VID-04.07 Impact on Urinary Continence Rates of Using an Open Antegrade Approach for Radical Prostatectomy Shiga Y, Yoshiyuki S, Yashi M, Endo F, Ikeda M, Oguchi T, Fujisaki A, Minagawa S, Iwabuchi T, Hattori K, Muraishi O St. Luke International Hospital, Tokyo, Japan Introduction and Objective: Urinary incontinence following prostatectomy is a common problem and lowers a pa- tient’s quality of life. The early inconti- nence rates for conventional retrograde approaches have been reported as high as 80% at the day after removal of the urinary catheter. Urinary continence is dependent upon preservation of the sphincter muscle, which is commonly damaged when dissecting the apex of the gland during conventional surgical approaches. Using a non-conventional antegrade approach, careful apical dis- section can more easily be performed. Using fine forceps, this approach allows better visualization and dissection of the small clump of the Santorini plexus. This helps avoid damage to the striated sphincter muscle. To measure the func- tional outcome, especially the recovery of earlier continence after radical prosta- tectomy using a non-conventional, ante- grade approach. Materials and Methods: A retrospective cohort observational study at a tertiary hospital in Tokyo, Japan was done to characterize mean operative blood loss and the incidence of urinary incontinence following retropubic radical prostatec- tomy using an antegrade approach on pa- tients between April 2007 and September 2008. Patients previously treated with neoadjuvant hormonal therapy or trans- urethral surgeries were excluded. Urinary function analysis was abstracted from the medical records of the 124 patients who met inclusion criteria. Results: The rates of being continence pad-free at 1 month and 3 months after the surgery were 75% and 95%, respec- tively. The mean postoperative urinary incontinence rate (calculated as (Inconti- nence volume / Total urine volume for 24 hours) x 100) was 0.42%. Complete uri- nary continence was achieved in 53 pa- tients (43.8%) the day after removal of the urethral catheter. Mean operative blood loss was 750 ml. Conclusions: Our technique of open an- tegrade radical prostatectomy provided higher early continence rates compared to retrograde prostatectomy previously re- ported. The antegrade approach allows dissection of the apex to be the last step of gland removal. This may result in lower blood loss as well as more precise identifi- cation of the anatomical boundaries of the apex. This precise identification helps to minimize the risk of damaging the striated sphincter muscle. The ultimate result is a successful surgical outcome with a mini- mum of urinary incontinence. Video Session 5: MIS, BPO, Reconstructive Surgery Tuesday, November 3, 13:30-15:10 VID-05.01 Robotic Repair of Rectovesical Fistula Secondary To Open Radical Prostatectomy Sotelo R 1 , De Andrade R 1 , Carmona O 1 , Astigueta J 1 , Ramirez D 1 , Di Grazia E 1 , Moreira O 1 , Clavijo R 1 , Canes D 2 1 Instituto Medico La Floresta, Caracas, Venezuela; 2 Lahey Clinic Medical Center, Burlington, MA, USA Introduction and Objectives: Rectovesi- cal fistula is a rare entity that can develop after trauma, radiation, congenital dis- eases, inflammatory bowel disease, and open radical prostatectomy. Herein we present our experience with robotic as- sisted fistula repair. Materials and Methods: Three patients were treated. The etiology of rectovesical fistula developed was open radical prosta- tectomy in all patients. The robotic proce- dure was preoperative following failed open repair in two patients, and primary in the third. All patients had previously undergone fecal diversion. The operative steps were as follows: (1) cystoscopy, (2) RVF catheteriza- tion (3) five-port transperitoneal laparo- scopic mobilization of omental pedicle flap, (4) cystotomy extending towards to the fistula tract, (5) robot docking (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, (10) suprapubic tube place- ment (11) drain placement. Results: Mean operative time was 153 min- utes (range 120-180). No intraoperative or postoperative complications occurred. All patients remain free of fistula recurrence by cystographic studies at mean followup of ranging from 2 weeks to 10 months. Bowel continuity has been restored in 2 patients and is planned in 1. Conclusions: While we await longer fol- lowup and experience in larger series, ro- botic repair of rectovesical fistula appears feasible and represents an attractive alterna- tive to open or laparoscopic approaches. VID-05.02 Duplicating Open Principles: Retrograde Robotic Radical Prostatectomy Sotelo R 1 , Carmona O 1 , Astigueta J 1 , De Andrade R 1 , Canes D 2 , Ramirez D 1 , Di Grazia E 1 , Fernandez G 1 1 Instituto Medico La Floresta, Caracas, Venezuela; 2 Lahey Clinic Medical Center, Burlington, MA, USA Introduction and Objective: Minimally invasive approaches for treatment of local- ized prostate cancer are replacing the gold standard open surgical approach, duplicat- ing its results with lower morbidity. Con- cerns have been raised regarding possible traction injury for an anterograde robotic or laparoscopic approach. To address this con- cern, we describe our initial experience with retrograde robotic radical prostatectomy. Materials and Methods: The steps are: transperitoneal port placement, posterior peritoneotomy, vas and seminal vesicle dis- section, and rectum release. The bladder is then released from the anterior abdominal wall, endopelvic fascia and lateral prostatic fascia are incised, beginning the neurovascu- lar bundle (NVB) release starting at the mid gland to the apex. A back-bleeding suture is placed, the dorsal venous complex is then ligated. The urethra is transected, apical dissection is completed and this plane joins the previously performed posterior dissec- tion. The bladder neck is then dissected. The pedicle, now better defined in relation to the distal NVB and prostate contour, is divided. The NVB dissection is then com- pleted. The urethro-vesical anastomosis per- formed. Results: The retrograde approach to laparo- scopic radical prostatectomy is feasible. Challenges in visualizing the apex can be overcome with a 30 degree down lens, and retraction on the back-bleeding stitch. Po- tentially, a precise apical NVB dissection is accomplished. The retrograde approach potentially avoids over dissection of the bundle beyond the urethra-prostate junc- tion. Conclusions: The retrograde robotic radi- cal prostatectomy can be accomplished, and subjectively gives a meticulous dissection of structures believed to be important in opti- mizing the results of radical prostatectomy. Follow up of functional outcomes in pa- tients undergoing this technique will ulti- mately answer important critiques of the anterograde approach. VIDEO SESSIONS UROLOGY 74 (Supplment 4A), October 2009 S161