In patients with large prostates and narrow and deep anatomy of the pelvis, the puboprostatic
ligaments were cut.
(32) reported the continence rates of the 1st, 3rd, and 6th months as 53%, 73%, and 100%, respectively, in the technique in which the puboprostatic ligament was protected.
Because we believed that the preservation of the puboprostatic ligament was one of the important parameters contributing to early continence, we protected the puboprostatic ligament in all patients in whom we performed fascia-preserving intrafascial prostatectomy.
The Endo-GIA blade (EndoGia Universal, Tyco Healthcare, and ETS Flex Endoscopic Articulating Linear Cutter, Ethicon Inc.) was used to divide the posterior and lateral bladder pedicles to the level of the puboprostatic
ligaments and the lateral prostatic pedicles, after the dissection of the endopelvic fascia.
We report the functional (urinary continence) outcome of the puboprostatic
ligament sparing technique among a group of Ugandan men with clinically localized prostate cancer.
(1) Additionally, the small prostate and rudimentary puboprostatic
ligaments (2) can be easily torn with trauma allowing lifting up of the prostate and longer gap between both urethral ends.
(1) Because the posterior urethra is fixed at both the urogenital diaphragm and the puboprostatic
ligaments, the bulbomembranous junction is more vulnerable to injury during pelvic fracture.
These include perioperative factors, such as age and prostate volume, (5) and certain anatomic or surgical factors important in continence preservation (injury to the arterial supply and preservation of urethral support mechanisms, including the endopelvic fascia and puboprostatic
This technique spares the puboprostatic
ligaments, which preserves the anterior support of the urethra and therefore contributes to continence [8,15,16].
ligaments (PPL) anchor the prostate to the pubis and must be manipulated to successfully remove a cancerous prostate gland.
To reduce the possibility that other surgical factors may influence our results, all RRPs were performed at the same institution by only 2 surgeons for both groups, using a similar surgical procedure (i.e., no bladder neck conservation, section of puboprostatic
ligaments, same lymph node dissection).
Incontinence rates were 1.3 % with bilateral nerve-sparing surgery (BNS), 3.4% with unilateral nerve-sparing surgery (UNS) and 13.7% with non-nerve-sparing surgery.[sup.42] Bladder neck preservation reduced incontinence rates at 12 months to 10.6% from 13.7% for bladder neck resection,[sup.43] and when both bladder neck-sparing and puboprostatic
ligament-sparing techniques were employed, the incontinence rate at 12 months was 6% compared to 8% for either technique alone.[sup.30] Incontinence rates at 12 months were lower for laparoscopic surgery compared to open RRP, with rates of 11.0 % versus 22.3% for diurnal incontinence and 4.0% versus 10.0% for nocturnal incontinence.[sup.44]