Outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty in Bulbomembranous Urethral Strictures Post-transurethral Resection of the Prostate.

OBJECTIVE: To evaluate the outcomes of ventral onlay buccal mucosal graft urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate. METHODS: After approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with post-TURP urethral stricture (PTS) and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram and voiding cystourethrogram. Follow-up evaluation included assessment of lower urinary tract symptoms, physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12months of follow-up. RESULTS: A total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 ± 5.5 mL/s (P < .0001), 20.1 ± 5.4 mL/s (P < .001), and 19.1 ± 5.3 mL/s (P < .003) at 3, 6, and 12months, respectively. IPSS significantly decreased to 8.93 ± 6.37 at the 12-month follow-up mark (P < .0001). Three patients developed stricture recurrence and two patients developed postoperative urinary incontinence. CONCLUSION: VOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results.

Tadalafil versus tamsulosin as combination therapy with 5-alpha reductase inhibitors in benign prostatic hyperplasia, urinary and sexual outcomes.

PURPOSE: To compare the urological and sexual outcomes of using either tamsulosin/finateride or tadalafil/finasteride as combination therapies in patients with large prostate. PATIENTS AND METHODS: Selection criteria included prostate volume > 40 ml and IPSS > 7. Patients with severe erectile dysfunction (IIEF-erectile functions ≤ 10) were excluded. Patients were randomized into group I (tamsulosin/finasteride) and group II (tadalafil/finasteride). The primary endpoint was to define urinary and sexual function changes (IPSS, IPSS-quality of life, urinary flow rates and IIEF domains) within each group. The secondary endpoint was to compare the treatment induced changes between both groups. RESULTS: At 4th and 12th weeks, 131 and 127 patients were available in both groups, respectively. Both groups showed significant LUTS improvement (IPSS changes: - 4.9 ± 2.7 and - 4.3 ± 2.9 at 4th week and - 6.1 ± 3 and - 5.4 ± 2.8 points by the 12th week in both groups, respectively). Group I had better average flow rates at both follow-up visits. Meanwhile, maximum flow rates were comparable in both groups at 12th week (13.5 ± 3.9vs. 12.6 ± 3.7, p > 0.05). In group I, all IIEF domains were significantly lowered at both visits (p < 0.05). Group II showed significant increase in IIEF-erectile function scores (1.3 ± 1.1 and 1.8 ± 1.2 at the 4th and 12th weeks) with a transient significant reduction of IIEF-orgasm and sexual desire noted only by the 4th week (- 0.8 ± 0.4 and - 0.6 ± 0.4, respectively). CONCLUSION: Within three months, both combinations are comparably effective in improving BPH related LUTS. Tamsulosin/finasteride provided significantly better Qmax only at 4th week. Tadalafil/finasteride had the advantage of improving sexual performance over the other combination.

Effects of algerian nettle (Urtica dioica L.) on benign prostatic hyperplasia and their mechanism of action elucidation: in vivo and in silico approaches.

This study investigated the effect of Urtica dioica roots etheric extract (UDEE) on oxidative stress, and urine obstruction with histopathological examinations of prostatic and renal tissues,and suggests computational methods as a complementary method, to make a hypothesis on the overall effect of UDEE in the treatment of benign prostatic hyperplasia (BPH).Gas chromatography/mass spectrometry was utilised to characterise UDEE.BPH was induced in rats through daily subcutaneous injections of testosterone propionate. Rats were also orally administered UDEE or a vehicle. After four weeks, prostate weight, urine output, and biochemical markers were evaluated. UDEE treatment demonstrated significant regression of prostatic enlargement, improved biochemical and histopathological characteristics, and regulation of antioxidant activity levels. Phytosteroids stand out, act by inhibiting 5α-reductase and aromatase. This study provides an insight into treatment of BPH, demonstrating safety of this compound towards the kidney compared to finasteride without severe side effects.

Translational and linguistic validation of the Arabic version of dysfunctional voiding symptom score questionnaire.

