Sub-sphincteric anastomosis (SSA) during laparoscopic robotic-assisted radical prostatectomy and its positive impact on continence recovery.

INTRODUCTION To assess the interest of a new sphincter preserving anastomosis technique for continence recovery after robot assisted laparoscopic Radical Prostatectomy (RALP). MATERIALS AND METHODS We performed a monocentric single operator study on 187 consecutive RALP. Patients were divided into two groups: Group 1 (standard anastomosis, until December 2017) and Group 2 (sub-sphincteric anastomosis (SSA), since January 2018). The SSA consisted in respecting the sphincteric sleeve during the anastomosis suturing only the internal layer of the urethra with the bladder and thereby avoiding the loss of sphincteric length induced by the suture. Pre, intra and postoperative data were prospectively collected and compared. Criteria of continence were: no pad use and complete absence of leakage at catheter removal at 1 month and 1 year. RESULTS The two groups were comparable in terms of PSA, gland volume and Gleason score. In group 2 (SSA), we observed a complete continence recovery in 75.6 % at catheter removal (p=0.0000035), in 82.9 % at 1 month (p=0.000092), and in 97.5% at 1 year (p=0.028), independently of bladder neck preservation (p=0.388). There was also a significant difference between the 2 groups concerning urinary reeducation requirement (p=0.0006), pad use and urinary quality of life (p=0.0000002). No anastomosis complication were reported. CONCLUSIONS The SSA significantly improved the rates of immediate, early and 1 year continence recovery after RALP. These results need further study among larger numbers of patients.