surgery, Division of Urology, McMaster University in Hamilton, Ontario, Canada.
Department of Surgery, Division of Urology, McMaster University
Hamilton, Ontario, Canada