Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital

Vol. 43 (x): 2017 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0466


SURGICAL TECHNIQUE

Lucas Medeiros Burttet 1, Gabrielle Aguiar Varaschin 2, Andre Kives Berger 3, Leandro Totti Cavazzola 2, 4, Milton Berger 1, 2, Brasil Silva Neto 1, 2
1 Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil; 2 Universidade Federal do Rio Grande do Sul, RS, Brasil; 3 Institute of Urology, University of Southern California, Los Angeles, CA, USA; 4 Departamento de Cirurgia Geral, Hospital de Clínicas de Porto Alegre, RS, Brasil

ABSTRACT  

Purpose: Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature.
Materials and Methods: We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature.
Results: Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status.
Conclusion: Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.

Keywords: Minimally Invasive Surgical Procedures; Prostatectomy; Urinary Incontinence

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