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Surgery in Motion

Advanced Reconstruction of Vesicourethral Support (ARVUS)

during Robot-assisted Radical Prostatectomy: One-year

Functional Outcomes in a Two-group Randomised

Controlled Trial

Vladimir Student Jr

. a , b ,

Ales Vidlar

a , b ,

Michal Grepl

a , b ,

Igor Hartmann

a , b ,

Eva Buresova

a , b ,

Vladimir Student

a , b , *


Department of Urology, University Hospital, Olomouc, Czech Republic;


Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 8 2 2 – 8 3 0

available at


journal homepage:

Article info

Article history:

Accepted May 23, 2016

Associate Editor:

Alexandre Mottrie




Erectile function

Functional reconstruction

Prostate cancer

Robot-assisted radical


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accompanying video.



The advent of robotics has facilitated new surgical techniques for

radical prostatectomy. These allow adjustment of pelvic anatomical and functional

relationships after removal of the prostate to ameliorate postprostatectomy inconti-

nence (PPI) and reduce the time to complete continence.


To describe the results of a new surgical technique for reconstruction

of vesicourethral anastomosis using the levator ani muscle for support during

robot-assisted radical prostatectomy (RARP).

Design, setting, and participants:

A prospective, randomised, single-blind study among

66 consecutive patients with localised prostate cancer (cT1–2N0M0) undergoing RARP

from June to September 2014, 32 using the new technique and 34 using the standard

posterior reconstruction according to Rocco.

Surgical procedure:

In the advanced reconstruction of vesicourethral support (ARVUS)

intervention group, the fibres of the levator ani muscle, Denonvilliers fascia,

retrotrigonal layer, and median dorsal raphe were used to form the dorsal support

for the urethrovesical anastomosis. Suture of the arcus tendineus to the bladder neck

served as the anterior fixation.


We compared demographic data and preoperative and postoperative

functional and oncologic results for the two groups. The primary endpoint was conti-

nence evaluated at different time points (24 h, 2, 4, and 8 wk, and 6 and 12 mo). The

secondary endpoints were perioperative and postoperative complications and erectile


Results and limitations:

Using a continence definition of 0 pads/d, the continence rates

for the ARVUS versus the control group were 21.9% versus 5.9% at 24 h (


= 0.079), 43.8%

versus 11.8% at 2 wk (


= 0.005), 62.5% versus 14.7% at 4 wk (



0.001), 68.8% versus

20.6% at 8 wk (



0.001), 75.0% versus 44.1% at 6 mo (


= 0.013), and 86.66% versus

61.29% at 12 mo (


= 0.04). International Index of Erectile Function questionnaire

results at 6 and 12 mo after surgery showed similar potency rates for the control group

(40.0% and 73.33%) and the ARVUS group (38.8% and 72.22%). There were four postop-

erative complications (2 in each group): three haematomas requiring transfusion and

one lymphocele that needed drainage. No urinary retention, anastomosis leak,

or perineal pain was observed. Limitations include the small sample size and the

single-institution design.

* Corresponding author. Department of Urology, University Hospital, I.P. Pavlova 6, Olomouc 77900,

Czech Republic. Tel. +42 60 3760396.

E-mail address:

(V. Student).



2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.