Purpose: We devised a single-step posterior reconstruction (PR) technique, which opposes the median dorsal raphe solely to the posterior counterpart of the detrusor apron, rather than to the Denonvilliers’ fascia. We demonstrated that this new PR method during robot-assisted laparoscopic prostatectomy (RALP) significantly shortens the time to the recovery of continence in a retrospective study. We investigated it by a prospective clinical trial.
Materials and Methods: We designed a single-blind, parallel group, randomized controlled trial. One hundred men who underwent RALP by a single surgeon at a referral center were randomly allocated to intervention group (n=50) or control group (n=50) from October 2012 through August 2013.
Results: In the control group, one subject was excluded due to open conversion and four patients were excluded due to open conversion and withdrew from participation. The baseline characteristics and perioperative outcomes were similar between groups. The median duration of complete continence recovery (no pad) did not differ significantly between intervention (106 days) and control (119 days, p=0.890) groups. However, social continence recovery (0 or 1 pad per day) was significantly shorter in the intervention group (median 18 days) than control group (median 30 days, p=0.024). At six months, 88.0% of patients in the intervention and 75.6% in the control group regained complete continence (p=0.114). Complication rates were 62.0% in the intervention group and 51.1% in the control group (p=0.307).
Conclusion: Single-step PR did not significantly shorten the duration of complete continence recovery. However, it seems to have marginal benefit on early social continence recovery.