Posterior, Anterior, and Periurethral Surgical Reconstruction of Urinary Continence Mechanisms in Robot-assisted Radical Prostatectomy: A Description and Video Compilation of Commonly Performed Surgical Techniques

Robot-assisted radical prostatectomy (RARP) is hampered by side effects that may have a serious impact on quality of life, particularly stress urinary incontinence. Continence rates may be improved by surgical reconstruction of the pelvic floor. Video illustrations of different surgical techniques may be particularly worthwhile for practicing urologists in understanding the pelvic-floor anatomy and in the training of residents and fellows in urology. We describe and video-illustrate commonly performed pelvic reconstructive techniques in RARP, as performed by experts in the field. Surgical techniques have been described, such as posterior musculofascial reconstruction, anterior reconstruction and periurethral suspension, preservation of membranous urethral lengthening, bladder-neck reconstruction, and combinations. An overview of continence rates of the different techniques is given. All reconstructive surgical techniques result in similar short-term continence rates and good-to-excellent outcomes 1 yr after surgery. There are only a few randomized clinical trials comparing a reconstructive technique with “no reconstruction” or a different reconstructive technique, and outcomes are conflicting. Although many of the procedures report a benefit with respect to early continence, benefits seem to diminish with longer follow-up. Whether any of the reconstructive techniques is superior to another is a matter of study. Early continence rates might be improved by surgical reconstruction of the pelvic floor.