Randomized study of the Rocco stitch aims to prove its long term benefits over urinary incontinence

Prostate cancer is increasingly frequent among men over the age of 50. The mortality rates, however, have decreased, due to the advancement of treatments and medication that fights the disease. One of the most common option for patients is the robot-assisted radical prostatectomy, which is a minimally invasive surgery with great results in removing the cancerous prostate. However, urinary incontinence (UI) is still a postoperative complication that can affect the patient’s quality of life. UI has been previously shown to be caused by the insufficiency of the urethral sphincter’s structural integrity, which is greatly reduced following RARP.

Surgeons have experienced with several surgical techniques for urethrovesical anastomosis (UVA), following removal of the prostate. Among these, with high popularity rates, is the posterior reconstruction of the Denonvilliers’ musculofascial plate, often known as the “Rocco stitch”. The procedure has received mixed reviews from practicing urologists, as far as the effect of urinary continence rates go. This has determined Jen Hoogenes, PhD, and her team of urologists at McMaster University, to conduct the first randomized test that determines the short and long-term return to urinary continence after RARP, by comparing data from patients that underwent conventional UVA, with patients that have had UVA with the additional Rocco stitch.

The experiment consisted of a single surgeon that performed in a random manner conventional anastomosis or anastomosis with the Rocco stitch. The patients that participated in the study were not informed about the procedure that was allocated to them and the surgeon didn’t know of the procedure he was about to perform up until immediately prior to the case. As a method of evaluating the success of the procedure, the patients were asked to complete the Expanded Prostate Cancer Index Composite Short Form (EPIC-26) questionnaire at baseline, 2, 3, 4, 6, 8, and 12-months postoperatively. Continence was defined as 0 pads/day and ≤ 1 pad/day

When the study was completed, a total of 73 patients were enrolled in the interventional Rocco stitch cohort, while 67 patients underwent the control, standard of care procedure. Factors such as PSA levels, mean BMI and cinical stage of the disease did not differ in a significant manner. Moreover, there were no noteworthy differences between the two groups of patients regarding the quantity of pad use or frequency of urine leak. „Overall bother” improved significantly in all patients from 2-12 months, suggesting the procedures helped with the continence issues. Although not statistically significant, 93% of the patients in the experimental Rocco stitch group stated that they were continent (≤ 1 pad per day), compared to 85.7% in the control group, at the 12 month mark.

Dr. Hoogens performed one of the largest randomized controlled trials of the Rocco stitch technique to date. There is more information to be collected from the EPIC-26 questionnaire that has to be reviewed so the study can present definitive evaluation of the two methods, but there are most surely grounds that can attest the efficiency of the Rocco stitch in dealing with urinary incontinence.