Puboprostatic Complex Preserving Dorsal Venous Complex ligation—The Miami Cancer Institute Technique

Objective:

Postoperative urinary incontinence remains a significant concern following robot-assisted radical prostatectomy (RARP), impacting long-term quality of life. This study evaluates the effectiveness of a novel puboprostatic ligament-preserving Dorsal Venous Complex (DVC) ligation with cystourethropexy—the “Miami Cancer Institute technique”—in improving early continence while ensuring oncologic safety.

Methods:

A retrospective analysis was conducted on 392 patients who underwent RARP at a high-volume tertiary cancer center from February 2018 to November 2023. All procedures were performed by the same experienced surgeon utilizing a uniform surgical protocol. The technique incorporated early, precise control of the DVC with preservation of the puboprostatic ligaments and external sphincteric support structures, followed by a tension-free cystourethropexy. Exclusion criteria included previous pelvic surgery, pre-existing incontinence, or prior pelvic radiation. The primary endpoint was continence recovery at 90 days. Secondary outcomes included operative variables and biochemical recurrence rates.

Results:

At 3 months postoperatively, 84.6% of patients achieved continence, defined as no pad or the use of a single security pad daily. The average operative duration was 162 minutes with a mean estimated blood loss of 82 mL. Biochemical recurrence occurred in 5.9% of patients within the first postoperative year and 13.8% during total follow-up. No patients required blood transfusion, and no clinically significant anastomotic leaks were reported.

Conclusion:

The Miami Cancer Institute technique is associated with improved early return of urinary continence and demonstrates satisfactory oncologic outcomes.

No commercial associations during the last 2 years that might create a conflict of interest in connection with the video.

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Runtime of video: 4 min 40 sec.