Retropubic Intracorporeal Placement of a Suburethral Autologous Sling During Robot-Assisted Radical Prostatectomy to Improve Early Urinary Continence Recovery: Preliminary Data

Background and Purpose: Urinary continence (UC) recovery remains bothersome for patients even after robot-assisted radical prostatectomy (RARP). We describe the first retropubic suburethral autologous sling created and placed during RARP. The surgical technique and preliminary data regarding its effectiveness in improving early UC recovery are presented. Patients and Methods: Between November 2013 and February 2014, 60 patients who underwent RARP at a single high-volume center were prospectively randomized into sling and nonsling groups. Early UC was assessed at 5 days (time of catheter removal), 10 days, and 30 days postoperatively by the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. Sling-related operative time and urethral erosion were also analyzed. Chi-square and independent sample t tests were used to investigate surgical and functional outcomes between groups. Results: Complete data were available for all patients. Meanstandard deviation (SD) numbers of pads used daily in nonsling and sling groups, respectively, were 1.9 +/- 1.2 versus 1.7 +/- 1.4 (P=0.5) at 5 days, 1.8 +/- 1.3 versus 1.3 +/- 1.3 (P=0.1) at 10 days, and 1.1 +/- 1.2 versus 0.4 +/- 0.8 (P=0.01) at 30 days. At 1 month, mean +/- SD ICIQ-UI-SF scores in nonsling and sling groups, respectively, were 4.8 +/- 4.6 versus 1.8 +/- 3.4 (P=0.01); sling patients were associated with pad-free status (76% vs 46%, P=0.03). The advantage in UC recovery was also observed in sling patients at 3, 6, and 12 months postoperatively. Surgical time did not differ between groups, and in sling patients, no cases of urethral erosion or uroflowmetry suggestive of urinary obstruction were found. Limitations included the small sample size and the lack of assessment of morphologic and urodynamic changes produced by the sling. Conclusions: The suburethral autologous sling is technically feasible and may improve early UC recovery after RARP. These preliminary results should be confirmed in a larger sample of patients.