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Full continence recovery comparison between Group 1 (standard anastomosis) and 2 (SSA). I: Surgery. 0: Day of catheter removal. Gray: Group 1. Black: Group 2.
Source publication
Introduction:
To assess the interest of a new sphincter preserving anastomosis technique for continence recovery after robot assisted laparoscopic Radical Prostatectomy (RALP).
Materials and methods:
We performed a monocentric single operator study on 187 consecutive RALP. Patients were divided into two groups: Group 1 (standard anastomosis, unt...
Contexts in source publication
Context 1
... between the two groups revealed a statistical difference for continence recovery: immediate ( p = 0.0000035), at 1 month ( p = 0.000092), at 1 year ( p = 0.028) (Fig. 5), for urinary reeducation requirement ( p = 0.0006), and at 1-year follow-up concerning the number of pads used per day and the results of the QOLu analogic scale ( p = ...
Context 2
... between the two groups revealed a statistical difference for continence recovery: immediate ( p = 0.0000035), at 1 month ( p = 0.000092), at 1 year ( p = 0.028) (Fig. 5), for urinary reeducation requirement ( p = 0.0006), and at 1-year follow-up concerning the number of pads used per day and the results of the QOLu analogic scale ( p = ...
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Citations
... In a prospective study, they reported superior continence rates associated with this particular technique. [50] CONCLUSIONS Bladder neck preservation, avoiding injury to the external sphincter, and maximal preservation of the external sphincter and the membranous urethra are the basic principles behind all sphincter preservation techniques during RP. Regarding bladder neck preservation, a randomized trial and many meta-analyses support its effectiveness in improving continence rates after an RP procedure without compromising cancer control. ...
Prolonged urinary incontinence represents one of the most severe complications after a radical prostatectomy procedure, significantly affecting patients’ quality of life. In an attempt to ameliorate postprostatectomy continence rates, several sphincter preservation techniques have been reported. The purpose of this article is to report several different sphincter preservation techniques and identify the ones which affect postoperative outcomes the most. For our narrative review, PubMed was searched using the keywords “sphincter,” “continence,” “preservation,” “techniques,” and “prostatectomy.” Other potentially eligible studies were identified using the reference lists of included studies. Sphincter preservation techniques can be summarized into bladder neck preservation, minimizing injury to the external urethral sphincter, and preserving the maximal length of the external sphincter and of the membranous urethra. Three anatomical structures must be recognized and protected in an attempt to maintain the sphincter complex: the bladder neck, the external urethral sphincter and the musculature of the membranous urethra. While there is strong evidence supporting the importance of bladder neck preservation, the role of maximal preservation of the external sphincter and of the intraprostatic part of the membranous urethra in improving continence rates has not yet been reported in a statistically significant manner by high-quality studies.
Objective To construct a Convolutional Neural Network (CNN) model that can recognize and delineate anatomic structures on intraoperative video frames of robot-assisted radical prostatectomy (RARP) and to use these annotations to predict the surgical urethral length (SUL). Background Urethral dissection during RARP impacts patient urinary incontinence (UI) outcomes, and requires extensive training. Large differences exist between incontinence outcomes of different urologists and hospitals. Also, surgeon experience and education are critical towards optimal outcomes. Therefore new approaches are warranted. SUL is associated with UI. Artificial intelligence (AI) surgical image segmentation using a CNN could automate SUL estimation and contribute towards future AI-assisted RARP and surgeon guidance. Methods Eighty-eight intraoperative RARP videos between June 2009 and September 2014 were collected from a single center. 264 frames were annotated according to: prostate, urethra, ligated plexus and catheter. Thirty annotated images from different RARP videos were used as a test dataset. The Dice coefficient (DSC) and 95th percentile Hausdorff distance (Hd95) were used to determine model performance. SUL was calculated using the catheter as a reference. Results The DSC of the best performing model were 0.735 and 0.755 for the catheter and urethra classes respectively, with a Hd95 of 29.27 and 72.62 respectively. The model performed moderately on the ligated plexus and prostate. The predicted SUL showed a mean difference of 0.64 - 1.86mm difference versus human annotators, but with significant deviation (SD 3.28 - 3.56). Conclusion This study shows that an AI image segmentation model can predict vital structures during RARP urethral dissection with moderate to fair accuracy. SUL estimation derived from it showed large deviations and outliers when compared to human annotators, but with a very small mean difference (<2mm). This is a promising development for further research on AI-assisted RARP. Keywords Prostate cancer, Anatomy recognition, Artificial intelligence, Continence, Urethral length.
Background:
Continence is an important functional outcome after robotic-assisted laparoscopic radical prostatectomy (RARP), and modifications of the surgical technique may improve outcomes.
Objective:
To illustrate a novel RARP technique and to describe the observed continence outcomes.
Design setting and participants:
A retrospective study of men treated with RARP between 2017 and 2021 was conducted.
Surgical procedure:
During RARP, periprostatic structures are preserved, the intraprostatic urethra is partially spared, and the anterior anastomosis stitches involve the plexus structures but not the anterior urethra.
Measurements:
A descriptive analysis of the pathological, functional, and short-term oncological outcomes was performed.
Results and limitations:
Of 640 men, 448 (70%) with at least 1 yr of follow-up and a median age of 66 yr were included. The median operative time was 270 min and the prostatic volume 52 ml. The transurethral catheter was removed after a median of 3 d, and leakage of urine in the first 24 h after catheter removal was observed in 66/448 patients (15%). Positive surgical margins were reported in 104/448 (23%). Prostate-specific antigen persistence after prostatectomy was observed in 26/448 (6%). During a median follow-up of 2 yr (interquartile range 1-3 yr), the biochemical recurrence after prostatectomy was observed in 19/448 patients (4%). One year after prostatectomy, 406/448 patients (91%) were continent and required no pad at all, while 42/448 (9%) required at least one pad per day.
Conclusions:
Not stitching the anterior urethra is a novel technical modification and may improve continence outcomes.
Patient summary:
We describe a novel way to stitch the bladder neck to the urethra after removal of the prostate using a surgical robotic system. Our technique appeared safe, with promising urinary continence results.
