Category: Laparoscopic/ Robotic: Prostate

MP15-12 - Preservation of Membranous Urethral Length during Robot-Assisted Radical Prostatectomy Improves Recovery of Early and Long-Term Urinary Zero-pad Continence

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective : To determine impact of surgical preservation of membranous urethral length (MUL)  on early and late 0-pad continence post robot-assisted radical prostatectomy (RARP). 

Methods :

To maximize preservation of MUL we stopped stapling the dorsal venous complex (DVC) early in the dissection.  Now, as the final step of extrication, we transect the DVC without stapling or suturing which allows full rotation of the prostate for circumferential release of apical attachments maximizing MUL. 354 had complete follow-up and were included: 167 prior and 187 MUL group. Outcomes were 0-pad continence at 30-days and 1-year post-RARP. Cox regression was used to model time to continence recovery, after controlling for significant covariates.

Results : Age, BMI, prostate volume, and pre-op IIEF-5 were similar between groups; however, proportion of pre-operative PSA>10 (10.8% vs 30.5%) and pathologic Gleason Score (pGS)>8 (13.8% vs. 23.5%) were higher in the MUL group (p<0.01, respectively). 0-pad continence at 30-days was sharply increased from 20.5% to 55.6% in the MUL group (p<0.001) and 1+year continence was 86.3% and 91.0%, respectively (p=0.167). Age-stratified 30-day and 1-year continence (Table 1) rates highlight substantially higher continence rates in older men (≥ 75 years).

In multivariable regression, MUL was the only significant predictor of 30-day continence (OR=5.101, 95%CI:3.079-8.451), while age (OR=0.938, 95%CI:0.882-0.999) was the only predictor of overall continence. In Cox regression (Figure 1), patients subsequent to technique change had significantly shorter time to continence recovery, after adjusting for pre-op PSA and pGS (p=0.003). 

Conclusions : Maximization of MUL during RARP improves 30-day pad-free continence and time to continence recovery. This benefit encourages maximization of MUL, particularly in effort to improve continence recovery in men ≥ 75.

Thomas E. Ahlering

Professor and Vice Chairman
University of California, Irvine
Orange, California

Dr. Ahlering is a highly regarded surgeon in Urologic cancers. His years of experience in treatment of prostate, bladder, kidney and testicular cancers has placed him as one of the original America's Best Doctors since his membership in 1994. Formerly the Chief of the Division of Urology (1992-2002) after his arrival at UC Irvine from the City of Hope in 1992, Dr. Ahlering became Chief of the Division of Urologic Oncology when the new Department of Urology was established in 2002. He received his medical degree at St. Louis University School of Medicine, followed by a residency in urology at the University of Southern California in Los Angeles and a two-year fellowship in urologic oncology under the clinical training of Dr. Donald G. Skinner and laboratory training under Peter Jones, Ph.D. He has received local, national, and international recognition for his expertise in urologic oncology, particularly in the development of minimally invasive radical prostatectomy assisted by the da Vinci robot. He has performed more than 2000 such robotic surgeries, including the first robotic prostatectomy surgeries in Southern California, Denmark, Australia, and Canada.

Linda M. Huynh

Senior Clinical Research Coordinator
University of California, Irvine
Orange, California

MSc Biomedical and Translatonal Science
Senior Clinical Research Coordinator
University of California, Irvine

Young Hwii Ko

Associate Professor
Yeungnam University Hospital
Daegu, Cheju-do, Republic of Korea

Kaelyn See

Irvine, California

Whitney Zhang

Irvine, Alabama

Douglas Skarecky

Irvine, California