Effect of a modified technique of posterior reconstruction by iliopectineal ligament suspension during robot-assisted laparoscopic radical prostatectomy on early continence: a randomized controlled trial.

OBJECTIVES: To evaluate the effect of a modified technique of posterior reconstruction by iliopectineal ligament suspension during robot-assisted radical prostatectomy (RARP) on recovery of early continence.

METHODS: A prospective, single surgeon, single center, randomized controlled trial was performed from August 2018 to March 2020 with 171 patients (92 control vs. 79 experimental). The posterior reconstruction was done using a standard technique in the control group and was modified for the experimental group by incorporating not only the "Rocco" stitch between Denonvilliers' fascia and the rhabdosphincter but also the iliopectineal ligaments bilaterally to further improve posterior support with this suspensory 'hammock'. Both groups of patients were followed for a year with questionnaires and 24-hour pad tests.

RESULTS: Both groups were comparable in terms of baseline demographic, clinical and pathological characteristics. With regards to recovery of urinary continence, no statistically significant differences were found for socially continent (0-1 pads per day) or fully continent (0 pads per day) rates at all time points examined (1, 3, 6, 12 months). Moreover, there was no statistically significant differences between the groups for presence of urinary symptoms, bowel symptoms, sexual function, and hormonal symptoms.

CONCLUSIONS: The modified technique of posterior reconstruction by iliopectineal ligament suspension is not associated with improved early continence as compared to the standard posterior reconstruction technique during RARP. Future studies may want to explore other variations of suspensory sutures that could strengthen posterior urethral support to achieve earlier recovery of continence.