Effect of Pubovesical Complex Reconstruction During Robot-Assisted Laparoscopic Prostatectomy on the Recovery of Urinary Continence

Abstract

OBJECTIVE: To assess whether pubovesical complex (PVC) reconstruction (termed Kim's stitch) improves urinary continence following robot-assisted laparoscopic prostatectomy (RALP). PATIENTS AND METHODS: The cohort consisted of 130 consecutive patients who underwent RALP in a tertiary-care hospital between July 2012 and June 2013. The first 70 patients did not undergo PVC reconstruction with Kim's stitch and formed the control group. The subsequent 60 patients underwent Kim's stitch and formed the intervention (Kim's stitch) group. The primary outcome measure was degree of urinary continence assessed 1, 3, and 6 months after surgery using the Expanded Prostate Cancer Index Composite Questionnaire. Continence was compared between the two groups using propensity scores and inverse-probability weighting to adjust for treatment selection bias. To evaluate adverse treatment effects, all patients underwent uroflowmetry before and 1 month after surgery. RESULTS: The prevalence of continence at 1, 3, and 6 months was 23.9%, 57.7%, and 77.6%, respectively, in the control group and 25.9%, 60.0%, and 89.7%, respectively, in the Kim's stitch group. After adjustment, the 6-month continence was different between the two groups (odds ratio = 2.25; 95% confidence interval, 0.91-5.55; P = .08). The 1- and 3-month continence rates and postoperative maximal urinary flow rate were similar between the two groups (Kim's stitch group, 21.5 ± 9.5; control group, 22.1 ± 8.6; P = .72). CONCLUSIONS: A PVC reconstruction (Kim's stitch) with posterior reconstruction during RALP has a beneficial effect on continence recovery without producing additional adverse effects.