Editing Robot-assisted Laparoscopic Prostatectomy (section)

== Factors affecting continence after robot-assisted radical prostatectomy ==

* Pre-operative factors[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807332/]
** Age
** Cancer characteristics
** Prostate size 
*** Generally, a smaller prostate is associated with fewer surgical complications but a higher likelihood of positive surgical margins.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656835/]
*** Larger prostate size associated with worse rates of urinary continence and recovery of sexual function[https://pubmed.ncbi.nlm.nih.gov/38290859/]
** Preoperative lower urinary tract symptoms
** Preoperative erectile dysfunction
** Preoperative membranous urethra length, measured by T2-weighted magnetic resonance images
** Presence of a median lobe
** Previous transurethral resection of the prostate
** Prostate cancer treatment
** Bony pelvic dimensions
** Cigarette smoking at the time of surgery
** Type 2 diabetes mellitus
* Operative[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807332/]
** Surgeon experience
** Surgical technique
*** Nerve-sparing
**** Meta-analysis published in 2014 of 27 studies found that patients who underwent nerve-sparing had improved urinary continence in the first 6 months after surgery. After this time, there was no difference in continence.[https://pubmed.ncbi.nlm.nih.gov/25454614/]
*** Bladder neck-sparing
*** Retzius-sparing
*** High nerve release technique
*** Preserving maximal urethral length
*** Dorsal venous complex ligation technique
*** Posterior reconstruction
**** Posterior reconstruction is the approximation and suturing of the posterior layer of the rhabdosphincter to the Denonvilliers’ fascia and to the posterior surface of the bladder before the vesico-urethral anastomosis is completed
**** Often known as the "Rocco" stitch since Rocco et al. presented for the first time a modification of the Walsh technique to maintain the early recovery of incontinence after open radical prostatectomy. Rocco et a. later adapted the technique to laparoscopy-assisted prostatectomy.
**** Aims (2):
***** Approximation of the urethral sphincter cranially by approximation of the Denonvilliers’ fascia to the posterior aspect of the rhabdosphincter and posterior median raphe
***** Reduces tension in the anastomosis and provides pelvic support to the bladder neck by fixation of the Denonvilliers’ fascia to the posterior wall of the bladder
***** Meta-analysis published in 2016 of 21 studies found that posterior reconstruction improved early continence recovery at 3-7, 30, and 90 days after catheter removal, while the continence rate at 180 days was statistically but not clinically affected. Statistically significantly lower anastomotic leakage rates were described after posterior reconstruction.[https://pubmed.ncbi.nlm.nih.gov/26991606/]