The “Hood” Technique: A Method by Which to Promote Early Recovery of Urinary Continence Following Robotic-Assisted Laparoscopic Prostatectomy

Prostate cancer represents a significant cause of both morbidity and mortality in men around the world. In the United States alone prostate cancer is the most common cancer amongst men, and is the third leading cause of cancer-related deaths (Siegel et al., CA Cancer J Clin 70(1):7–30, 2020). Over the past several decades, robot-assisted radical prostatectomy (RARP) has evolved to become the standard-of-care in the surgical treatment of prostate cancer. However, a well-known side effect of this surgery is post-operative urinary incontinence. There is considerable heterogeneity in the urologic literature with respect to the frequency with which this occurs. Wei et al., for example, report rates of urinary incontinence varying drastically from 6% to 69% (Wei et al., J Urol 164(3 Pt I):744–748, 2000). These rates are undoubtedly confounded by differing definitions of incontinence, variations in surgical techniques, and patient selection methodologies. Nonetheless, urinary continence is intimately tied to quality-of-life (QOL) post-operatively and merits further investigation. Wagaskar et al. (Eur Urol 80(2):213–221, 2021) have previously described the “hood technique,” developed at our institution by Dr. Ashutosh Tewari. This technique allows the preservation of structures in the space of retzius (or retropubic space) via an anterior approach. Below we summarize the physiology of urinary continence as it relates to prostatic surgery. We also provide a detailed explanation on the hood technique and summarize outcomes on patients who underwent this technique.