INTRODUCTION: Dysfunctional voiding is a multifactorial condition that encompasses a wide variety of symptoms rendering its diagnosis a challenging process. In this setting, several tools have been proposed to aid the diagnosis of this disease among which is the Dysfunctional Voiding Symptom Score (DVSS). The DVSS has been translated and validated to different languages including Japanese, Thai, Chinese, Serbian, and Portuguese. The aim of the current study is to translate and cross-culturally validate the DVSS into the Arabic language. MATERIAL AND METHODS: The DVSS was translated and culturally adapted to the Arabic language following the standards of the ISPOR for the translation and cultural adaptation process for patient-reported outcomes measures. Subsequently, the translated version underwent a pre-test on 15 patients with dysfunctional voiding. Afterwards, the translated version was filled by 82 pediatric patients and/or their parents with dysfunctional voiding and then the same questionnaire was refilled by the patients and their families one week later at home. Finally, a group of healthy children and/or their parents were recruited to fill the questionnaire as a control group. Cronbach's alpha, Pearson's correlation, and Interclass correlation were used to assess for internal consistency and reliability between test-retest of the Arabic version. RESULTS: The mean total score of DVSS for the case and control groups was 16.66 ± 6.07 and 6.11 ± 3.36, respectively (P < 0.001). The Arabic-DVSS showed excellent internal consistency (Cronbach's α > 0.9) for all the questions except Q1, Q3, Q6, and Q7 that showed good internal consistency. DISCUSSION: Translational and linguistic validation of the DVSS questionnaire into Arabic language is an important step toward its introduction in the clinical practice in Arabic countries; however, this step has also to consider the cultural variations between countries and not just linguistic translation. Generally, the Arabic-DVSS showed a satisfactory test-retest internal consistency and reliability with an excellent Cronbach's α (0.982) and ICC (0.962) for the total score of the Arabic-DVSS. Yet, the main limitation of this study was that it was only advocated for the translation and validation of the Arabic-DVSS and did not assess its value in patients' follow-up. CONCLUSION: The Arabic version of the DVSS is reliable and valid to help in the evaluation of DV in children of Arabic countries.

New imaging technologies for robotic kidney cancer surgery.

Objective: Kidney cancers account for approximately 2% of all newly diagnosed cancer in 2020. Among the primary treatment options for kidney cancer, urologist may choose between radical or partial nephrectomy, or ablative therapies. Nowadays, robotic-assisted partial nephrectomy (RAPN) for the management of renal cancers has gained popularity, up to being considered the gold standard. However, RAPN is a challenging procedure with a steep learning curve. Methods: In this narrative review, different imaging technologies used to guide and aid RAPN are discussed. Results: Three-dimensional visualization technology has been extensively discussed in RAPN, showing its value in enhancing robotic-surgery training, patient counseling, surgical planning, and intraoperative guidance. Intraoperative imaging technologies such as intracorporeal ultrasound, near-infrared fluorescent imaging, and intraoperative pathological examination can also be used to improve the outcomes following RAPN. Finally, artificial intelligence may play a role in the field of RAPN soon. Conclusion: RAPN is a complex surgery; however, many imaging technologies may play an important role in facilitating it.

Initial Experience and Evaluation of a Nomogram for Outcome Prediction in Management of Medium-sized (1-2 cm) Kidney Stones.

