Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy

Urinary incontinence is one of the most significant causes of concern among patients who get surgical treatment for prostate cancer, even after the introduction of the robot. The aim of this study is to summarize current knowledge of the factors influencing urinary continence (UC) and the technical innovations to optimize UC recovery after robotic assisted radical prostatectomy (RARP). A non-systematic review was conducted from January 2000 to October 2018 to identify original and review articles in English describing the anatomy of the prostate and pelvis. An emphasis was addressed to article describing technical innovations to optimize UC after RARP. Improved knowledge of the normal structure in the pelvis should lead to a greater understanding of the pathophysiology of urinary incontinence, and further development of intraoperative techniques to improve the outcomes of UC. The literature has shown certain technique modification to meliorate UC as potential benefit to reduce the risk of urinary incontinence after RARP. These techniques might be divided in 3 categories to improve an early return to UC: 1) preservation, 2) reconstruction and 3) reinforcement of the anatomic structures in the pelvis, which will make new supporting system after RARP. In the present review, the authors summarize factors influencing incontinence after RARP and outline a common denominator for all the surgical techniques described in the literature for UC recovery.