Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter

Objectives: We believe early incontinence after radical retropubic prostatectomy (RRP) is mainly due to the shortening of the sphincter's anatomic and functional length as a result of caudal retraction of the urethral sphincteric complex and disruption of the posterior median fibrous raphe. We illustrate a technique of anatomic and functional reconstruction of the rhabdosphincter (RS) aimed at achieving early continence recovery after RRP. Our modification to the Walsh RRP avoids caudal retraction of the urethrosphincteric complex and reconstructs the posterior fibrous raphe. Methods: Prior to completion of the vesicourethral anastomosis, the posterior fibrous tissues of the sphincter are joined to the residual Denonvilliers fascia on the posterior bladder wall 1-2 cm cephalad and dorsally to the new bladder neck. The study end point was assessment of early and long-term continence rate. Modified RRP (group 1: 250 patients) was compared with unmodified RRP (historical group 2: 50 patients). A crude comparison of treatment effect was assessed by using Pearson chi-square. Multiple logistic regression was used to assess treatment efficacy at discharge, 1, 3, and 12 mo, while taking into account age, pathologic stage, and Gleason score. Continence was defined as 0-1 pad per day. Results: Patients in group 1 achieved significantly better continence at discharge (62.4% vs. 14.0%), 1 mo (74.0% vs. 30%), and 3 mo of follow-up (85.2% vs. 46%); long-term recovery was similar in the two treatment groups (94% vs. 90%). Conclusions: The technical modification that we proposed achieved a substantial and significant reduction in time to continence with no adverse effects.