BACKGROUND: The gold standard treatment for solitary medium-sized (1-2 cm) renal stones is not defined by recent guidelines, since management modalities including shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PNL) are recommended. Improved ability to predict patient outcomes would aid in patients' counseling and decision-making. OBJECTIVE: To develop a nomogram predicting treatment failure, based on preoperative clinical variables, to be used in the preplanning setting. DESIGN, SETTING, AND PARTICIPANTS: We recruited 2605 patients from 14 centers and carried out a multicenter retrospective analysis of 699 SWL, 1290 RIRS, and 616 PN L procedures performed as first-line treatment for 1-2-cm kidney stones. The variables evaluated included age, gender, previous renal surgery, body mass index, stone size, location, stone density, skin-to-stone distance, presence of urinary tract infections (UTIs), and hydronephrosis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariate logistic regression was fitted to predict treatment failure, defined as the presence of residual fragments >4 mm. A nomogram was developed based on the coefficients of the logit function. RESULTS AND LIMITATIONS: A total of 2431 (93.3%) patients were stone free; 174 (6.7%) treatment failures were recorded and considered the event to be predicted. On univariate analysis, type of procedure, preoperative hydronephrosis, stone density, stone location, and laterality turned out to be statistically significant. Skin-to-stone distance, UTIs, and previous renal surgery were predictors of failure on multivariate analysis. Each variable was given a score based on statistical relevance. The main limitation of the current study is its retrospective nature. CONCLUSIONS: This nomogram provides a prediction of treatment failure and need of reintervention for medium-sized kidney stones. External validation is needed to determine its reproducibility and validity. PATIENT SUMMARY: We developed a preoperative model of treatment outcomes for 1-2-cm kidney stones. Its application may assist urologists to counsel patients with regard to stone management modality.

Prostatic artery embolization for the management of benign prostatic hyperplasia/lower urinary tract symptoms in elderly patients unfit for surgery: Our initial experience. / Embolización arteria prostática para el manejo de la hiperplasia benigna de próstata/síndrome tracto urinario inferior en pacientes añosos no candidatos a cirugía: nuestra experiencia inicial.

OBJECTIVE: To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery. MATERIALS AND METHODS: 17 elderly patients with moderate to severe LUTS/BPH were included in the study and treated with prostatic artery embolization. The patients were evaluated by transrectal ultrasonography (to assess prostate size), IPSS, and PVR urine volume preoperatively and 6 months after the procedure. RESULTS: The mean age of patients was 76.67 ± 7.69. The mean prostate volume was 139.8 ± 81.83 g. The mean preoperative IPSS and PVR were 23 ± 5.4, and 94.43 ± 88.94 ml, respectively. The mean operative time was 90 minutes. Only three patients suffered from postoperative complications (two patients suffered from urinary tract infection and one patient had partial penile necrosis). At 6 months follow up, there was a significant reduction in the prostate volume (101 ± 73.65 cc), IPSS (12.5 ± 3.65), and PVR urine volume (48.64 ± 43.55). CONCLUSION: prostatic artery embolization is a safe and effective nonsurgical alternative treatment of BPH/LUTS particularly in elderly patients with multiple comorbidities.

OBJETIVO: Evaluar la seguridad y eficacia de la embolización arteria prostática en el manejo de STUI secundarios a HBP en pacientes añosos no candidatos a cirugía.MATERIAL Y MÉTODOS: 17 pacientes añosos con STUI moderados/severos fueron incluidos en el estudio y tratados con ambolización de la arteria prostática. Los pacientes fueron evaluados con ecografía transrectal (para determinar el tamaño prostático), IPSS, y residuo post-miccional preoperatorio y a los 6 meses del procedimiento. RESULTADOS: La edad mediana de los pacientes fue de 76,67 ± 7,69. EL volumen prostático medio fue de 139,8 ± 81,83 g. EL IPSS preoperatorio y RPM medio fueron de 23 ± 5,4, y 94,43 ± 88,94 ml, respectivamente. El tiempo quirúrgico medio fue de 90 minutos Solamente 3 pacientes tuvieron complicaciones postoperatorias (2 pacientes tuvieron una infección tracto urinario y un paciente tuvo una necrosis peneana). A los 6 meses de seguimiento, hubo una reducción significativa del volumen prostático (101 ± 73,65 cc), IPSS (12,5 ± 3,65), y RPM volumen orina (48,64 ± 43,55). CONCLUSIONES: La embolización de la arteria prostática es un procedimiento seguro y efectivo como una alternativa no quirúrgica al tratamiento de HBP/STUI particularmente en pacientes añosos con múltiples comorbilidades.

