Short Communication Novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy: Description and comparative outcomes Chang Wook Jeong, 1 Jong Jin Oh, 1 Seong Jin Jeong, 1 Sung Kyu Hong, 1 Seok-Soo Byun, 1 Gheeyoung Choe 2 and Sang Eun Lee 1 1 Department of Urology, Seoul National University Bundang Hospital, Seongnam, and 2 Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea Abbreviations & Acronyms ADA = anterior detrusor apron DF = Denonvilliers’ fascia EPIC = expanded prostate cancer index composite MDFR = median dorsal fibrous raphe PDA = posterior counterpart of the detrusor apron PR = posterior reconstruction RALP = robot-assisted laparoscopic prostatectomy Correspondence: Sang Eun Lee M.D., Ph.D., Department of Urology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi-do, Korea. Email: selee@snubh.org Received 18 October 2011; accepted 7 February 2012. Abstract: The aim of the present study was to assess the impact of a novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy on conti- nence recovery. A total of 116 consecutive patients who received the novel posterior reconstruction (case group) were retrospectively compared with a cohort of 126 patients who did not receive posterior reconstruction (control group). The primary end- point was the duration of continence recovery (no pad use) after robot-assisted laparo- scopic prostatectomy. The posterior reconstruction was obtained by opposing the median dorsal fibrous raphe to the posterior counterpart of the detrusor apron, rather than the Denonvilliers’ fascia. The case group showed higher continence rates at all points of evaluation, which were 2 weeks (30.1% vs 19.8%), 1 month (58.4% vs 45.7%), 3 months (82.7% vs 70.5%) and 6 months postoperatively (95.3% vs 86.4%) (P = 0.007). Application of the novel posterior reconstruction technique, age and length of membra- nous urethra were significant variables for the complete recovery of continence on multivariable analysis. This study shows that the application of this novel PR technique significantly improves the recovery of continence in patients undergoing robot-assisted laparoscopic prostatectomy. Key words: prostatectomy, prostatic neoplasms, robotics, treatment outcome, urinary incontinence. Introduction Two recent prospective studies reported no benefit of PR after RALP, 1,2 which was the opposite result of those of previous studies. 3–7 Surprisingly, the PR techniques used in these two studies seem to be quite different from the previous techniques. They seem to have used single-step PR, which opposes the MDFR only to the DF. 1,2 However, the original technique incorporated additional reconstruction between the MDFR and the posterior bladder wall 1–2 cm from the new bladder neck. 3–8 In a preliminary histological study, we found that the structure between the posterior bladder neck and the seminal vesicles consisted of longitudinal smooth muscle and fibroa- dipose tissue. These findings are consistent with the concept of inner and outer lamellae proposed by Secin et al. 9 This structure should be designated as the “PDA,” because it is equivalent to the ADA of the bladder. 10 The PDA corresponds to the anatomical structure, which was described as “the posterior bladder wall 1–2 cm from the new bladder neck” in the original description of the PR technique. The PDA is a strong, thick functional tissue containing muscle that is more appropriate for pulling and fixing the MDFR than the DF. As such, we hypothesized that the key proximal structure for PR is not DF, but rather PDA. Furthermore, single-step reconstruc- tion between MDFR and PDA could be enough for PR. Thus, we investigated whether our new PR technique, which entails opposition of the MDFR solely to the PDA, would improve continence recovery compared with the standard RALP technique without PR. International Journal of Urology (2012) doi: 10.1111/j.1442-2042.2012.02988.x © 2012 The Japanese Urological Association 1