Simple Procedure Minimizes Incontinence After Prostatectomy

A new study describes a simple, effective means of reconstructing key anatomic structures after prostatectomy, reducing post-surgical urinary incontinence.

Researchers at the New York-Presbyterian Hospital (NYP; New York, NY, USA) /Weill Cornell Medical Center (CUMC; New York, NY, USA) reviewed three-dimensional (3D) videos that detailed the urologic anatomy of patients who had retained full continence after prostatectomy. Based on their observations, the researchers then devised the new technique, which preserves the puboprostatic collar, modeling it first in cadaver tissues. They then tested the new procedure in 50 consecutive patients scheduled to undergo robot-guided prostatectomy for the treatment of localized prostate cancer. The procedure added just two to five minutes to the standard prostate-removing operation.

Post-surgical results showed that one week after patients first had their urinary catheters removed, 29% were already fully continent; by six weeks, that figure rose to 62%; by eight weeks, 88% of the men were fully continent; and by 16 weeks, 95% had achieved continence. The new procedure is described in a study published in the April 2007 issue of the journal Urology.

"Our technique uses tissues that would normally remain behind after prostatectomy--tissues that we can flip around and support to our advantage,” said lead author Dr. Ashutosh K. Tewari, director of robotic prostatectomy and outcomes research at NYP/CUMC. "We reconstruct the anterior and posterior parts of the sphincter and surgically join the bladder and the anastomosis (the gap in tissues left by prostatectomy) with the surrounding structures. In doing so, we reconstruct the major anatomical players controlling urinary continence.”

The puboprostatic ligaments, puboperinealis muscle, and arcus tendineus are all recognized as important for continence. This complex of ligaments, muscles, and tendineus aponeurosis acts in unison to provide continence and can be disrupted during robotic prostatectomy.


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New York-Presbyterian Hospital
Weill Cornell Medical Center