New surgical technique preserves continence in men after prostate removal

A new surgical technique could remove the risk of urinary incontinence after surgery to remove the prostate for men with prostate cancer.

The technique is called complete urethral preservation (CUP) and was developed by Professor Greg Shaw, consultant urologist at UCLH, which is the biggest centre for robotic prostate removal in the UK.

Urinary incontinence is a common problem after full removal of the prostate – known as radical prostatectomy. Usually it is a short-term problem, but it can be permanent and bothersome.

Prof Shaw said: “CUP seems to bring about a rapid recovery in urinary continence, with most patients not experiencing any urine leakage during their recovery. This is very different from the recovery seen in most men after conventional robotic radical prostatectomy.

“The continence recovery compares favourably with other new surgical techniques that also aim to preserve continence. The data are early but very promising.”

The technique is described in a paper published in the British Journal of Urology (the BJUi). The paper contains a video of the procedure.

Traditionally, when robotic radical prostatectomy is performed, the urine tube (urethra) which runs through the middle of the prostate is cut where it enters and leaves the prostate gland. Once the prostate is removed the cut ends are joined back together. This means that a length of urethra is sacrificed during the operation.

It has become clear that the urethral length is important in preserving urinary continence after radical prostatectomy.

With the new technique the entire length of the urethra is spared. The urethra is carefully dissected along its length as it runs through the prostate, before being severed. Once the prostate is removed the two severed ends of the urethra are rejoined.

The technique does not require any specialised equipment or any major change in the surgical approach used by most UK surgeons performing robotic radical prostatectomy. The technique can be taught relatively easily, and the published paper and video describe a step by step technique to allow UK surgeons to adopt it and improve continence recovery for their patients.

As a next step, the team aims to formally evaluate the technique in a trial.

Read the paper.