Top

World Journal of Urology

Published in:

01-08-2020 | Prostatectomy | Original Article

Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes

Authors: Viktor Kováčik, Matúš Maciak, Vladimír Baláž, Jozef Babeľa, Viliam Kubas, Peter Bujdák, Peter Beňo

Published in: World Journal of Urology | Issue 8/2020

Abstract

Purpose

Anterior and posterior reconstructions of pelvic structures are used during a robot-assisted radical prostatectomy to obtain better continence outcomes. This study was conducted to evaluate the Advanced Reconstruction of Vesicourethral Support (ARVUS), a novel postprostatectomy reconstruction technique.

Methods

The study was designed as a prospective, controlled, partially randomized and blinded experiment. The statistical analysis was based on the generalized linear modeling (GLM) framework with random effects: the logit link was used to model the probability of achieving continence and the logarithmic link was used to evaluate the overall score of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The significance of the fixed effects and all possible two-way interactions was tested using the critical level of 0.05.

Results

The probability of achieving the continence significantly depends on the neurovascular bundle sparing (p < 0.001) and the time after the surgery (p < 0.001). Analogously, the expected ICIQ-SF score significantly depends on the nerve-sparing status (p = 0.035) and the time after the surgery (p < 0.001). No statistically significant difference between the unilateral or bilateral nerve sparing was found. The ARVUS technique seems to perform slightly worse with respect to the expected continence, but this difference is within the margins of random fluctuations (p = 0.715).

Conclusions

The study demonstrates a significant positive association between the nerve-sparing approach and the patient’s continence, however, regardless of the unilateral or bilateral approach. In terms of the continence rate, no statistically significant benefits of ARVUS were observed.

Sooriakumaran P, Nyberg T, Akre O, Haendler L, Heus I, Olsson M, Carlsson S, Roobol MJ, Steineck G, Wiklund P (2014) Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: observational study of mortality outcomes. BMJ 348:g1502PubMedPubMedCentralCrossRef

Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, Menon M, Mottrie A, Myers RP, Patel V, Tewari A, Villers A, Artibani W (2016) A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 970(2):301–311CrossRef

Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E et al (2016) ProtecT Study Group. Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375(15):1425–1437PubMedPubMedCentralCrossRef

Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H, Wilson TG, Zattoni F, Mottrie A (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62:405–417PubMedCrossRef

Dev HS, Sooriakumaran P, Srivastava A, Tewari AK (2012) Optimizing radical prostatectomy for the early recovery of urinary continence. Nat Rev Urol 9(4):189–195PubMedCrossRef

Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944PubMedCrossRef

Student V, Vidlar A, Grepl M, Hartmann I, Buresova E, Student V (2017) Advanced reconstruction of vesicourethral support (ARVUS) during robot-assisted radical prostatectomy: 1-year functional outcomes in a two-group randomised controlled trial. Eur Urol 71(5):822–830PubMedCrossRef

Mottrie A, Van Migem P, De Naeyer G, Schatteman P, Carpentier P, Fonteyne E (2007) Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases. Eur Urol 52:746–751PubMedCrossRef

Rocco B, Gregori A, Stener S, Santoro L, Bozzola A, Galli S, Knez R, Scieri F, Scaburri A, Gaboardi F (2007) Posterior reconstruction of the rhabdosphincter allows a rapid recovery of continence after transperitoneal video laparoscopic radical prostatectomy. Eur Urol 51:996–1003PubMedCrossRef

10.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentralCrossRef

11.

Tholomier C, Bienz M, Hueber PA, Trinh QD, Hakim AE, Alhathal N, Lebeau T, Benayoun S, Valdivieso R, Liberman D, Saad F, Lattouf JB, Widmer H, Begin L, Latour M, Zorn KC (2014) Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: the largest Canadian 5-year experience. Can Urol Assoc J 8:195–201PubMedPubMedCentralCrossRef

12.

Michl U, Tennstedt P, Feldmeier L, Mandel P, Oh SJ, Ahyai S, Budäus L, Chun FKH, Haese A, Heinzer H, Salomon G, Schlomm T, Steuber T, Huland H, Graefen M, Tilki D (2016) Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy. Eur Urol 69(4):584–589. https://doi.org/10.1016/j.eururo.2015.07.037 PubMedCrossRef

13.

Reeves F, Preece P, Kapoor J, Everaerts W, Murphy DG, Corcoran NM, Costello AJ (2015) Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta-analysis. Eur Urol 68(4):692–704PubMedCrossRef

14.

Steineck G, Bjartell A, Hugosson J, Axén E, Carlsson S, Stranne J, Wallerstedt A, Persson J, Wilderäng U, Thorsteinsdottir T, Gustafsson O, Lagerkvist M, Jiborn T, Haglind E, Wiklund P (2015) LAPPRO steering committee. Degree of preservation of the neurovascular bundles during radical prostatectomy and urinary continence 1 year after surgery. Eur Urol 67(3):559–568PubMedCrossRef

15.

