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Innovative Procedure Helps Men Minimize Incontinence After Prostatectomy

n strong and supported to maintain urinary continence."

Numerous attempts have been made to modify prostatectomy and preserve continence, but none have proven ideal. Trying to find a better way, Drs. Tewari and Vaughan reviewed 3-D videos that detailed the urological anatomy of patients who had retained full continence after prostatectomy. "We were trying to figure out what went right in those cases," Dr. Vaughan says.

Armed with those insights, they devised the new technique, modeling it first in cadaver tissues. They then tested the new procedure in 50 consecutive patients scheduled to undergo robot-guided prostatectomy for the treatment of localized prostate cancer.

The procedure added just two to five minutes to the standard prostate-removing operation.

"Our technique uses tissues that would normally remain behind after prostatectomy tissues that we can flip around and support to our advantage," Dr. Tewari explains. "We reconstruct the anterior and posterior parts of the sphincter and surgically join the bladder and the anastomosis (the gap in tissues left by prostatectomy) with the surrounding structures. In doing so, we reconstruct the major anatomical players controlling urinary continence."

The post-surgical results were impressive. One week after patients first had their urinary catheters removed, 29 percent were already fully continent; by six weeks, that figure rose to 62 percent; by eight weeks, 88 percent of the men were fully continent; and by 16 weeks, 95 percent had achieved continence.

The researchers stressed that the men involved in the study had all been diagnosed with non-aggressive, localized cancers. "With more aggressive tumors, surgeons must often excise the tissues that we need for reconstruction, so the technique is not useful in those cases," Dr. Vaughan says.

"But those cases are relatively uncommon, so most patients who undergo prostatecto
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