Full functional-length urethral sphincter preservation during radical prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Pelvic Floor Reconstruction

Background:

• Urinary continence after radical prostatectomy (RP) depends on urethral sphincter function and pelvic floor stabilization.
• Maintaining functional urethral length is crucial for successful continence post-RP.

Purpose of the Study:

• To describe a modified surgical technique for preserving full functional urethra length (FFLU) during RP.
• To evaluate the impact of the FFLU technique on early and late urinary continence rates.

Main Methods:

• Analysis of 691 patients undergoing RP, comparing 285 without and 406 with the FFLU technique.
• FFLU preservation involved individualized apical preparation along anatomic landmarks and meticulous preservation of the pelvic floor and Mueller's ligaments.
• Continence was assessed at 7 days and 12 months post-catheter removal, defined as no pad use or leakage.

Main Results:

• Early continence rates (1 week post-catheter removal) were significantly higher with the FFLU technique (50.1%) compared to the non-FFLU technique (30.9%).
• Late continence rates (12 months) were comparable between groups (96.9% FFLU vs. 94.7% non-FFLU).
• Surgical technique was the only significant correlate for early continence; positive surgical margins did not differ significantly between groups.

Conclusions:

• The FFLU technique combined with enhanced preservation of urethral sphincter complex fixation significantly improves early urinary continence outcomes.
• This surgical modification offers a promising approach to enhance functional recovery after radical prostatectomy.