Dados do Trabalho

Título

- EARLY, POSTERIOR AND PRIORITY RELEASE OF THE URETHRA AND MINIMAL TRACTION APPROACH, COULD IMPROVE EARLY CONTINENCE IN ROBOTIC PROSTATECTOMY?

Introdução e Objetivo

Recent studies and guidelines point to a better result in early continence in surgeries with the “retzius sparing” technique. The objective of this study is to verify if it is possible to improve the results of early continence in robotic radical prostatectomy using the traditional anterograde approach when we perform a robotic prostatectomy with less traction and with early release of the urethra via the posterior approach. Thus avoiding injury to the muscle fibers of the urinary sphincter. And allowing for a longer, healthier urethra.  

Método

We selected 10 patients with low and intermediate risk prostate cancer and performed a robotic radical prostatectomy and performed an early access to the urethra in posterior approach, without traction in ultra-preserving robotic prostatectomy Da Vinci Xi system with 3 instruments. Bladder neck sparing release - opening of the detrusor apron to separate the vesico-prostatic adhesion and the anterior bladder neck. Dissection of the seminal vesicles - after opening the Denonvillier's fascia.Posterior release of the prostate - maximum release of the posterior prostatic fascia, with release of the neuro-vascular bands until we find the urethra. Early posterior access to the urethra and identification of the urethral-prostatic transition at its apex. Early section of the urethra to avoid urethral traction, in addition to allowing for a longer and more vascularized urethra. With excellent protection and security of the rectum. Bilateral nerve-sparing, using the lateral intrafascial technique. And subsequent ligation of the pedicles. Anterior apex is released, minimal bleeding and excellent visualization of the prostatic apex and the dorsal vein complex are observed.  The prostate is removed, separated, for subsequent bagging.A single absorbable suture is used to reapproximate the remnant Denonvillier's fascia, posterior detrusor and posterior rhabdosphincter prior to completion of the vesicourethral anastomosis.Proceeded with ventral reconstruction. Specimen extraction

Resultados

The patients presented early urinary continence up to 7 days after catheter removal, according to the validated questionnaires applied. Less bleeding. 5 days of catheter.  

Conclusão

Lower urethral traction, previously sectioned by posterior and anterograde approach: contributes to better functional results, less bleeding, shorter catheter time.It is necessary to study the technique in a well-designed study with a large number of cases.