MP15-18 RECONSTRUCTION OF THE RETZIUS SPACE BY PERITONEAL SUTURE FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY IMPROVES POSTOPERATIVE URINARY INCONTINENCE

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-18 RECONSTRUCTION OF THE RETZIUS SPACE BY PERITONEAL SUTURE FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY IMPROVES POSTOPERATIVE URINARY INCONTINENCE Ryo Takata, Mitsugu Kanehira, Yoichiro Kato, Tomohiko Matsuura, Renpei Kato, Shigekatsu Maekawa, and Wataru Obara Ryo TakataRyo Takata More articles by this author , Mitsugu KanehiraMitsugu Kanehira More articles by this author , Yoichiro KatoYoichiro Kato More articles by this author , Tomohiko MatsuuraTomohiko Matsuura More articles by this author , Renpei KatoRenpei Kato More articles by this author , Shigekatsu MaekawaShigekatsu Maekawa More articles by this author , and Wataru ObaraWataru Obara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In robot-assisted radical prostatectomy (RARP), the Retzius space is opened through a peritoneal incision from the abdominal cavity to secure working space. However, the surgery is completed without closing the peritoneum. Therefore, the RARP destroys the anatomical feature that the bladder is elevated cephalad by the peritoneum. Also, bladder morphology is deformed, which may affect the early establishment of urinary continence. This study investigated whether the Retzius space reconstruction could establish early urinary continence. METHODS: Thirty-three patients with localized prostate cancer have enrolled in the study. In addition, 111 patients who underwent RARP between 2018 and February 2020 were selected as a control. Patients who undergo Retzius sparing RARP or extended lymph node dissection were excluded. The Retzius space was released by semicircular peritoneal incision medial to the bilateral obliterated umbilical arteries. The peritoneum was closed using 3-0 PDS after extracting the prostate and bladder neck - urethral anastomosis. A pelvic drain was not placed. We compared the operative time, perioperative complications, urinary continence at each time point. Continence was defined as the use of one pad or less as a safety pad. RESULTS: There was no significant increase in operative time with Retzius space reconstruction. There was no significant difference in blood loss and perioperative complications between patients with and without Retius space repair. Cystography at the first postoperative week showed that the bladder's long axis was obtuse to the urethra, and the anterior bladder wall was in contact with the anterior abdominal wall compared to the conventional technique. The safety pad rate was 35% in the repaired Retzius space group at the first postoperative month and 25% in the non-repaired group. At three months postoperatively, 63% of patients in the repaired group and 47% of patients in the non-repaired group showed urinary continence. Furthermore, in patients with a membranous urethral length (MUL) of 12 mm or more, the safety pad rate at six months was 100% in the repaired group. CONCLUSIONS: Retzius space reconstruction effectively restored the bladder's physiological structure without complications and establishes early urinary continence. In particular, early achievement of urinary continence was observed in patients with a MUL of 12 mm or more. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e270-e271 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryo Takata More articles by this author Mitsugu Kanehira More articles by this author Yoichiro Kato More articles by this author Tomohiko Matsuura More articles by this author Renpei Kato More articles by this author Shigekatsu Maekawa More articles b