Hefermehl L, Bossert K, Ramakrishnan VM, Seifert B, Lehmann KA (2018) Prospective analysis of the effects of nerve-sparing radical prostatectomy on urinary continence based on expanded prostate cancer index composite and international index of erectile function scoring systems. Int Neurourol J 2(2):123–132CrossRef

16.

Preisser F, Theissen L, Wild P, Bartelt K, Kluth L, Köllermann J, Graefen M, Steuber T, Huland H, Tilki D, Roos F, Becker A, Chun FK, Mandel P (2019) Implementation of intraoperative frozen section during radical prostatectomy: short-term results from a German Tertiary-Care Center. Eur Urol Focus. https://doi.org/10.1016/j.euf.2019.03.007 PubMedCrossRef

17.

Porpiglia F, Checcucci E, Amparore D, Manfredi M, Massa F, Piazzolla P, Manfrin D, Piana A, Tota D, Bollito E, Fiori C (2019) Three-dimensional elastic augmented-reality robot-assisted radical prostatectomy using hyperaccuracy three-dimensional reconstruction technology: a step further in the identification of capsular involvement. Eur Urol. https://doi.org/10.1016/j.eururo.2019.03.037 PubMedCrossRef

18.

Sugimura Y, Hioki T, Yamada Y, Fumino M, Inoue T (2001) An anterior urethral stitch improves urinary incontinence following radical prostatectomy. Int J Urol 8:153–157PubMedCrossRef

19.

Noguchi M, Noda S, Nakashima O, Matsuoka K, Kojiro M (2004) Suspension technique improves rapid recovery of urinary continence following radical retropubic prostatectomy. Kurume Med J 51:245–251PubMedCrossRef

20.

Patel VR, Coelho RF, Palmer KJ, Rocco B (2009) Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 56:472–478PubMedCrossRef

21.

Grasso AA, Mistretta FA, Sandri M, Cozzi G, De Lorenzis E, Rosso M, Albo G, Palmisano F, Mottrie A, Haese A, Graefen M, Coelho R, Patel VR, Rocco B (2016) Posterior musculofascial reconstruction after radical prostatectomy: an updated systematic review and a meta-analysis. BJU Int 118:20–34PubMedCrossRef

22.

Coelho RF, Chauhan S, Orvieto MA, Sivaraman A, Palmer KJ, Coughlin G, Patel VR (2011) Influence of modified posterior reconstruction of the rhabdosphincter on early recovery of continence and anastomotic leakage rates after robot-assisted radical prostatectomy. Eur Urol 59:72–80PubMedCrossRef

23.

Sutherland DE, Linder B, Guzman AM, Hong M, Frazier HA 2nd, Engel JD, Bianco FJ Jr (2011) Posterior rhabdosphincter reconstruction during robotic assisted radical prostatectomy: results from a phase II randomized clinical trial. J Urol 185(4):1262–1267PubMedCrossRef

24.

Menon M, Muhletaler F, Campos M, Peabody JO (2008) Assessment of early continence after reconstruction of the periprostatic tissues in patients undergoing computer assisted (robotic) prostatectomy: results of a two group parallel randomized controlled trial. J Urol 180:1018–1023PubMedCrossRef

25.

Cui J, Guo H, Li Y, Chen S, Zhu Y, Wang S, Wang Y, Liu X, Wang W, Han J, Chen P, Nie S, Yin G, Shi B (2017) Pelvic floor reconstruction after radical prostatectomy: a systematic review and meta-analysis of different surgical techniques. Sci Rep 7(1):2737PubMedPubMedCentralCrossRef

26.

Tewari A, Jhaveri J, Rao S, Yadav R, Bartsch G, Te A, Ioffe E, Pineda M, Mudaliar S, Nguyen L, Libertino J, Vaughan D (2008) Total reconstruction of the vesico-urethral junction. BJU Int 101:871–877PubMedCrossRef

27.

Manfredi M, Checcucci E, Fiori C, Garrou D, Aimar R, Amparore D, De Luca S, Bombaci S, Stura I, Migliaretti G, Porpiglia F (2019) Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures. BJU Int. https://doi.org/10.1111/bju.14716 PubMedCrossRef

Title: Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes
Authors: Viktor Kováčik
Matúš Maciak
Vladimír Baláž
Jozef Babeľa
Viliam Kubas
Peter Bujdák
Peter Beňo
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Prostatectomy
Prostatectomy
Published in: World Journal of Urology / Issue 8/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02975-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Advanced Reconstruction of Vesicourethral Support (ARVUS) during robot-assisted radical prostatectomy: first independent evaluation and review of other factors influencing 1 year continence outcomes

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2020

Laser fibre, rather than the stone, may harm the scope: retrospective monocentric analysis of 26 pre- and intraoperative factors of flexible ureteroscope (fURS) damage

Experience with detrusorotomy in children by open and robotic approach

One-stop biparametric MRI and MRI/ultrasound fusion-guided biopsy: can we include the histopathology result and our treatment recommendations in our diagnostic pathway?

Randomized, controlled trial of fesoterodine fumarate for overactive bladder in Parkinson’s disease

Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study

Robot-assisted laparoscopic ureteral reimplantation in children: a valuable alternative to open surgery