Prostatic artery embolization for the management of benign prostatic hyperplasia/ lower urinary tract symptoms in elderly patients unfit for surgery: our initial experience / Embolización arteria prostática para el manejo de la hiperplasia benigna de próstata/síndrome tracto urinario inferior en pacientes añosos no candidatos a cirugía: nuestra experiencia inicial

OBJECTIVE: To evaluate the safety and efficacy of prostatic artery embolization in the management of LUTS secondary to BPH in elderly patients unfit for surgery. MATERIALS AND METHODS: 17 elderly patients with moderate to severe LUTS/BPH were included in the study and treated with prostatic artery embolization. The patients were evaluated by transrectal ultrasonography (to assess prostate size), IPSS, and PVR urine volume preoperatively and 6 months after the procedure. RESULTS: The mean age of patients was 76.67 ± 7.69. The mean prostate volume was 139.8 ± 81.83 g. The mean preoperative IPSS and PVR were 23 ± 5.4, and 94.43 ± 88.94 ml, respectively. The mean operative time was 90 minutes. Only three patients suffered from postoperative complications (two patients suffered from urinary tract infection and one patient had partial penile necrosis). At 6 months follow up, there was a significant reduction in the prostate volume (101 ± 73.65 cc), IPSS (12.5 ± 3.65), and PVR urine volume (48.64 ± 43.55). CONCLUSION: prostatic artery embolization is a safe and effective non-surgical alternative treatment of BPH/ LUTS particularly in elderly patients with multiple comorbidities

OBJETIVO: Evaluar la seguridad y eficacia de la embolización arteria prostática en el manejo de STUI secundarios a HBP en pacientes añosos no candidatos a cirugía. MATERIAL Y MÉTODOS: 17 pacientes añosos con STUI moderados/severos fueron incluidos en el estudio y tratados con ambolización de la arteria prostática. Los pacientes fueron evaluados con ecografía transrectal (para determinar el tamaño prostático), IPSS, y residuo post-miccional preoperatorio y a los 6 meses del procedimiento. RESULTADOS: La edad mediana de los pacientes fue de 76,67 ± 7,69. EL volumen prostático medio fue de 139,8 ± 81,83 g. EL IPSS preoperatorio y RPM medio fueron de 23 ± 5,4, y 94,43 ± 88,94 ml, respectivamente. El tiempo quirúrgico medio fue de 90 minutos Solamente 3 pacientes tuvieron complicaciones postoperatorias (2 pacientes tuvieron una infección tracto urinario y un paciente tuvo una necrosis peneana). A los 6 meses de seguimiento, hubo una reducción significativa del volumen prostático (101 ± 73,65 cc), IPSS (12,5 ± 3,65), y RPM volumen orina (48,64 ± 43,55). CONCLUSIONES: La embolización de la arteria prostática es un procedimiento seguro y efectivo como una alternativa no quirúrgica al tratamiento de HBP/STUI particularmente en pacientes añosos con múltiples comorbilidades

COVID-19 and urology: a comprehensive review of the literature.

OBJECTIVE: To discuss the impact of COVID-19 on global health, particularly on urological practice and to review some of the available recommendations reported in the literature. MATERIAL AND METHODS: In the current narrative review the PubMed database was searched to identify all the related reports discussing the impact of COVID-19 on the urological field. RESULTS: The COVID-19 pandemic is the latest and biggest global health threat. Medical and surgical priorities have changed dramatically to cope with the current challenge. These changes include postponements of all elective outpatient visits and surgical procedures to save facilities and resources for urgent cases and patients with COVID-19 patients. This review discuss some of the related changes in urology. CONCLUSIONS: Over the coming weeks, healthcare workers including urologists will be facing increasingly difficult challenges, and consequently, they should adopt triage strategy to avoid wasting of medical resources and they should endorse sufficient protection policies to guard against infection when dealing with COVID-19 patients.

En-bloc resection of bladder tumors for pathological staging: the value of lateral margins analysis.

