Sling technique boosts post-RARP early continence recovery

Jan 27 2014

Researchers have shown that addition of the bladder neck sling suspension technique to robot-assisted radical prostatectomy (RARP) can improve the early return of continence after surgery.

“[R]ecent cumulative analyses have shown better 12-month urinary continence recovery after RARP in comparison with retropubic or laparoscopic radical prostatectomy (RRP or LRP),” comments the team, led by Yoshiyuki Kojima (Fukushima Medical University School of Medicine, Japan).

“However, early urinary incontinence remains one of the most bothersome postoperative complications, even in RARP.”

The study involved 57 patients of whom 27 underwent the bladder sling suspension technique, while the remainder underwent standard nonsling technique.

The team found that in the nonsling group total International Prostate Symptom Score (IPSS) significantly increased from 7.0 at baseline to 16.0 at 4 weeks. By contrast, in patients treated with the sling technique, IPSS was 12.5 at baseline and 11.0 at 4 weeks, a nonsignificant change.

There were similar findings for voiding and storage subscales of the IPSS, as well as the International Consultation on Incontinence Questionnaire-Short Form and the Expanded Prostate Cancer Index Composite urinary incontinence score.

Additionally, at 4 weeks, the mean pad weight gain during the 1-hour pad test was significantly smaller in the sling-treated group at 4.5 g compared with 15.5 g in the nonsling group, and 29.6% versus 10.0% of patients, respectively, had no pad leakage.

In contrast to these early findings, at weeks 12 and 24, there were no significant differences between the two groups in any of the outcomes measured.

Writing in Urology, Kojima et al explain that the technique is inspired by the treatment of female stress urinary incontinence, involving an adaptation of the retropubic suspension techniques used in such patients.

“[O]ur procedure might not only support the proximal urethra and bladder neck, but also provide a direct compressive force on the urethra/bladder outlet, increase the functional length of the urethral sphincteric complex, and potentially reestablish and reinforce the suburethral tissue used as a backboard for urethral closure,” they suggest.

These results indicate that the technique is a simple and feasible means to improve early continence return, say the researchers. However, they note that their findings are only in a small sample from a single institution.

“Additional larger randomized control studies are required to confirm these encouraging findings,” they therefore conclude.

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