Preservation of Lateral Prostatic Fascia is Associated with Urine Continence after Robotic-Assisted Prostatectomy

Background: Among several clinical factors, nerve or prostatic fascia preservation is associated with an improved continence outcome in several studies. Objective: We study the clinical aspects associated with urine continence after prostatectomy, paying special attention to the extent and location of fascia preservation. Design, setting, and participants: European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life - Core 30 (QLQ-C30) and Prostate Cancer Module (PR25) questionnaires were used to evaluate quality-of-life (QoL) parameters prior to and at 6 and 12 mo after surgery for 151 men treated with robot-assisted laparoscopic prostatectomy (RALP) for localised prostate cancer. Fascia preservation was scored at 12 locations around the circumference of the prostate. Any involuntary urine loss showed a strong correlation with several domains of the EORTC QLQ-C30 and was therefore chosen as the definition of urine incontinence. Intervention: Robot-assisted laparoscopic prostatectomy (RALP). Measurements: Any urine incontinence. Results and limitations: Of the preoperative and intraoperative characteristics, a low fascia preservation (FP) score and a higher score for preoperative voiding complaints (EORTC QLQ-P25 domain 1) were associated with an increased risk of urine incontinence and pad use at 6 and 12 mo postoperatively. In the multivariate binary logistic regression analysis, the extent of fascia preservation at the lateral aspects of the prostate as assessed by the FP score was the best predictor of urine continence at 6 and 12 mo postoperatively. The odds ratio for urine incontinence in men with preservation of the lateral prostatic fascia was 0,378 (95% Cl, 0.121-0.624) and 0.289 (95% CL 0.201-0.524) for preservation at the right and left aspects, respectively. This is a retrospective analysis not containing pad-test data. Conclusions: Fascia preservation at the lateral aspect of the prostate was the best predictor of urine continence after RALP. These data suggest that preservation of fascial support lateral rather than dorsolateral to the urethra and prostate may protect neurovascular Structures important to improving postprostatectomy urine continence. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.