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

Andrea Cestari, Davide Soranna, Giuseppe Zanni, Antonella Zambon, Matteo Zanoni, Mattia Sangalli, Massimo Ghezzi, Fabio Fabbri, Francesco Sozzi, Vincenzo Dell'Acqua, Patrizio Rigatti

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalJournal of Endourology
Volume31
Issue number9
DOIs
Publication statusPublished - Jan 1 2017

Fingerprint

Suburethral Slings
Vas Deferens
Robotics
Prostatectomy
Perfusion
Pneumoperitoneum
Pressure
Urethra
Prostate
Catheters
Operative Time
Mental Competency
Sutures
Urinary Bladder

Keywords

  • Prostate cancer
  • Robotic prostatectomy
  • Suburethral slings
  • Urinary continence
  • Urodynamics

ASJC Scopus subject areas

  • Urology

Cite this

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. / Cestari, Andrea; Soranna, Davide; Zanni, Giuseppe; Zambon, Antonella; Zanoni, Matteo; Sangalli, Mattia; Ghezzi, Massimo; Fabbri, Fabio; Sozzi, Francesco; Dell'Acqua, Vincenzo; Rigatti, Patrizio.

In: Journal of Endourology, Vol. 31, No. 9, 01.01.2017.

Research output: Contribution to journalArticle

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title = "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",
abstract = "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.",
keywords = "Prostate cancer, Robotic prostatectomy, Suburethral slings, Urinary continence, Urodynamics",
author = "Andrea Cestari and Davide Soranna and Giuseppe Zanni and Antonella Zambon and Matteo Zanoni and Mattia Sangalli and Massimo Ghezzi and Fabio Fabbri and Francesco Sozzi and Vincenzo Dell'Acqua and Patrizio Rigatti",
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T1 - 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

AU - Cestari, Andrea

AU - Soranna, Davide

AU - Zanni, Giuseppe

AU - Zambon, Antonella

AU - Zanoni, Matteo

AU - Sangalli, Mattia

AU - Ghezzi, Massimo

AU - Fabbri, Fabio

AU - Sozzi, Francesco

AU - Dell'Acqua, Vincenzo

AU - Rigatti, Patrizio

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - Prostate cancer

KW - Robotic prostatectomy

KW - Suburethral slings

KW - Urinary continence

KW - Urodynamics

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