This study demonstrates the use of retrograde perfusion sphincterometry to measure retrograde leak point pressure during robot-assisted laparoscopic radical prostatectomy before establishment of pneumoperitoneum, after insufflation, and before and after the use of an autologous suburethral sling using vas deferens, after the anastomosis was completed. The adjustment of the sling to achieve optimal suburethral support was achieved by measuring the retrograde leak point pressure intraoperatively using retrograde perfusion sphincterometry. Although this study does demonstrate the use of a simple technique to study the RLPP during robot-assisted laparoscopic radical prostatectomy, data to confirm that the sling helps with early urinary continence are lacking.
The lack of validated questionnaires and a control group significantly limits any conclusion regarding the efficacy of the sling. Two previous randomized trials (references 20 and 21 in the article by Cestari et al.) failed to show any significant benefit to suburethral slings but there was no means to intraoperatively measure the extent of support at the bladder neck/urethra.
Future studies using retrograde perfusion sphincterometry with slings and other techniques to improve post-robot-assisted laparoscopic radical prostatectomy continence may confirm the validity of retrograde perfusion sphincterometry and the efficacy of surgical techniques to improve continence.
