robot - assisted laparoscopic radical prostatectomy ( ralrp ) has been found to result in urinary continence rates as high as 97% at 12 months . with a 3-dimensional view , magnification and more freedom of movement result in precise application of surgical techniques and
avoid excessive dissection or damage to crucial tissues that may contribute to urinary continence . to achieve maximum continence in a minimum of postsurgical time , various methods have been described .
one of the most widely used techniques is posterior reconstruction with the rocco stitch , which has been shown to improve both short- and long - term continence rates .
anterior reconstruction techniques , total anatomic restoration , and fascia preservation techniques have been published , and all are thought to improve continence rates . with the description of many methods for anatomic reconstruction to provide good continence results , the early return of continence is a goal in ralrp . in this study we sought to compare the early incontinence outcomes of our patients , whom we treated with ralrp using no reconstruction , posterior reconstruction only , or total anatomic restoration combined with posterior reconstruction techniques .
we retrospectively analyzed the patients who underwent ralrp for localized prostate cancer performed by a single surgeon ( v.t . ) in our clinic between january 1 , 2009february 1 , 2016 .
of those patients , we included only those without positive surgical margins or biochemical recurrence .
the surgeries in all patients were performed with the da vinci si or xi surgical systems ( intuitive surgical inc . ,
our first cases were generally either the standard approach or posterior reconstruction . with improved experience
patients with neurogenic bladder or a history of incontinence or urethral or pelvic interventions were excluded from the study .
posterior reconstruction was achieved , as previously defined by using the rocco stitch ( a 30 v - loc suture ; covidien , minneapolis , minnesota , usa ) .
after the operation , the drains were removed , and the patients were discharged on postoperative day 2 , unless their drain output was higher than 100 ml/24 hours .
all patients were interviewed by the same physician 1 week and 1 , 3 , 6 , and 12 months after the surgery .
continence was defined as no leakage or use of a safety pad for minimal leakage .
the main outcome measure was continence at postoperative week 1 and at months 1 , 6 , and 12 .
all groups were compared by 1-way anova or the kruskal - wallis test for continuous variables , and the  or fisher 's exact test for categorical variables .
results were entered into an excel for mac 2011 database and analyzed with statistical package for social sciences ( spss ) 20 software for mac ( spss inc . ,
posterior reconstruction was achieved , as previously defined by using the rocco stitch ( a 30 v - loc suture ; covidien , minneapolis , minnesota , usa ) .
after the operation , the drains were removed , and the patients were discharged on postoperative day 2 , unless their drain output was higher than 100 ml/24 hours .
all patients were interviewed by the same physician 1 week and 1 , 3 , 6 , and 12 months after the surgery .
continence was defined as no leakage or use of a safety pad for minimal leakage .
the main outcome measure was continence at postoperative week 1 and at months 1 , 6 , and 12 .
all groups were compared by 1-way anova or the kruskal - wallis test for continuous variables , and the  or fisher 's exact test for categorical variables .
results were entered into an excel for mac 2011 database and analyzed with statistical package for social sciences ( spss ) 20 software for mac ( spss inc . ,
between the years of 2009 and 2016 , 234 patients underwent ralrp in our clinic for localized prostate disease that satisfied our criteria .
seventy - four patients underwent surgery with the standard approach , 88 had posterior reconstruction , and 77 had total anatomic restoration and posterior reconstruction .
patients who underwent ralrp with the standard approach were placed in group 1 , those who had the standard approach and posterior reconstruction with the rocco stitch were placed in group 2 , and those who underwent total anatomic restoration with posterior restoration were placed in group 3 .
mean patient age , body mass index ( bmi ) , prostate specific antigen ( psa ) , prostate volume , and international index of erectile function ( iief ) scores were similar among the groups ( table 1 ) .
preoperative demographics , operative statistics , and postoperative outcomes of patients statistically significant with a confidence interval of 95% . in group 1 ,
49 patients had a gleason score of 3 + 3 and 25 had 3 + 4 . in group 2 ,
59 patients were 3 + 3 , and 29 were 3 + 4 . in group 3 ,
operative time , however , was significantly longer in group 3 compared to other groups .
after 1 week , 24.3% of the patients in group 1 ( 18/74 ) , 31.8% in group 2 ( 28/88 ) , and 45.8% in group 3 ( 33/72 ) were continent ( p = .020 ) .
one month after the surgery , the continence rates for groups 1 , 2 , and 3 were 56.7 , 67 , and 75% , respectively ( p = .065 ) .
after 6 and 12 months , the continence rates for groups 1 , 2 , and 3 were 72.9 and 87.8% , 81.8 and 89.7% , and 84.7 and 91.6% , respectively ( p = .178 and .7484 ) .
prolonged paralytic ileus was managed conservatively in 4 patients , and fever and pain were managed with antipyretics and analgesic agents in 9 patients .
in the past decade , ralrp has been one of the most favored techniques used to treat prostate cancer .
the main reasons to decide on ralrp over other techniques are the lower rates of incontinence and impotence and good cancer control .
