For men diagnosed with localized prostate cancer, deciding on a treatment plan can be challenging. The choice often comes down to finding a balance between effective cancer treatment and preserving quality of life. One of the biggest concerns I hear from my patients considering robotic-assisted radical prostatectomy (RARP) is the fear of post-surgery incontinence. The thought of needing pads or diapers is a significant worry for men who want to return to their everyday lives with confidence, whether it’s attending a granddaughter’s softball game or enjoying a round of golf with friends.
With recent advances in surgical techniques, there is new hope for improved outcomes. I’m excited about an innovative approach known as the anterior pelvic floor-sparing technique, which I’ve adopted for certain patients undergoing RARP. This technique has been shown to significantly improve functional outcomes, especially in terms of an early return to continence, while effectively treating prostate cancer.
In traditional radical prostatectomy, removing the prostate often involves detaching some of the surrounding structures, including those near the pelvic floor. While this allows for complete removal of the cancerous tissue, it can sometimes impact the pelvic anatomy that controls continence, leading to urinary leakage. The anterior pelvic floor-sparing technique, however, aims to preserve this pelvic floor anatomy more carefully, helping to maintain the support structures around the bladder.
One of the primary goals when this technique was developed in Europe about three years ago was to address the critical need for better post-surgery continence. Numerous studies have shown that men who regain urinary control more quickly after surgery experience a higher quality of life and greater satisfaction with their treatment (American Urological Association Guidelines).
The original study published in European Urology found that patients who underwent the pelvic floor-sparing technique had a significantly faster return to continence compared to those who had traditional methods of RARP (Wagaskar et al., 2021). In this study, 85% of men achieved full continence within three months of surgery. By six months, over 95% of patients were pad-free, demonstrating a major improvement over traditional approaches, where only 60-70% of patients typically reach continence by that time. These results highlight the technique’s effectiveness in speeding up recovery and enhancing quality of life for prostate cancer patients.
When considering any surgical approach, the first question is always: Does it effectively treat the cancer? In the case of the anterior pelvic floor-sparing technique, the answer is yes. Multiple studies have shown that the oncologic outcomes—meaning the cancer removal success rates—are just as high as with the traditional approach. This was even borne out in the original study (Wagaskar et al., 2021).
If you’re a man recently diagnosed with localized prostate cancer, this technique could offer peace of mind that you can have your cancer treated effectively without a prolonged struggle with incontinence. I obtain an MRI after diagnosis to confirm there are no suspicious tumors on the anterior portion of the prostate, where this sparing plane is located, to determine a patient’s candidacy for this technique. While there are still risks—including incontinence that may require future surgery—the pelvic floor-sparing approach can significantly improve your chances of recovering continence sooner. This means that you may be able to enjoy your regular activities with more confidence and fewer lifestyle adjustments.
If you or someone you know has been recently diagnosed with prostate cancer, feel free to reach out to Nebraska Urology for more information. We are passionate about providing exceptional cancer care. With extensive experience and over 400 robotic cancer surgeries performed each year, our team is dedicated to delivering the best possible outcomes. From diagnosis to recovery and beyond, we’re here to guide and support you every step of the way.
American Urological Association. “Incontinence After Prostate Treatment Guidelines.” AUA Guidelines
Wagaskar, V.G., et al. (2021). “Hood Technique for Robotic Radical Prostatectomy—Preserving Periurethral Anatomical Structures in the Space of Retzius and Sparing the Pouch of Douglas, Enabling Early Return of Continence Without Compromising Surgical Margin Rates.” European Urology.
AuthorDr. AJ Pomajzl