THE COMPLETE SAVING OF STRIATED SPHINCTER DURING RADICAL PROSTATECTOMY IDENTIFYING VERUMONTANUM

Gerardo Pizzirusso1, Federico Lanzi1, Nicola Tosi1, Filippo Gentile1, Federica Scipioni1, Aude Canale1, Filippo Cecconi1, Giovanni De Rubertis1, Gabriele Barbanti1
  • 1 AOU Senese - U.O.C. di Urologia (Siena)

Objective

Verumontanum can be considered an anatomical landmark in saving the maximal length of urethra and, consequently, the maximum of striated sphincter . Either by retrograde and antegrade approach to the radical prostatectomy it is fundamental an anatomical preparation of urethral sphincter with an excellent visualization of the apex. After that urethra can be resected with the maximum respect of anatomical boundaries of urethral sphincter and minimizing the risk of leaving prostatic tissue in situ. The aim of our study is to investigate functionally and oncologically the role of verumontanum as a landmark for the complete saving of striated sphincter in patients undergone radical prostatectomy.

Methods and results

From January 2008 to December 2012 we prospectively collected the data of 159 patients undergone radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. We determined two cohorts: Group A (77 patients) undergone RRP without the saving of verumontanum, and Group B (82 patients) undergone RRP with the saving of verumontanum. Both, Group A and B, were homogeneous in terms of preoperative PSA, pathological staging and pathological Gleason Score. Continence was evaluated with ICIQ-SF questionnaire at month 1, 3, 6 and 12. Mean follow-up was (range) 23,7 (13-57) months for Group A and 22.4 (13-59) months for GroupB. In 6/77 (7,8%) cases of Group A and in 8/82 (9.7%) of Group B it was found a positive apical surgical margin (p=0.3219): of these patients, 3 in Group A and 4 in Group B developed biochemical recurrence (p=0.4877). Overall, 94.3% of Group A and 95.3% of Group B patients completely fulfilled our continence criteria (no pads and ICIQ-SF≤2) at a minimum follow-up of 12 months; continence was obtained within the first month in 55 (76%) patients of Group A Vs 60 (78%) of Group B, 58 (80,5%) Vs 68 (87.5%) within the third month, 65 (90,3%) Vs 72 (92%) within the sixth month and in 72 (94,3%) Vs 78 (95.3%) respectively. The saving of verumontanum didn’t result significant in overall continence (p=0.09) but resulted influential in early recovery of continence (p<0.0001).

Discussion

Either by retrograde and antegrade approach to the radical prostatectomy it is fundamental an anatomical preparation of urethral sphincter with a limitation due to the profile of prostatic apex. An anatomical intraoperative landmark in saving the maximum of striated sphincter may be represented by verumontanum. In our experience, radical retropubic prostatectomy with the saving of verumontanum determined an early continence recovery without increasing the risk of leaving prostatic tissue in situ. The limit of this study is represented by the small number of both groups and the exiguity of events; our pilot study underlines the need of large, randomized trials to define the role of verumontanum in overall and early continence recovery

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