EURURO Vol. 72 No. 4

Letter to the Editor

Reply to Fabrizio Dal Moro’s Letter to the Editor re:

Vladimir Student Jr., Ales Vidlar, Michal Grepl, Igor

Hartmann, Eva Buresova, Vladimir Student. Advanced

Reconstruction of Vesicourethral Support (ARVUS)

during Robot-assisted Radical Prostatectomy:

One-year Functional Outcomes in a Two-group

Randomised Controlled Trial. Eur Urol

[4_TD$DIFF]

2017;71:822–30:

CoRPUS and ARVUS

We would like to thank Dr. Dal Moro for his appreciation of

our work and for his kind and valuable remarks. His

complete reconstruction of the posterior urethral support

(CORPUS) technique

[1]

was a great inspiration for us. When

performing this technique in nerve-sparing radical prosta-

tectomy, we were concerned about avoiding damage to the

neurovascular bundles (NVBs) as they run along the

dorsolateral aspect of urethra at the level of rhabdo-

sphincter, as shown by Walz et al

[2] .

Therefore, the

advanced reconstruction of vesicourethral support (ARVUS)

technique that we developed strictly avoids the NVBs

[3]

. We agree that when moving in a medial direction from

the puboprostatic ligaments, performing both of these

techniques could be challenging. Creating a hammock using

levator ani fibres could be difficult in such a case, but we

have actually carried out this procedure in some of our

patients (depending on the individual anatomy of the

periprostatic fascias) and we believe that an experienced

robotic surgeon would be able to perform it. The question is

whether part of the NVB could be damaged in this situation.

There could be some nerves high on the lateral side of the

prostate, as shown by Ganzer et al

[4]

, but their function is

still unclear as they significantly decrease in number

moving towards the apex of the prostate. Another question

is in what situations CORPUS or ARVUS reconstruction

should be performed. When trying to preserve the fascias

around the prostate (eg, high anterior release) a recon-

struction may even not be needed, because these techni-

ques, although introduced mainly for preservation of

erection, could have a positive effect on continence as well

[5]

. All these questions are yet to be answered.

To conclude, we agree that both techniques have proved

to be safe and feasible, and both show good functional

results in terms of improving urinary continence after

robot-assisted radical prostatectomy.

Conflicts of interest:

The authors have nothing to disclose.

References

[1]

Dal Moro F, Crestani A, Valotto C, Zattoni F. CORPUS—novel com- plete reconstruction of the posterior urethral support after robotic radical prostatectomy: preliminary data of very early continence recovery. Urology 2014;83:641–7

[2]

Walz J, Burnett AL, Costello AJ, et al. A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 2010;57:179–92.

[3]

Student Jr

[6_TD$DIFF]

. V, Vidlar A, Grepl M, Hartmann I, Buresova E,

[11_TD$DIFF]

Student V. Advanced reconstruction of vesicourethral support (ARVUS) during robot-assisted radical prostatectomy: one-year functional out- comes in a two-group randomised controlled trial. Eur Urol 2017;

[12_TD$DIFF]

71:822–30

[4]

Ganzer R, Blana A, Gaumann A, et al. Topographical anatomy of periprostatic and capsular nerves: quantification and computerised planimetry. Eur Urol 2008;54:353–61

[5]

van der Poel HG, de Blok W, Joshi N, van Muilekom E. Preservation of lateral prostatic fascia is associated with urine continence after robotic-assisted prostatectomy. Eur Urol 2009;55:892–901.

Vladimir Student Jr.

Vladimir Student*

Department of Urology, University Hospital, Olomouc, Czech Republic

*Corresponding author. Department of Urology, University Hospital, I.P.

Pavlova 6, Olomouc 77900, Czech Republic. Tel. +42 60 3760396.

E-mail address:

studentv@seznam.cz

(V. Student).

April 18, 2017

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) e 9 7

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

DOIs of original articles:

http://dx.doi.org/10.1016/j.eururo.2016.05.032

http://dx.doi.org/10.1016/j.eururo.2017.04.022

http://dx.doi.org/10.1016/j.eururo.2017.04.023

0302-2838/