Table 1. A summary of high-impact studies, randomized controlled studies, systematic reviews, and meta-analyses regarding intraoperative surgical techniques on continence recovery in RARP.
| Techniques | Studies | Articles | Patients | Definition | Early continence | Late continence | Complication |
|---|---|---|---|---|---|---|---|
| Bladder-neck sparing (BNS) | Ma et al. (28) 2016, ORP, LARP, RARP | 2 RCT; 6 pro-; 5 retro- | 1,130 with BNS, 1,154 w/o | No pad | 6 mo, OR 1.66, P=0.001 | >12 mo, OR 3.99, P=0.0002 | Baldder-neck stricture less likely OR 0.49, P=0.006 |
| Retzius-sparing (RS) | Checcuci et al. (29) 2019 RARP | 3 RCT;2 pro-; 5 retro- | 220 with RS; 231 w/o | No pad | 1 mo, OR 2.54, P=0.002; 3 mo, OR 3.86, P<0.001; 6 mo, OR 3.61, P=0.001 | 12 mo, OR 7.29, P=0.004 | No difference |
| Dirie et al. (30) 2019 RARP | 1 RCT; 2 pro-; 3 retro-; 3 case | 751 with RS; 250 w/o | No pad or safety | 1 mo, 61% vs. 43%, OR 3.53, P=0.004 | No difference | ||
| High nerve release | Srivastava et al. (31) 2013 RARP | Pro- | 277 w NSG1; 805 w NSG2; 289 w NSG3; 46 w NSG4 | No pad | 3 mo, 71% w NSG1; 54% NSG2, 45% NSG3, 43% NSG4 (P<0.001) | On multivariate analysis; NSG, independent predictor | No difference in PSM and complication |
| Preserving maximal urethral length (PMUL) | Hamada et al. (32) 2014 RARP | Pro- | 30 with TR and PMUL; 30Wpmul; 30 w TR | No pad | 1 mo, 70% and 50% w PMUL vs. 10% w/o; 3 mo, 96% and 90% vs. 23%; 6 mo, 100% and 100% vs. 53% | No difference in PSM and complication | |
| Dorsal venous complex (DVC) ligation | Lei et al. (33) 2011 RARP | Retro- | 240 w DVC-SSL; 303 w SL-DVC | 5 mo, 61% w DVC-SSL vs. 39% w SL-DVC (P<0.001) | 12 mo, similar (69% vs. 74%) | Shorter Op. time (137 vs. 147 min); greater EBL (184 vs. 175 mL) | |
| Posterior reconstruction (PR) | Grasso et al. (34) 2016 ORP, LARP RARP |
3 RCT; 5 pro-; 13 retro- | 2,080 with PR; 1,520 w/o | No pad | For RARP; 1 wk, RR 1.75; 1 mo, RR 1.60; 3 mo, RR 1.21; 6 mo, RR 1.12 | No difference | |
| Anterior reconstruction (AR) | Patel et al. (35) RARP | Pro- | 237 with AR; 94 w/o | No pad | 3 mo, 92.8% w AR vs. 83% w/o, P=0.013 | Median time recovery 6 vs. 7 wk, P=0.02 | No difference |
| Total reconstruction (TR) | Koliakos et al. (36) 2010 RARP | RCT | 23 with TR; 24 w/o | No pad | 0day, 39% w TR vs. 12.5% w/o, P=0.036; 7 wk, 65% vs. 33%, P=0.029 | The mean pad use: 2.25 vs. 1.43, P=0.032 | No difference |
| Hurtes et al. (37) 2012 RARP | RCT, multi-center | 34 with TR; 28 w/o | No pad | 1 mo, 26.5% w TR vs. 7.1% w/o, P=0.047; 3 mo, 45.2% vs. 15.4%, P=0.016 | No difference in PSM and complication | ||
| Suprapubic tube (SP) | Li et al. (38) 2019 RARP | 3 RCT; 3 pro-; 4 retro- | 492 with SP; 756 w/o | similar rates; no difference; only difference in penile pain 39% w SP, 62% w/o | No difference in overall pain, bacteriuria, stricture, retention |
ORP, open radical prostatectomy; LARP, laparoscopy-assisted radical prostatectomy; RARP, robot-assisted radical prostatectomy; RCT, randomized controlled trial; pro-, prospective study; retro-, retrospective study; PSM, positive surgical margin; NSG, nerve-sparing grade; DVC-SSL, athermal dorsal vein complex division followed by selective suture ligation prior to RARP anastomosis; SL-DVC, suture ligation prior to athermal DVC division prior to bladder-neck dissection; EBL, estimated blood loss.