Introduction
Pathophysiology of Urinary Incontinence Post RARP
Surgical Techniques to Optimize Urinary Continence
Techniques to Preserve the Continence Mechanism
Preservation of the Bladder Neck
Neurovascular Bundle Preservation
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The pudendal nerve, in its classical description, supplies the external striated rhabdosphincter after coursing caudal to the levator ani and away from the field of RARP. However, some authors have suggested the presence of an intrapelvic somatic supply to the rhabdosphincter, located 5.3 ± 1.8 mm [11] from the prostatic apex.
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The internal sphincter has been demonstrated to have dense autonomic nerve supply.
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The cavernosal nerves of the classical neurovascular bundle (NVB) have also been shown to directly innervate the membranous urethra.
Apical Dissection and Preservation of the External Sphincter
Preservation of Ancillary Anatomical Structures Supporting the External Sphincter
Membranous Urethral Length
Reconstructive Techniques to Improve UC Recovery
Posterior Reconstruction
Combined Anterior and Posterior Reconstruction
Vesico-Urethral Anastomosis
Miscellaneous Steps to Improve UC
Use of Regenerative Materials
Intraoperative use of Suburethral Slings
Conclusion
Surgical technique | Helps UC recovery | No effect | Maximum level of evidence |
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Bladder neck preservation | * | 1a | |
NVB preservation | * | 1b | |
Meticulous apical dissection | * | 2b | |
Sparing of external sphincter | * | 2b | |
Preservation of supporting structures | * | 2b | |
Maximal preservation of urethral length | * | 2b | |
Posterior reconstruction | * | 1a | |
Total anatomical reconstruction | * | 1b | |
Secure VU anastomosis | * | 3 | |
Regenerative materials | * | 2b | |
Autologous slings | * | 1b |