Urinary Continence After Robot-Assisted Laparoscopic Radical Prostatectomy Using the Peritoneal Fixation Technique

Abstract

Introduction

The Retzius-sparing technique for prostate cancer has shown favorable continence recovery outcomes. Magnetic resonance imaging after Retzius-sparing showed that the bladder anterior wall is widely connected to the abdominal wall, which contributes to urinary continence. We aimed to evaluate whether the Peritoneal Fixation technique, which involves suturing the anterior bladder wall onto the abdominal wall above the pubic bone, contributes to the recovery of urinary continence.

Methods

Patients who underwent robot-assisted laparoscopic radical prostatectomy between May and September 2023 were included in the study. We investigated urinary incontinence on the day of catheter removal and 1 month postoperatively. The posterior urethral angle was evaluated at rest and under abdominal pressure.

Results

A total of 54 patients who underwent the Peritoneal Fixation technique (n = 27) and conventional surgery (n = 27) were included. The continence acquisition rate on the day after catheter removal was significantly higher in the Peritoneal Fixation group (40.7%) than in the conventional group (7.4%) (p < 0.05). At 1 month postoperatively, the Peritoneal Fixation group showed favorable results, with a continence rate of 44.4% compared with 29.6% in the conventional group (p = 0.26). The change in the posterior urethral angle at rest and during abdominal pressure significantly differed between the Peritoneal Fixation and conventional groups (−3.0° vs. 2.7°; p < 0.05), indicating that the urethra is being pushed from the rectal side in the Peritoneal Fixation group.

Conclusion

The use of the Peritoneal Fixation technique for prostate cancer suggests the potential for achieving favorable urinary continence outcomes.