Impact of a retrotrigonal layer backup stitch on post- prostatectomy incontinence

Purpose: To evaluate the impact of a retrotrigonal layer backup stitch (RTBS) during robot-assisted laparoscopic radical prostatectomy (RALP) on post-prostatectomy incontinence. Materials and Methods: We compared the difference in continence recovery between 94 patients (group 1, as historical controls) and 57 patients (group 2). The only technical difference between our two groups was the incorporation of the retrotrigonal layer into the posterior aspect of the vesicourethral anastomosis (group 1: without RTBS; group 2: with RTBS). Postoperative continence recovery was defined as the use of no absorbent pads. Results: In group 1, the continence rate at 3, 6, and 12 months postoperatively was 40.4%, 70.2%, and 90.4%, respectively; in group 2, the continence rate was 42.1%, 70.1%, and 89.7%, respectively. The median (95% confidence interval) time to continence recovery was four months (range, 1 to 12 months) in group 1 and four months (range, 1 to 9 months) in group 2. Kaplan-Meier curves showed no significant difference in the recovery of continence between the two groups (log rank test, p=0.629). Conclusions: A RTBS does not appear to improve urinary incontinence after RALP. Further anatomical study and prospective randomized studies will be needed to confirm this.