Urologic surgeons have devised a new procedure that helps men minimize incontinence after prostatectomy. It adds only a few minutes to standard robotic prostatectomy. “Modifying existing tissues, our technique added only a few minutes to standard robotic prostatectomy, yet attained a 95 percent continence rate among patients 16 weeks after their surgeries,” explains lead researcher Dr. Ashutosh K. Tewari, director of robotic prostatectomy and outcomes research at New York-Presbyterian/Weill Cornell Medical Center.
“This is a real breakthrough in prostate cancer care, as a significant number of patients have post-prostatectomy urinary incontinence,” adds senior researcher Dr. E. Darracott Vaughan, attending urologist at New York-Presbyterian/Weill Cornell Medical Center. “Too often, the threat of incontinence can be a key factor in a patient’s decision for or against prostatectomy,” he adds.
The new technique was tested in 50 consecutive patients scheduled to undergo robot-guided prostatectomy for the treatment of localized prostate cancer. The procedure added just two to five minutes to the standard prostate-removing operation.
“Our technique uses tissues that would normally remain behind after prostatectomy tissues that we can flip around and support to our advantage,” Dr. Tewari explains. “We reconstruct the anterior and posterior parts of the sphincter and surgically join the bladder and the anastomosis (the gap in tissues left by prostatectomy) with the surrounding structures. In doing so, we reconstruct the major anatomical players controlling urinary continence.”
The post-surgical results showed: One week after patients first had their urinary catheters removed, 29 percent were already fully continent; by six weeks, that figure rose to 62 percent; by eight weeks, 88 percent of the men were fully continent; and by 16 weeks, 95 percent had achieved continence.
The researchers stressed that the men involved in the study had all been diagnosed with non-aggressive, localized cancers. “With more aggressive tumours, surgeons must often excise the tissues that we need for reconstruction, so the technique is not useful in those cases,” Dr. Vaughan says.