Introduction of “Rocco stitch” improves post-operative prostatectomy recovery

4th November 2008

The Birmingham Prostate Clinic has introduced the new 'Rocco stitch' to improve post-operative recovery following a prostatectomy.

The Rocco stitch has been developed to speed up the return of continence following surgery.

Why do men experience some degree of incontinence immediately after prostate surgery?

Before surgery men have three layers holding back urine – the internal sphincter muscle, the prostate lobes and an external sphincter muscle. After surgery, there is only one layer - the external sphincter. Removing the prostate disturbs the area between the bladder and urethra, which carries urine out of the body.

During surgery, the bladder is pulled down to join the urethra and in so doing, restoring continuity.

After surgery , it is mainly the external urethral sphincter alone that is responsible for maintaining continence. In the first few days after surgery, this sphincter muscle is sometimes not strong enough to ensure full continence.

The Rocco stitch is specially designed to help reconstruct the join between the bladder and the urethra. This is an extra stitch that is not usually used. It reconstructs a muscle layer called the rectoreuthralis. It is not well understood how it works but it appears to pull out the sphincter complex from the pelvic floor changing the angle of the join (anastomosis) and probably most importantly it reduces the tension in the anastomosis. It is thought that this allows the external urethral sphincter to work more effectively.

Our early results

Alan Doherty, Clinical Director of The Birmingham Prostate Clinic comments: “Incontinence is something which many patients fear. Rapid recovery of continence after surgery is obviously a major priority.

“Understandably, the priority is to treat the cancer. But the return of continence is very important in terms of overall recovery and gaining a sense of life returning back to normal.

“We are therefore very pleased to see this surgical development which seems to offer important benefits to patients.”

However, early results from the use of the “Rocco stitch” show patients regaining continence within as little as four weeks.

Mr Doherty is one of the UK’s most experienced surgeons undertaking laparoscopic nerve-sparing prostatectomies, having completed more than 500 procedures.

The nerve-sparing prostatectomy has been developed to reduce damage to the adjacent erectile and bladder nerves.

“The prostatectomy is a complex operation,” explains Mr Doherty. “By undertaking a large number of these operations, the surgeon is able to constantly develop and refine techniques, producing better results for the patient in all aspects of recovery.”