Does reconstruction of the vesicourethral junction result in improved continence after radical prostatectomy?

Abstract

This Practice Point discusses the paper by Tewari and colleagues, which reports the effects on postoperative continence of incremental modifications to the surgical technique for creating the vesicourethral anastomosis during robot-assisted laparoscopic radical prostatectomy. Compared with an initial control technique, use of a 'posterior support' improved postoperative continence, both in terms of time to continence and absolute rate, and outcomes were even better when an 'anterior support' was also used (>97% continence within 1 year). The authors conclude that their data support the use of these technical modifications. Notably, however, surgical outcomes improve with surgical experience, even if the causes of amelioration are not known. The temptation to associate technical modifications with improved outcomes is great, but it is often difficult to definitively assess the benefits of incremental modification by comparison of consecutive patient groups. To properly evaluate surgical technique, we have to be committed to evidence-based medicine and accept the need for patient randomization.