BACKGROUND: In endoscopic resection of colorectal tumors, the pathological assessment of the lateral margins is a strong predictor of tumor recurrence after resection. The aim of the current study is to evaluate the value of the peritumoral margins assessment in ERBT on tumor recurrence. METHODS: We retrospectively analyzed the data of 50 consecutive patients with NMIBC and treated by ERBT between January and December 2017. RESULTS: The lateral margins showed dysplasia in 16 patients and malignancy in three patients. Local recurrence occurred in 14 (28%) patients. It was noted that 57% of patients with recurrence showed some degree of dysplasia or malignancy in the lateral margin; however, on multivariate logistic regression lateral margins lesions were not significantly associated with recurrence (OR 2.175, 95% CI: 0.430-10.996, P=0.35). CONCLUSIONS: ERBT may improve the pathological report of bladder tumor. There was a trend toward increased rate of recurrence in patients with dysplasia or malignancy in their lateral margins; however, this was not statistically significant on multivariate analysis. Further studies with larger sample sizes are required to assess the value of lateral margin analysis.

Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve.

Ex vivo fluorescence confocal microscopy (FCM) is an optical technology that provides fast H&E-like images of freshly excised tissues, and it has been mainly used for "real-time" pathological examination of dermatological malignancies. It has also shown to be a promising tool for fast pathological examination of prostatic tissues. We aim to create an atlas for FCM images of prostatic and periprostatic tissues to facilitate the interpretation of these images. Furthermore, we aimed to evaluate the learning curve of images interpretation of this new technology. Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope® 2500 M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. Images of FCM with the corresponding H&E are illustrated to create the atlas. Furthermore, the two pathologists were asked to re-evaluate the 80 specimens after 90 days interval in order to assess the learning curve of images' interpretation of FCM. FCM was able to differentiate between different types of prostatic and periprostatic tissues including benign prostatic glands, benign prostatic hyperplasia, high-grade intraepithelial neoplasm, and prostatic adenocarcinoma. As regards the learning curve, FCM demonstrated a short learning curve. We created an atlas that can serve as the base for urologists and pathologists for learning and interpreting FCM images of prostatic and periprostatic tissues. Furthermore, FCM images is easily interpretable; however, further studies are required to explore the potential applications of this new technology in prostate cancer diagnosis and management.

"Real-time" Assessment of Surgical Margins During Radical Prostatectomy: State-of-the-Art.

Histopathologic examination of the pathologic specimens using hematoxylin & eosin stains represents the backbone of the modern pathology. It is time-consuming; thus, "real-time" assessment of prostatic and periprostatic tissue has gained special interest in the diagnosis and management of prostate cancer. The current study focuses on the review of the different available techniques for "real-time" evaluation of surgical margins during radical prostatectomy (RP). We performed a comprehensive search of the Medline database to identify all the articles discussing "real-time" or intraoperative assessment of surgical margins during RP. Several filters were applied to the search to include only English articles performed on human subjects and published between January 2000 and March 2019. The search revealed several options for pathologic assessment of surgical margins including intraoperative frozen sections, confocal laser endomicroscopy, optical spectroscopy, photodynamic diagnosis, optical coherence tomography, multiphoton microscopy, structured illumination microscopy, 3D augmented reality, and ex vivo fluorescence confocal microscope. Frozen section represents the gold standard technique for real-time pathologic examinations of surgical margins during RP; however, several other options showed promising results in the initial clinical trials, and considering the rapid development in the field of molecular and cellular imaging, some of these options may serve as an alternative to frozen section.

Drug-Induced Urolithiasis in Pediatric Patients.

Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi.

Is Extraprostatic Extension of Cancer Predictable? A Review of Predictive Tools and an External Validation Based on a Large and a Single Center Cohort of Prostate Cancer Patients.

Our aim was to review and externally validate all the available predictive tools (PTs) predicting extraprostatic extension (EPE) using the area under the curve, calibration plots, and scaled Brier score. A literature search was performed showing 19 models predicting EPE. External validation was carried out on 6360 prostate cancer patients submitted to RP. Most of the PTs showed poor discrimination and unsatisfactory calibration. The majority of the available PTs are not reliable for the prediction of EPE in populations other than the development one; thus, they may not be completely appropriate for patients' counselling or for surgical strategy preplanning.

