Bladder Neck Plication Stitch: A Novel Technique During Robot-Assisted Radical Prostatectomy to Improve Recovery of Urinary Continence

Background and Purpose: Efforts to improve postprostatectomy incontinence have led to many modifications in surgical technique. We present our experience with a novel technique to improve continence outcomes in patients who are undergoing robot-assisted radical prostatectomy (RARP). Patients and Methods: A consecutive series of 159 patients after initiation of a bladder neck plication stitch was compared with the most recent group before the change. After completion of the vesicourethral anastomosis, a single suture was used to plicate the distal bladder neck. A structured questionnaire was used for follow-up. Continence criteria used were 1 pad per day for social continence and 0 pad per day for total continence. Results: A total of 334 patients were included in the study: 159 in the plication stitch group vs 175 in the control group. Average age was 59.1 vs 59.6 years, average body mass index was 27.9 vs 28.3 kg/m2, and average prostate volume was 58.1 vs 60.9 cc, respectively. The mean time to reach social continence was 3.63±3.01 vs 5.33±4.89 weeks (P=0.004), and total continence was 5.10±3.80 vs 8.49±6.32 weeks (P=0.002), respectively. Chance of total continence improved with the bladder plication stitch: Odds ratio of 1.95±0.72 (P<0.001) at 1 month, 1.25±0.56 (P=0.113) at 3 months, and 2.07±0.66 (P=0.005) at 12 months. There were no bladder neck contractures or other urinary complications noted in either group. Conclusions: The bladder plication stitch is a simple and effective technical modification for shortening the period of recovery of urinary continence in RARP patients. Randomized controlled trials are under way to further evaluate this technique.