Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques

Background: Robot-assisted radical prostatectomy (RARP) is hampered by side effects that may have a serious impact on quality of life, particularly stress urinary incontinence. Continence rates may be improved by surgical reconstruction of the pelvic floor. Objective: Video illustrations of different surgical techniques may be particularly worthwhile for practicing urologists in understanding the pelvic-floor anatomy and in the training of residents and fellows in urology. Design, setting, and participants: We describe and video-illustrate commonly performed pelvic reconstructive techniques in RARP, as performed by experts in the field. Surgical procedure: Surgical techniques have been described, such as posterior musculofascial reconstruction, anterior reconstruction and periurethral suspension, preservation of membranous urethral lengthening, bladder-neck reconstruction, and combinations. Measurements: An overview of continence rates of the different techniques is given. Results and limitations: All reconstructive surgical techniques result in similar short-term continence rates and good-to-excellent outcomes 1 yr after surgery. There are only a few randomized clinical trials comparing a reconstructive technique with “no reconstruction” or a different reconstructive technique, and outcomes are conflicting. Conclusions: Although many of the procedures report a benefit with respect to early continence, benefits seem to diminish with longer follow-up. Whether any of the reconstructive techniques is superior to another is a matter of study. Patient summary: Early continence rates might be improved by surgical reconstruction of the pelvic floor.