Urethral sphincter fatigue after robot-assisted radical prostatectomy: descriptive questionnaire-based study and...

Area of Science:

• Urology
• Surgical Oncology
• Pelvic Floor Anatomy

Background:

• Robot-assisted radical prostatectomy (RARP) can lead to sphincter fatigue and continence issues.
• The neurovascular bundle (NVB) plays a crucial role in pelvic floor function.
• Neuronal nitric oxide synthase (nNOS) is implicated in smooth and striated muscle function.

Purpose of the Study:

• To investigate if NVB preservation improves recovery from sphincter fatigue after RARP.
• To examine the role of nNOS and nNOS-positive nerves in pelvic floor striated muscles.

Main Methods:

• A cohort of 211 patients undergoing RARP had their continence and sphincter fatigue assessed at 1, 3, and 6 months.
• Anatomical study using cadaveric sections to identify nNOS localization.
• Statistical analysis (chi-square test) to correlate NVB preservation with outcomes.

Main Results:

• Sphincter fatigue symptoms showed significant differences based on NVB preservation status at 1 and 3 months post-RARP.
• Sarcolemmal nNOS was detected in the rhabdosphincter and levator ani muscles.
• nNOS-positive nerve fibers originating from the NVB were identified.

Conclusions:

• NVB preservation is associated with reduced postoperative sphincter fatigue after RARP.
• Reduced sphincter fatigue may contribute to improved urinary continence.
• The presence of sarcolemmal nNOS and its nerve supply from the NVB in pelvic floor striated muscles is confirmed.