Mount Sinai Study Shows Novel Surgical Technique For Prostate Cancer Improves Urinary Continence

Senior Author:  Ash Tewari, MBBS, MCh, Chair of the Department of Urology at the Mount Sinai Health System, Professor, Urology, Oncological Sciences, Icahn School of Medicine at Mount Sinai

First Author:  Vinayak G Wagaskar, MBBS, MCh, Clinical Fellow, Department of Urology Icahn School of Medicine at Mount Sinai

Bottom Line: This study described a novel surgical technique, the RARP “hood technique” which showed a reduction in postoperative urinary incontinence and facilitated a early return of continence in patients with localized prostate cancer.

What: In this study, the novel “hood technique” preserved tissue after prostate removal and has the appearance of a “hood” comprising the detrusor apron, arcus tendineus, puboprostatic ligament, anterior vessels, and some fibers of the detrusor muscle. This hood surrounds and safeguards the membranous urethra, external sphincter, and supportive structures.

Why Is the Study Important: Radical prostatectomy is the reference standard for the treatment of localized prostate cancer. This technique has been modified and refined over many years. Nevertheless, the procedure continues to have several common side effects, including urinary incontinence, which can significantly impact the quality of life for prostate cancer survivors and which is the focus of this study.

The hood technique for robotic-assisted prostatectomy described in this study represents a modification to the anterior approach similar to previously published techniques and also preserves the musculofascial structures anterior of the prostate.  This novel study shows that the hood technique confers three key benefits: early continence, a low positive surgical margin rate, and the ability to visualize anatomical landmarks.

Who: This is a study of 300 patients (median age 64 yr.) with localized prostate cancer treated with the RARP hood technique at a major urban hospital between April 2018 and March 2019. This study was conducted at the Mount Sinai Health System.

Conclusions:  Results indicate that the hood technique spares musculofascial structures anterior to the urethral sphincter complex with early return of continence after surgery, without compromising positive surgical margin rates. Exclusion of anterior tumor location contributed to a reduction in positive surgical margins.

Paper Title:  Hood Technique for Robotic Radical Prostatectomy—Preserving Periurethral Anatomical Structures in the Space of Retzius and Sparing the Pouch of Douglas, Enabling Early Return of Continence Without Compromising Surgical Margin Rates

Journal: European Urology

Review Article Link: https://www.sciencedirect.com/science/article/pii/S0302283820307715?via%3Dihub

Said Mount Sinai’s Dr. Ash Tewari:

“A common side effect that patients worry about following a radical prostatectomy is urinary incontinence. But this study shows that using a novel surgical technique, the RARP “hood technique” we can reduce postoperative urinary incontinence and facilitate early return of continence in patients with localized prostate cancer. In the study, patients also reported better preservation of anatomical structures around the urethra and were able to achieve early return of urinary continence without a negative impact on complications and cancer outcomes.”

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