Intraoperative retrograde perfusion sphinterometry to evaluate efficacy of autologous vas deferens 6-branch suburethral sling to properly restore sphincteric apparatus during robotic assisted radical prostatectomy

Objectives: To describe urodynamically the effect of the use of 6-branch autologous suburethral sling, made with absorbable sutures and vas deferens, to support bladder neck and urethra during Robotic Assisted Radical Prostatectomy (RALP), to improve early urinary continence recovery. Materials & Methods: Retrograde leak point pressure (RLPP) was intraoperatively evaluated, by means of retrograde perfusion sphinterometry (RPS), in 77 patients (mean age ± SD: 65.64±7.23 years, mean BMI ± SD 26.69±3.89) scheduled to undergo RALP at our institution. RLPP was evaluated before (RLPPb) and after pneumoperitoneum induction (RLPPp). RLPP was then evaluated after urethrovesical anastomosis (RLPPa) and after proper sling tensioning (RLPPs), with the aim to obtain the same pressure as after pneumoperitoneum induction. EUC recovery, defined as the use of no pad, was assessed 10, 30 days and 6 months after catheter removal. Results: RPS and proper autologous 6-branch sling positioning were feasible in all patients, whithout perioperative complications and negligible impact on overall operative time. Pneumoperitoneum induction increased similarly RLPP in all patients. An important decrease of sphicteric capability was evident after prostate removal and the following urethrovesical anastomosis, while proper sling tensioning allowed for the restoration of sphincteric apparatus cabability to its pre-surgical status (mean RLPPs 40.84 cmH2O vs RLPPp 40.39 cmH2O, p-value= 0.942). EUC recovery within 10 days after catheter removal was achieved in 59 (77%) patients and progressively improved over time. Conclusions: RPS, intraoperatively performed during RALP, allows for a precise evaluation of the impact of the surgical procedure on sphincteric apparatus competence. Moreover the use of 6- branch suburethral sling, in association with the RPS, allows for the restoration of the proper supporting system to the urethral sphincter, similar to the preoperative condition, offering the basis for an early urinary continence recovery after radical prostate surgery.