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Minerva Urologica e Nefrologica 2019 August;71(4):324-38

DOI: 10.23736/S0393-2249.19.03395-2


lingua: Inglese

Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy

Fabio ZATTONI 1, 2, Walter ARTIBANI 3, Vipul PATEL 4, Francesco MONTORSI 5, Francesco PORPIGLIA 6, Lance J. HAMPTON 7, Bernardo ROCCO 8, Prokar DASGUPTA 9, Ashok K. HEMAL 10, Alexandre MOTTRIE 11, 12, Ash TEWARI 13, Fabrizio DAL MORO 1, 2

1 Unit of Urology, Santa Maria della Misericordia Academic Medical Center Hospital, Udine, Italy; 2 Department of Surgery, Oncology and Gastroenterology-Urology, University of Padua, Padua, Italy; 3 Department of Urology, University of Verona, Verona, Italy; 4 Global Robotics Institute, Florida Hospital Celebration Health, Orlando, FL, USA; 5 Division of Oncology, Unit of Urology, San Raffaele Hospital IRCCS, Vita-Salute San Raffaele University, Milan, Italy; 6 Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy; 7 Division of Urology, Department of Surgery, VCU Health and McGuire VA Medical Center, Richmond, VA, USA; 8 University of Modena and Reggio Emilia, Modena, Italy; 9 MRC Centre for Transplantation, Guy’s Hospital, King’s College London, London, UK; 10 Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA; 11 ORSI Academy, Melle, Belgium; 12 Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; 13 Icahn School of Medicine of Mount Sinai, New York, NY, USA

Urinary incontinence is one of the most significant causes of concern among patients who get surgical treatment for prostate cancer, even after the introduction of the robot. The aim of this study is to summarize current knowledge of the factors influencing urinary continence (UC) and the technical innovations to optimize UC recovery after robotic assisted radical prostatectomy (RARP). A non-systematic review was conducted from January 2000 to October 2018 to identify original and review articles in English describing the anatomy of the prostate and pelvis. An emphasis was addressed to article describing technical innovations to optimize UC after RARP. Improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of UC. The literature has shown certain technique modification to meliorate UC as potential benefit to reduce the risk of urinary incontinence after RARP. These techniques might be divided in 3 categories to improve an early return to UC: 1) preservation, 2) reconstruction and 3) reinforcement of the anatomic structures in the pelvis, which will make new supporting system after RARP. In the present review, the authors summarize factors influencing incontinence after RARP and outline a common denominator for all the surgical techniques described in the literature for UC recovery.

KEY WORDS: Prostatic neoplasms; Anatomy; Prostatectomy; Robotic surgical procedures; Urinary continence; Imaging, three-dimensional

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