Abstract: PD15-03
Sources of Funding: none

Introduction

Urinary continence recovery remains one of the most bothersome side effect of modern radical prostate surgery and several technical modifications, especially in RALP procedures, have been reported in order to improve EUC recovery, such as the use of suburethral slings. Proper sling tensioning is of pivotal importance to restore the proper sphinteric capacity._x000D_ With the aim to improve the EUC recovery after RALP, we evaluate the impact of the use of intraoperative evaluation of the RLPP for proper sling tensioning of a 6-branch retropubic suburethral autologous sling, created and placed during (RARP), compared to the use of the 6-branch sling alone with subjective evaluation of its tensioning._x000D_

Methods

In 44 continent and neurologically healthy patients (mean age 66.7 years – range 53-75; mean BMI 26.8 – range 20.3 – 36) – Group 1, affected by localized prostate cancer and submitted to RARP at our Institution, RLPP was evaluated: a)before pneumoperitoneum induction, b)after pneumoperitoneum induction, c)after urethrovescical anastomosis and d)during suburethral autologous sling tensioning._x000D_ Proper sling tensioning had the goal to restore RLPP as close as possible to its value at stage b (after pneumoperitoneum induction)._x000D_ EUC recovery was assessed at time of catheter removal, 10 and 30 days post catheter removal through a structured interview including the record of the daily number of pads used. Urinary continence was defined as the use of no pad. The results were compared to a similar cohort of 60 patients (mean age 64.2 years – range 51-79; mean BMI 25.6 – range 21.1 – 33.1) submitted to RALP at our Institution – Group 2, where the 6-branch sling were subjectively tensioned by the surgeon._x000D_

Results

Complete data collection was available for all (100%) patients. Mean surgical time was 218 min (range 150-320) vs 200 (range 145-315), mean postoperative stay was 4.9 days (range 3-11) vs 3.5 (range 2-9) and mean catheterization time was 9.93 days (range 7-13) vs 5.4 (range 5-7) in Group 1 and Group 2 respectively . Postoperative complications occurred in 3 patients (6%), including 1 case of acute urinary retention after catheter removal in Group 1 and in 7 patients (11%) including 1 case of acute urinary retention in Group 2. Table 2 lists the EUC recovery results in both groups. The 2 patients that experienced acute urinary retention at the time of catheter removal was treated uneventfully with a further 7-days catheterization._x000D_ _x000D_ Table 1_x000D_ EUC recovery – 0 pads_x000D_ (n of patients - %) 6-branch autologous sling and tensioning following RLPP 6-branch autologous sling and subjective tensioning P value_x000D_ Catheter removal 36 (81.8) 36 (60) 0.02_x000D_ 10 days 38 (86.4) 42 (70) 0.03_x000D_ 30 days 38 (86.4) 52 (87) ns_x000D_

Conclusions

Our initial experience indicates that the use of a six-branches suburethral autologous sling in association of intraoperative RLPP evaluation for its proper tensioning is safe, effective and reproducible and offers superior EUC recovery in patients submitted to RALP procedures compared to the use of the autologous sling alone with its subjective tensioning related to the surgeon’s experience and feeling.

Funding

none