Novel Surgical Technique For Prostate Cancer Improves Urinary Continence
Researchers have found that novel surgical technique, the RARP "hood technique" which showed a reduction in postoperative urinary incontinence and facilitated a early return of continence in patients with localized prostate cancer.
The novel "hood technique" preserved tissue after prostate removal and has the appearance of a "hood" comprising the detrusor apron, arcus tendineus, puboprostatic ligament, anterior vessels, and some fibers of the detrusor muscle. This hood surrounds and safeguards the membranous urethra, external sphincter, and supportive structures.
Radical prostatectomy is the reference standard for the treatment of localized prostate cancer. This technique has been modified and refined over many years. Nevertheless, the procedure continues to have several common side effects, including urinary incontinence, which can significantly impact the quality of life for prostate cancer survivors and which is the focus of this study.
The hood technique for robotic-assisted prostatectomy described in this study represents a modification to the anterior approach similar to previously published techniques and also preserves the musculofascial structures anterior of the prostate. This novel study shows that the hood technique confers three key benefits: early continence, a low positive surgical margin rate, and the ability to visualize anatomical landmarks.
This is a study of 300 patients (median age 64 yr.) with localized prostate cancer treated with the RARP hood technique at a major urban hospital between April 2018 and March 2019. This study was conducted at the Mount Sinai Health System.
The results indicate that the hood technique spares musculofascial structures anterior to the urethral sphincter complex with early return of continence after surgery, without compromising positive surgical margin rates. Exclusion of anterior tumor location contributed to a reduction in positive surgical margins.
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Hood Technique for Robotic Radical Prostatectomy—Preserving Periurethral Anatomical Structures in the Space of Retzius and Sparing the Pouch of Douglas, Enabling Early Return of Continence Without Compromising Surgical Margin Rates.