Impact of a novel anterior suspension stitch on return of urinary continence after Robotic Radical Prostatectomy (RRP), with description of surgical technique

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Eur Urol

Abstract

Introduction & Objectives: During radical prostatectomy, the pubourethral angle is increased due to the loss of periprostatic supportive tissue, and the symphysis to bladder neck distance is increased due to the loss of prostatic urethral length. We hypothesize that recreating the pubourethral angle and decreasing the symphysis to bladder neck distance during RRP improves continence outcomes. We achieved this by performing an anterior suspension stitch (“Jeong suspension”). Materials & Methods: 41 patients underwent ‘Jeong suspension’ (suspension group) by two surgeons at a single institution between 2017-2021. In this suspension procedure, the anterior bladder wall attached to the symphysis of pubis is identified during the bladder takedown. This point is then suspended to the symphysis pubis after anastomosis, pulling the urethrovesical anastomosis anterior and superior, restoring the periurethral anatomy. Outcomes were compared to contemporary 2:1 propensity-score matched patients who did not undergo ‘Jeong suspension’ (control). The patients were administered validated questionnaires at 1, 3, 6, and 12 months after the procedure and social Continence defined as the use of no pads or one security pad. Outcomes were assessed independently by a state-wide quality collaborative. Kaplan Meier analysis was used to calculate median time to continence in weeks. Cox regression tested the effect of ‘Jeong stitch’ accounting for known confounders. Results: After propensity score matching, groups were similar in all baseline variables, except PSA which was statistically, but not clinically higher in suspension group (mean 12 ng/dl vs 9 in control;p<0.01). 36 patients in the suspension group achieved continence(88%), compared to 58 (71%) in control group. Median time to social continence was 20 weeks for suspension group, compared to 36 for control;p=0.003. Cox regression confirmed independent association of suspension to continence [HR 1.90 (CI 1.24-2.92)]. Conclusions: The Jeong suspension stitch during RRP is technically easy-to-perform and safe. This stitch significantly improves time to social continence when compared to matched patients not undergoing the technique. [Figure presented]

Volume

85

First Page

S593

Last Page

S594

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