ReviewUrologie (Heidelberg, Germany)2025
[Surgical techniques to improve continence after robot-assisted laparoscopic radical prostatectomy based on video-anatomy-a review].
Review in Urologie (Heidelberg, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
2 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundSince robot-assisted laparoscopic prostatectomy (RALP) has become widely accepted in German-speaking countries, there needs to be an agreement on the most efficient surgical techniques. This should be based on the video-anatomy of the prostate and a summary of the actual literature. MATERIALS AND
methodsBased on video material of different surgical techniques, a systematic literature search in PubMed has been performed focusing on preservation of continence and minimal rates of positive margins. This is based on the anatomy of the male pelvis applying a standard nomenclature. The original 3825 publications could be reduced to 604 articles according to the inclusion criteria (randomized controlled trials, meta-analyses, systematic reviews, and clinical studies). When expanding the search to encompass individual operation techniques, we identified 27 relevant articles.
resultsCrucial surgical details include preserving the levator fascia, the puboprostatic collar, a long urethral stump with protection of the urethral lissosphincter and posteriorly reconstruction of the rectourethralis with the prostatovesical muscle. Fascial preservation for the levator ani muscle results in 1‑year continence between 78.0 and 98.3%, preservation of the puboprostatic collar and detrusor apron between 95.6 and 100%, maximal functional urethral length between 90.5 and 97.5%. Posterior reconstruction leads to a 3-month continence between 92.3 and 96.9%. Preserving the Retzius' space and thus the total anterior sphincter apparatus results in 1‑year continence of 95.8%; however, it is associated with a higher rate of positive surgical margins (14-42 vs. 10-29%).
conclusionBased on the increase of knowledge and the feasibility to translate this into novel surgical techniques, the continence rates could be significantly improved. This includes approaches to spare anatomical structures of the sphincter apparatus, such as preservation of the levator fascia, the puboprostatic collar, the urethral lissosphincter, but also reconstructive techniques, such as posterior reconstruction of the vesicoprostatic and rectourethralis muscle. Demanding techniques, such as the Retzius-sparing approach result in higher continence rates, but are also associated with a higher rate of surgical margins.
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