INTRODUCTION We present our experience with a novel three-layer two-step posterior reconstruction (PR) technique using peritoneum during robot-assisted radical prostatectomy (RARP) to improve recovery of postoperative urinary continence. METHODS Forty-eight patients with localized prostate cancer were enrolled in this study and were divided randomly into two groups, which were treated by the standard PR technique (standard PR group; n = 24) or the three-layer PR technique using peritoneum (three-layer PR group; n = 24) during RARP. We prospectively analyzed the continence rate by the 1-hour pad test. All patients underwent urethrocystography at 6 days postoperatively to evaluate position of vesicourethral junction. Pelvic MRI was also performed at 6 months postoperatively for anatomical evaluation. RESULTS Four weeks after RARP, the urinary continence rate was significantly higher in the three-layer PR group (57%) than in the standard PR group (26%, p = 0.036). Urethrocystography demonstrated that the postoperative craniocaudal distance from the symphysis pubis to the level of the vesicourethral junction was significantly shorter in the three-layer PR group than in the standard PR group (p < 0.01), suggesting that there was less tension on the vesicourethral anastomosis after three-layer PR. MRI confirmed that three-layer PR provided firmer reinforcement of the structures, supporting the posterior aspect of the urethral sphincter complex. CONCLUSIONS This prospective comparative study might suggest that three-layer two-step PR using peritoneum during RARP is a simple and feasible method seeming to improve early recovery of postoperative continence compared with standard two-step PR, although larger multicenter randomized controlled trials will be needed.

中文翻译：

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在机器人辅助的前列腺根治术中使用腹膜进行三层两步后路重建，以改善尿失禁的恢复：一项前瞻性比较研究。

简介我们介绍了在机器人辅助根治性前列腺切除术（RARP）期间使用腹膜的新型三层两步后路重建（PR）技术的经验，以提高术后尿失禁的恢复。方法纳入本研究的48例局限性前列腺癌患者，随机分为两组，分别采用标准PR技术（标准PR组； n = 24）或采用腹膜三层PR技术（3例）进行治疗。层PR组； n = 24）。我们通过1小时的便笺本测试前瞻性分析了尿失禁率。所有患者均在术后6天接受了膀胱镜检查以评估膀胱尿道交界处的位置。术后6个月还进行了骨盆MRI检查，以进行解剖学评估。结果RARP四个星期后，三层PR组的尿失禁率（57％）明显高于标准PR组（26％，p = 0.036）。尿道膀胱造影显示，三层PR组从耻骨联合到膀胱尿道交界处的颅后尾距离明显短于标准PR组（p <0.01），表明膀胱尿道吻合口张力较小经过三层PR。MRI证实三层PR提供了更牢固的结构增强，支持了尿道括约肌复合体的后部。