Surgical technique remains the most important factor associated with recovery of urinary continence after radical prostatectomy

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Published: 16 Mar 2023
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Dr Rafael Sanchez-Salas - McGill University Health Center, Montreal, Canada

Dr Rafael Sanchez-Salas speaks to ecancer about his talk at EAU 2023. His talk was on the IMPROVE trial and how surgical technique remains the most important factor associated with recovery of urinary continence after radical prostatectomy.

He suggests that professionals need to be highly trained in surgery for better patient outcomes. Neurovascular bundle preservation via surgery was the only factor found to be associated with recovery of urinary continence in the IMPROVE trial.

Dr Sanchez-Salas discusses how the results from this trial are game changing from a clinical perspective.

We are going to participate at the Game Changer session with a trial that was performed in Paris in France when I was working there. The name of the trial is IMPROVE and it’s a trial that is assessing continence after radical prostatectomy, actually robotic radical prostatectomy. 

The IMPROVE trial is quite important because it proves that the surgical technique and surgeon is the most important factor to recover continence after the procedure. There are several options of recovery measures that you can deploy but beyond those, including pelvic muscle floor training or pharmacologic options like duloxetine or solifenacin, at the end of the analysis with the nodal vascular bundle dissection related complete to surgical technique came up as the only factor really associated with continence recovery. 

How can the study results impact clinical practice?

At the end of the day it becomes simple. You need to improve your technique; you need to be well trained in robotic radical prostatectomy because that’s what we analysed. We did robotic radical prostatectomy, but the training, the exposure, through videos, through courses is essential because the more refined your technique is, the better your outcomes will be, especially the functional outcomes. We are talking about a similar situation to Formula 1, for instance: you can have the best car ever but if you are not a good driver you will never get on the podium.

I really want to thank you for giving me the opportunity to share the improved results and I hope the community, the urological community, assume how important surgical technique is for our patients.