Reliability of the different versions of Partin tables in predicting extraprostatic extension of prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: Accurate prediction of extraprostatic extension (EPE) of prostate cancer (PCa) is the keystone for deciding whether to perform a neurovascular bundle sparing (NVBs) radical prostatectomy or not, which will subsequently affect the postoperative functional outcomes especially potency. Partin tables are the most commonly used predictive tools (PTs) for prediction of EPE. Moreover, they are the most commonly externally validated. In these settings, the aim of our work is to perform a systematic review of the literature and a meta-analysis for the discriminative performance of the different versions of Partin tables for EPE prediction. EVIDENCE ACQUISITION: A systematic search of Medline, Scopus and Cochrane library was performed to include all the external validation (EV) studies that reported the discriminative performance (area under the curve [AUC]) of the different versions of Partin tables as a PT for EPE. Different versions of Partin tables (1997, 2001, 2007, 2010, and 2013) were included in separate meta-analyses. The pooled AUC with 95% CI were calculated to determine the weighted summary AUC using the random effect model. EVIDENCE SYNTHESIS: Twenty-six studies carried out in different countries including the USA, Korea, Germany, Ireland, China, Austria, France, Italy, the UK, and India were included. Considering the small number and generally low quality of the EV studies in literature, most of the included studies showed some sort of bias especially in the sample size & missing data domain. The pooled EPE AUC were 0.642 (95% CI; 0.601-0.682), 0.672 (95% CI; 0.617-0.727), 0.659 (95% CI; 0.623-0.695), 0.669 (95% CI; 0.623-0.715) and 0.644 (95% CI; 0.545-0.742) for the 1997, 2001, 2007, 2010 and 2013 versions, respectively. CONCLUSIONS: Despite being the most commonly used predictive tool for prediction of EPE, the pooled EPE AUC for different versions of Partin tables showed poor discriminative performance. Thus, surgeons must be cautious when referring to Partin tables for prediction of EPE. Further EV studies are required to confirm these results.

Effect of puboprostatic ligament reconstruction on continence recovery after robot-assisted laparoscopic prostatectomy: our initial experience.

BACKGROUND: Prostate cancer represents a serious health problem worldwide. Radical prostatectomy is the gold standard for management of localized prostate cancer. Urinary incontinence is among the most common complications affecting robot-assisted laparoscopic prostatectomy (RALP) patients' postoperative quality of life. Several surgical modifications were introduced to overcome this problem including the puboprostatic ligament reconstruction. In this study, we discuss our technique of anterior reconstruction of the puboprostatic ligament during RALP and its effect on the continence outcome postoperatively. METHODS: In this retrospective study, the data of 95 consecutive patients were analyzed and the patients were divided in two groups; the control group "group A" (47 patients) and the anterior reconstruction group "group B" (48 patients). The primary endpoint of this study was to compare both groups as regards the postoperative continence rates. RESULTS: Complete continence (no pads) rates were reported at time of catheter removal (T0), 1 month (T1), 4 months (T4), 6 months (T6) and 12 months (T12) postoperatively. Moreover, the social continence (0-1 security pad) was reported at 12 months postoperatively. Complete continence was significantly different between both groups at T0 and T6 (P=0.022, and P=0.035 respectively). The social continence was not significantly different between both groups (85.1% vs. 89.6% in group A vs. group B). CONCLUSIONS: Despite anterior reconstruction of the puboprostatic ligament showed no significant effect on the overall continence, it showed earlier return to continence up to 6 months, which supports the theory that anterior puboprostatic reconstruction may provide better immediate continence and shorten the time to continence for RALP patients. However, most of the published literature showed better continence rates with the total anatomical reconstruction (combined anterior and posterior). Therefore, we started to offer patients in our center total anatomical reconstruction during RALP.