Session: MP61: Prostate Cancer: Localized: Surgical Therapy II
MP61-06: Impact of posterior reconstruction urethrovesical anastomosis on 5-year incidence of undergoing continence improving procedures after robot-assisted radical prostatectomy: a randomized controlled trial
Introduction: Posterior reconstruction of the Denonvilliers’ musculofascial plate also known as the Rocco stitch, have shown mixed results on early return to urinary continence, yet little data exist on long-term outcomes. The objective of this study was to evaluate the long-term need for incontinence improving procedures post robot-assisted radical prostatectomy (RARP) comparing posterior reconstruction urethrovesical anastomosis (PR-UVA) versus conventional urethrovesical anastomosis (C-UVA). Methods: Consecutive patients with clinically localized prostate cancer undergoing RARP were randomized to PR-UVA or C-UVA groups. Return to continence outcomes were assessed using a validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC] Short Form-26) at baseline, 2, 3, 4, 6, 8, and 12-month follow-up. Five-year outcomes were assessed by frequency of continence-improving procedures. Results: A total of 163 patients were randomized from April 2014 to July 2015 and 140 patients completed follow-up. Pre-operative clinical and functional variables were equivalent between study arms. Using a continence definition of 0-1 pads/day, the continence rates for PR-UVA versus the C-UVA were 39% versus 38% at 2 months (p=1.0), and 93% versus 86%, respectively, at 12 months (p=0.3). Frequency of urine leak, quantity of pad use, subjective urinary control, and overall bother improved significantly in all patients during the 12-month study period (p < 0.001); however, no difference was demonstrated between groups. Five-year results showed no difference in the number of patients undergoing a continence-improving procedure (HR 0.90, 95% CI 0.29-2.80; p = 0.09). Conclusions: PR-UVA failed to show a benefit in short-term return to urinary continence or need for an incontinence improving procedure at 5-year follow-up post RARP. SOURCE OF Funding: The Masonic Foundation of Ontario.
