The Robotic-assisted laparoscopic prostatectomy (RALP) is today a rapidly expanding procedure around the world. Several studies have shown that RALP is feasible, with limited blood loss and favorable complication rates. However, the early urinary incontinence remains a great challenge and can significantly compromise the quality of life (QoL) of the patients. We present here our technical refinements to improve early continence during RALP.

We present in this video four technical refinements during RALP to improve early continence: periurethral suspension stitch; reconstruction of the posterior aspect of the rhabdosphincter; modified vesico-urethral anastomosis and bladder neck reconstruction. The continence outcomes with the use of each technical refinement are presented.

Suspension stitch - We analized 331 consecutive patients who underwent RALP were prospectively. Ninety four patients underwent RALP without the placement of suspension stitch and 237 patients underwent RALP with the suspension stitch. The suspension technique resulted in significantly greater continence rates at 3 months after RALP (p=0,013), although the rates at 6 and 12 months were not significantly affected. Posteriors reconstruction - We analized the continence outcomes in fifty patients who underwent posterior reconstruction during RALP. Our complete "early continence" rate (no pads) was of 58% at one week.

Our current experience with RALP is more than 2400 cases and we are continously refining our technique. With the modifications of the technique described, currently, more than half of our patients are pad free one week following removal of the catheter. The majority of the patients are dry by 4 weeks postoperatively.