V1236 A NOVEL TECHNIQUE FOR PRESERVATION OF PUBOVESICAL FASCIA DURING ROBOTIC RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: It has previously been reported that following radical prostatectomy the outcome that patients fear most is urinary incontinence. While the majority of patients undergoing radical prostatectomy maintain continence, surgical technique continues to evolve with the goal of improving functional outcomes. Recently, the importance of anatomic structures supporting the urethra and bladder neck in maintaining continence has been appreciated. The purpose of this video is to demonstrate a novel technique designed to improve continence by preserving the anterior support and the pubovesical fascia during robotic radical prostatectomy. METHODS: The pubovesical fascia sparing approach involves a medial incision on the endopelvic fascia to maintain in continuity the pelvic floor supporting structures including the puboprostatic ligaments, pubovesical fascia, and the arcus tendineus. An automatic stapling device used for dorsal vein transection also serves to secure the urethra anteriorly in a high, fixed position to the puboprostatic ligaments and the pubic symphysis. RESULTS: This video demonstrates a novel technique designed to preserve the support of the urethra and bladder neck. A stapling device is used to anchor the urethra to the puboprostatic ligaments which are in turn left with a broad attachment to the arcus tendineus levator ani and the pubovesical fascia. This maintains the natural support of the urethra and bladder neck. The patient demonstrated in this video had total continence with no leakage at 3 weeks follow-up. CONCLUSIONS: Preservation of urethral and bladder neck support may contribute to post-prostatectomy continence. Though prospective, randomized trials will be required to validate this technique, it has the potential to improve patient quality of life following robotic radical prostatectomy