Current Opinion in Urology Eprint - June 2011 - (Page 185)

Robotic-assisted laparoscopic prostatectomy: a critical analysis of its impact on urinary continence Abhishek Srivastava, Sonal Grover, Prasanna Sooriakumaran, Jaspreet Joneja and Ashutosh K. Tewari Lefrak Center of Robotic Surgery and Prostate Cancer Institute, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, NewYork, NewYork, USA Correspondence to Ashutosh K. Tewari, MD, MCh, Ronald P. Lynch Professor of Urologic Oncology, Director, Lefrak Center of Robotic Surgery, Director, Prostate Cancer Institute, New York Presbyterian Hospital, Brady Foundation Department of Urology, Weill Medical College of Cornell University, 525 East 68th Street, Starr 900, New York, NY 10065, USA Tel: +1 212 746 5634; fax: +1 212 746 9842; e-mail: ashtewarimd@gmail.com Current Opinion in Urology 2011, 21:185–194 Purpose of review Over 90% of all prostate cancer patients are diagnosed at a stage when the disease is organ-confined and potentially curable. Currently, more than 60% of all prostate cancer surgeries in the USA are performed using the robotic approach. We review the current literature evaluating the technical advances to optimize continence recovery following robotic prostatectomy. Recent findings Recent studies suggest that the several technical nuances during robotic prostatectomy can result in earlier continence recovery in patients without compromising the oncologic outcome. The key is in delicate handling of tissues, reducing trauma, preserving support structures, and restoring postoperative anatomy as close as possible to preoperative anatomy. There should also be standardization in assessment of continence recovery. Summary Much progress has been achieved in elucidating the anatomic, physiologic, and neural basis of the male continence mechanism, resulting in novel adaptations of the conventional approach to radical prostatectomy with the aim of preserving continence and accelerating its return. Various principles for augmenting continence return have been proposed which have been evaluated in series of open, laparoscopic, and roboticassisted radical prostatectomy. Going forward, we foresee a paradigm shift from individual techniques toward a unified approach of interwoven principles aimed at preserving and augmenting the functional and innervative anatomy of the continence mechanism. Keywords anatomy, cancer, continence, prostate, prostatectomy, robotic Curr Opin Urol 21:185–194 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 0963-0643 Introduction Prostate cancer is the most common nondermatologic cancer affecting men in the Western world [1]. Over 90% of all prostate cancer patients are diagnosed at a stage when the disease is organ-confined and potentially curable [2]. Radical prostatectomy is a standard primary treatment option for such cases and has traditionally been performed by the open retropubic route [3]. However, bleeding and other complications are not uncommon with this approach [4], leading some towards newer minimally invasive approaches (conventional laparoscopic and robotic-assisted laparoscopic radical prostatectomy, LRP and RALP, respectively). In fact, currently more than 60% of all prostate cancer surgeries in the USA are performed using the robotic approach [5]. 0963-0643 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins With advances in surgical techniques and technologies, as well as the stage migration towards diagnosis of early curable disease, it is reasonable for patients to expect that cancer control does not excessively compromise functional outcomes. Also, the epidemic of prostate-specific antigen testing has resulted in surgical candidates being younger than was the case in the past [6]. Hence, prostate cancer surgeons need to not only provide cancer control with surgery, as evidenced by positive surgical margin (PSM) rates at the time of surgery and biochemical recurrence (BCR) rates thereafter, but must also optimize functional results in terms of recovery of sexual potency and urinary continence. As the treatment arsenal for clinically localized prostate cancer increases with less radical surgical options like focal brachytherapy, highintensity ultrasound, and photodynamic therapy [7,8], patients consider the relative impacts of these treatment DOI:10.1097/MOU.0b013e3283455a21 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Table of Contents for the Digital Edition of Current Opinion in Urology Eprint - June 2011

Current Opinion in Urology Eprint - June 2011
Contents
Extended Lymph Node Dissection: Blabber, Kidney
Robotic-Assisted Laparoscopic Prostatectomy: A Critical Analysis of Its Impact on Urinary Continence
A Critical Analysis of the Long-Term Impact of Brachytherapy for Prostate Cancer: A Review of the Recent Literature
Contemporary Role of Radiation Therapy in the Adjuvant or Salvage Setting Following Radical Prostatectomy

Current Opinion in Urology Eprint - June 2011

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