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Continence preserving technique / approach

Continance preserving approach in LRP for patients with ca prostate

Continence preserving technique/ approach in patients undergoing laparoscopic radical prostatectomy (LRP) for ca prostate.

T Manohar, SK Nandakishore , UB Joshi

Centre for advanced urology and minimally invasive surgery, Bengaluru

Introduction and objective:

The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy especially in achieving early continence and potency. We report (video) on our structured technical modification to achieve early continence in cost effective laparoscopic approach

Material and methods:

All patients underwent transperitoneal laparoscopic radical prostatectomy. Adequate intra abdominal urethral length was aimed at in each case. Watertight anastomoses using quill monoderm suture, preserving the urethral fibers of the levator ani, posterior Rocco stitch, small diameter bladder neck and anterior suspension stitch were used depending on the intrabdominal length of the urethra. Catheter removed 3 weeks post surgery after a slow fill MCUG.

Results:

89% of the patients achieved continence by 1 month. Of them 12 achieved with in 7 days and 9 achieved continence on the day 1 post catheter removal days. All patients had watertight anastomoses with no urine leak post op.

Conclusion

With a structured methodical approach we were able to achieve early continence as early as day 1 –day 7 after catheter removal in a cost effective laparoscopic approach with minimal patient morbidity, and good oncological and functional outcomes.