these 3 aspects have been called a  trifecta .  when lack of complications and positive surgical margins are added , and the term changes to a  pentafecta .
 one of the most important elements of both the trifecta and pentafecta is continence .
ralrp has been found to have excellent continence rates . in long - term follow - up ,
continence rates have been reported to be up to 96% at 12 months and up to 94.6% at 36 months after surgery . in our study ,
similar to the literature , we had a mean rate of continence of 87.8% in a standard ralrp group in 12 months .
with posterior reconstruction , the continence rates rose to 89.7% , and with total anatomic reconstruction , it improved to as high as 91.6% .
even though the standard van velthoven technique produced adequate results for long - term continence rates , for early and immediate continence , various methods have been proposed for posterior reconstruction .
one of the most widely used methods is the rocco stitch , described by rocco and colleagues in 2009 . even though their technique produces excellent continence rates at 3 months ( 92.8% ) , very early continence rates ( at 1 month following surgery )
coelho and colleagues compared their series of 473 ralrp cases with posterior reconstruction with 330 patients without reconstruction . at 90 days , they found 91.1% and 91.8% continence rates in reconstruction and nonreconstruction groups , respectively . in 7 days , however , the reconstruction group had significantly better continence rates ( 28.7% vs 22.7% ; p = .048 ) .
rocco and colleagues , in their comparative series , compared 120 patients who underwent ralrp with posterior reconstruction with 120 historic open retropubic radical prostatectomies .
they reported continence rates of 70% at 1 month , 93% at 6 months , and 97% at 12 months .
however , generally , anterior reconstruction was performed only with suturing the bladder to the puboprostatic ligaments or pubic bone .
menon and colleagues reported patients who underwent either standard or ralrp with anterior and posterior reconstruction techniques .
they reported an incontinence rate of 51% in the standard group and 54% in the ralrp group after 7 days .
tan and colleagues compared standard , anterior , and total reconstruction techniques and found that successful outcomes significantly favored total reconstruction it 1 , 6 , 12 , 26 , and 52 weeks after removal .
one week after catheter removal , groups 1 , 2 , and 3 had continence rates of 24.3 , 31.8 , and 45.8% , respectively , with total anatomic restoration being the most successful , as mentioned in the literature .
after 1 month , continence in the total anatomic restoration group improved to 75% , being the highest among groups .
groups 1 and 2 also had comparable continence rates ( 56.7% and 67% , both significant ) .
it is clear that anatomic restoration improves continence rates in the early period after ralrp .
the difference in continence rates at week 1 was statistically significant ( p ] lt ] .05 ) .
even though other parameters seemed higher in the total - restoration group , immediate continence after 1 week was significantly better .
urinary incontinence rates in studies comparing different approaches in ralrp pr , posterior reconstruction ; ar , anterior reconstruction ;
we recognize the following limitations in our study : first , we had a small number of cases .
the first operations were performed with the standard approach and , with increasing experience , total anatomic restoration was preferred .
further experience may cause better continence rates . also , the continence criteria were not strict .
we accepted minimal leakage as continent , and that definition may have improved our outcomes for all groups .
total anatomic restoration may have an important role in early return to continence ( especially immediately after catheter removal ) , even though the long - term rates in the 3 groups were similar .
although nearly all patients undergoing ralrp are continent in the long term , we believe total anatomic restoration is the most effective approach for early return to continence .
 background and objectives : robot - assisted laparoscopic radical prostatectomy ( ralrp ) is said to provide excellent long - term continence . in this study , we compared the early incontinence outcomes of our patients , who had undergone no reconstruction , posterior reconstruction only , or total anatomic restoration and posterior reconstruction.methods:we retrospectively analyzed the patients who underwent ralrp for localized prostate cancer by a single surgeon in our clinic from january 1 , 2009february 1 , 2016 . 
 continence was defined as no leakage or use of a safety pad for minimal leakage . 
 the main outcome measure was continence at postoperative week 1 and months 1 , 6 , and 12.results:between 2009 and 2016 , 239 patients underwent ralrp for localized prostate disease . 
 seventy - four patients underwent a standard approach ( group 1 ) , 88 had posterior reconstruction ( group 2 ) , and 77 had posterior reconstruction with total anatomic restoration ( group 3 ) . 
 after 1 week , 24.3% of the patients in group 1 ( 18/74 ) , 31.8% in group 2 ( 28/88 ) , and 45.8% in group 3 ( 33/72 ) were continent ( p = .02 ) . 
 one month after the surgery , continence rates for groups 1 , 2 , and 3 were 56.7 , 67 , and 75% , respectively ( 0.065 ) . 
 after 6 and 12 months , continence rates for groups 1 , 2 , and 3 were 72.9 and 87.8% , 81.8 and 89.7% , and 84.7 and 91.6% , respectively ( p = .178 and .7484).conclusion : anatomic restoration improves continence rates in the early period after ralrp . even though other parameters were higher in the total restoration group , immediate continence ( at 1 week ) was significantly better . 
INTRODUCTION
METHOD
Surgical Techniques
Statistical Analysis
RESULTS
DISCUSSION
CONCLUSION