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Re: Influence of anterior fibromuscular stroma on incontinence outcomes in RASP and HoLEP

Prostate Cancer and Prostatic Diseases volume 28, page 523 (2025)Cite this article

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We appreciate the authors’ interest expressed in their commentary [1] regarding the article by Antonio Andrea Grosso et al. [2], which provides valuable insights into the role of the anterior fibromuscular stroma (AFS) in maintaining continence in patients undergoing de-obstructive surgery for benign prostatic hyperplasia (BPH). We concur with the authors’ assertion that continence maintenance cannot be solely attributed to the competence of the external urethral sphincter and that other factors, some of which remain unidentified, play significant roles in determining this outcome.

Given this perspective, we strongly advocate for surgeons to take utmost care to preserve all anatomical structures, including the AFS, during BPH surgeries. In alignment with this objective, we believe that the early apical release technique utilized in our en-bloc HoLEP series minimizes damage to this crucial anatomical structure [3, 4]. Indeed, our series reports a significantly lower rate of early incontinence compared to other studies, even among older and comorbid patients [5, 6]. Similarly, the urethral-sparing technique employed during robot-assisted simple prostatectomy (RASP) ensures the integrity of the urethra, sphincter, and AFS [7, 8].

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References

  1. Lin YH, Juang HH. Influence of anterior fibromuscular stroma on incontinence outcomes in RASP and HoLEP: a critical analysis of Grosso et al.‘s findings. Prostate Cancer Prostatic Dis. Feb 14. https://doi.org/10.1038/s41391-024-00807-1. Epub ahead of print. 2024.

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Authors and Affiliations

  1. Department of experimental and clinical Medicine—University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy

    Antonio Andrea Grosso, Fabrizio Di Maida, Agostino Tuccio & Andrea Minervini

  2. Department of Oncology, Division of Urology, University of Turin, Turin, Italy

    Daniele Amparore, Cristian Fiori & Francesco Porpiglia

Authors
  1. Antonio Andrea Grosso
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  2. Daniele Amparore
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  3. Fabrizio Di Maida
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  4. Cristian Fiori
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  5. Agostino Tuccio
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  6. Francesco Porpiglia
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  7. Andrea Minervini
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Contributions

Antonio Andrea Grosso, Daniele Amparore, Fabrizio Di Maida: project development and manuscript writing. Cristian Fiori, Francesco Porpiglia, Agostino Tuccio, Andrea Minervini: manuscript editing.

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Correspondence to Antonio Andrea Grosso.

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Grosso, A.A., Amparore, D., Di Maida, F. et al. Re: Influence of anterior fibromuscular stroma on incontinence outcomes in RASP and HoLEP. Prostate Cancer Prostatic Dis 28, 523 (2025). https://doi.org/10.1038/s41391-024-00855-7

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