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Tewari AK, Ali A, Ghareeb G, Ludwig W, Metgud S, Theckumparampil N, Takenaka A, Chugtai B, Shrivastava A, Kaplan SA, Leung R, Paryani R, Grushow S, Durand M, Peyser A, Chopra S, Harneja N, Lee RK, Herman M, Robinson B, Shevchuck MM. Improving Time to Continence After Robot-Assisted Laparoscopic Prostatectomy: Augmentation of the Total Anatomic Reconstruction Technique by Adding Dynamic Detrusor Cuff Trigonoplasty and Suprapubic Tube Placement. J Endourol 2012; 26:1546-52. [DOI: 10.1089/end.2012.0544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashutosh K. Tewari
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Adnan Ali
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - George Ghareeb
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Wesley Ludwig
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Sheela Metgud
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Nithin Theckumparampil
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Atsushi Takenaka
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Bilal Chugtai
- Department of Urology, Weill Cornell Medical College of Cornell University, New York, New York
| | - Abhishek Shrivastava
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Steve A. Kaplan
- Department of Urology, Weill Cornell Medical College of Cornell University, New York, New York
| | - Robert Leung
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | | | - Siobhan Grushow
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Matthieu Durand
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Alexandra Peyser
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Sameer Chopra
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Niyati Harneja
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Richard K. Lee
- Department of Urology, Weill Cornell Medical College of Cornell University, New York, New York
| | - Michael Herman
- Department of Urology, Center for Prostate Cancer Research and Clinical Care (CPCR&CC), Weill Cornell Medical College of Cornell University, New York, New York
| | - Brian Robinson
- Department of Pathology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Maria M. Shevchuck
- Department of Pathology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Tan G, Srivastava A, Grover S, Peters D, Dorsey P, Scott A, Jhaveri J, Tilki D, Te A, Tewari A. Optimizing Vesicourethral Anastomosis Healing After Robot-Assisted Laparoscopic Radical Prostatectomy: Lessons Learned from Three Techniques in 1900 Patients. J Endourol 2010; 24:1975-83. [DOI: 10.1089/end.2009.0630] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gerald Tan
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Abhishek Srivastava
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Sonal Grover
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - David Peters
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Philip Dorsey
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Ann Scott
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Jay Jhaveri
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Derya Tilki
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Alexis Te
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
| | - Ashutosh Tewari
- LeFrak Center of Robotic Surgery and Institute of Prostate Cancer, James Buchanan Brady Foundation Department of Urology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York
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Nguyen L, Jhaveri J, Tewari A. Surgical technique to overcome anatomical shortcoming: balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging. J Urol 2008; 179:1907-11. [PMID: 18353395 DOI: 10.1016/j.juro.2008.01.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Indexed: 12/22/2022]
Abstract
PURPOSE Shorter urethral sphincter length on preoperative endorectal magnetic resonance imaging has been associated with an increased risk of postoperative urinary incontinence as well as longer time to achieve continence. We determined that our techniques of anatomical reconstruction for restoring the continence mechanism could markedly improve continence outcomes, especially in patients with a shorter urethral sphincter. MATERIALS AND METHODS Our cohort consisted of 274 patients who underwent robotic radical prostatectomy, as performed by a single surgeon, and for whom preoperative magnetic resonance imaging and postoperative evaluations were available. All sphincter lengths were measured on T2-weighted images as the distance from the prostatic apex to the penile bulb, cross-referencing all 3 planes. Continence was defined as zero pads or a liner used for security reasons only. RESULTS The 2 surgical modifications considerably hastened the return of continence at 6 months. The continence rate in the shorter sphincter group (less than 14 mm) was 47% for the control technique, 81% for anterior reconstruction and 90% for total reconstruction. The continence rate in the longer sphincter group (more than 14 mm) was 80% for the control technique and 83% for anterior reconstruction, while it approached 99% for total reconstruction. With the control technique the average time to achieve continence was significantly different between the shorter and longer sphincter groups (25 vs 12 weeks, p = 0.037). The significance disappeared for anterior reconstruction (7.4 vs 6.2 weeks, p = 0.27) and total reconstruction (3.6 vs 2.7 weeks, p = 0.13). CONCLUSIONS The results of this study are encouraging for patients with a short urethral sphincter who are considering radical prostatectomy.
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Affiliation(s)
- Lang Nguyen
- New York-Presbyterian Hospital, Weill Cornell's Institute of Prostate Cancer and Robotic Surgery, New York, New York, USA
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