Korean J Urol.  2011 Oct;52(10):709-714. 10.4111/kju.2011.52.10.709.

Impact of a Retrotrigonal Layer Backup Stitch on Post-Prostatectomy Incontinence

• Chung MS
• Lee SH
• Jung HB
• Park WK
• Chung BH

• KMID: 2061435
• DOI: http://doi.org/10.4111/kju.2011.52.10.709

Abstract

PURPOSE
To evaluate the impact of a retrotrigonal layer backup stitch (RTBS) during robot-assisted laparoscopic radical prostatectomy (RALP) on post-prostatectomy incontinence.
MATERIALS AND METHODS
We compared the difference in continence recovery between 94 patients (group 1, as historical controls) and 57 patients (group 2). The only technical difference between our two groups was the incorporation of the retrotrigonal layer into the posterior aspect of the vesicourethral anastomosis (group 1: without RTBS; group 2: with RTBS). Postoperative continence recovery was defined as the use of no absorbent pads.
RESULTS
In group 1, the continence rate at 3, 6, and 12 months postoperatively was 40.4%, 70.2%, and 90.4%, respectively;in group 2, the continence rate was 42.1%, 70.1%, and 89.7%, respectively. The median (95% confidence interval) time to continence recovery was four months (range, 1 to 12 months) in group 1 and four months (range, 1 to 9 months) in group 2. Kaplan-Meier curves showed no significant difference in the recovery of continence between the two groups (log rank test, p=0.629).
CONCLUSIONS
A RTBS does not appear to improve urinary incontinence after RALP. Further anatomical study and prospective randomized studies will be needed to confirm this.

Keyword

Prostatectomy; Prostatic neoplasms; Urinary incontinence

MeSH Terms

Humans
Prostatectomy
Prostatic Neoplasms
Urinary Incontinence

Figure

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  FIG. 1 The anatomical relationships of the retrotrigonal layer. This layer extends from the posterior aspect of the trigone to the base of the prostate (Reproduced with permission from Wiley Interscience [3]).

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  FIG. 2 The retrotrigonal layer and backup stitch of this layer during vesicourethral anastomosis. (A) The intraoperative appearance of the retrotrigonal layer (arrow). During dissection of posterior bladder neck, this layer was found in the midline at the prostato-vesical junction (*indicates the posterior bladder wall). It appears as a pinkish white midline strip with vertically orientated fibers. (B) After this layer was divided, the vasa and seminal vesicles were found just beneath the retrotrigonal layer (arrow indicates the transected retrotrigonal layer). (C) The appearance during vesicourethral anastomosis. The retrotrigonal layer (arrow) was sutured together with the posterior bladder wall. (D) This suture was anastomosed with the membranous urethra. (E) Schematic figure of RTBS technique. SV: seminal vesicle, VD: vas deference, MU: membranous urethra.

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  FIG. 3 Kaplan-Meier curves showing the urinary continence probability after robot-assisted laparoscopic radical prostatectomy without (group 1) and with (group 2) the placement of the retrotrigonal layer back up stitch (RTBS).

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