Intra-Operative Damage to the Pelvic Diaphragm Musculature and Difficulty in Exposure of the Urethra Are Risk Factors of Postoperative Urinary Incontinence after Laparoscopic Radical Prostatectomy: Review of Surgical Video

Purpose: The aim of this study was to clarify risk factors related to postoperative urinary incontinence after laparoscopic radical prostatectomy (LRP). Patients and Methods: Outcomes of 214 consecutive patients who underwent LRP at our institute between April 2001 and January 2009 were reviewed. Patients were divided into 2 groups, continent patients (group A: n = 172), who used one or fewer urinary pads per day 6 months after LRP, and incontinent patients (group B: n = 42), who used two or more pads per day 6 months after LRP. Patient age, prostate specific antigen before LRP, blood loss, duration of indwelling urethral catheter, and the positive margin rate between the 2 groups were compared. In addition, surgical videos were reviewed with attention paid to surgical procedures. We examined the correlation between the occurrence of urinary incontinence and the rate of patients with intra-operative damage to the pelvic diaphragm musculature and difficulty in exposure of the urethra during LRP. Results: There were no significant differences in patient age, prostate specific antigen before LRP, blood loss, duration of indwelling urethral catheter, positive margin rate between groups A and B. However, significant differences were found in the rate of patients with damage to the pelvic diaphragm musculature (16.3 and 73.8%, respectively) and difficulty in exposure of the urethra (20.9 and 83.3%, respectively) during LRP. Conclusions: Intra-operative damage to the pelvic diaphragm musculature and difficulty in exposure of the urethra during LRP are risk factors of urinary incontinence after LRP.