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Carilli M, Iacovelli V, Sandri M, Forte V, Verze P, Califano G, Di Bello F, Antonelli A, Bertolo R, Minervini A, Di Maida F, Cadenar A, Giudici S, Falabella R, La Falce S, Leonardo C, Proietti F, Pastore AL, Al Salhi Y, Secco S, Patruno G, Ambrosi Grappelli VM, Celia A, Silvestri T, Vittori M, Cipriani C, Bove P. Early Continence Recovery after Robot-Assisted Radical Prostatectomy: A Multicenter Analysis on the Role of Prostatic Shape. J Endourol 2025; 39:381-388. [PMID: 39973443 DOI: 10.1089/end.2024.0605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
Aim: The aim of the study was to investigate the relationship between prostatic apical shape and continence recovery after robot-assisted radical prostatectomy (RARP) in a large multicentric cohort. Materials and Methods: Data of patients who underwent transperitoneal RARP at 10 referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Patients were stratified into four groups based on the multiparametric magnetic resonance imaging (mpMRI) prostatic apex shape. Pre-, intra-, and postoperative variables were compared. Continence recovery was defined as no pad or 1 safety pad/day. Results: A total of 822 patients were retrieved and classified as Group A (n = 206), Group B (n = 221), Group C (n = 143), and Group D (n = 252) based on the mpMRI. At baseline, statistically significant differences were found in Charlson's comorbidity index (CCI) (p < 0.001), body mass index (BMI) (p = 0.01), prostatic urethral length (p = 0.008), and membranous urethral length (p = 0.03). In terms of bladder neck-sparing technique, a statistically significant difference was found among groups (p = 0.005). Group D achieved continence significantly earlier than the other groups after RARP, with a median recovery time of 3 months (95% confidence interval [CI]: 3-3), compared with 4 months for all other groups (95% CI: 4-4). Group D showed an earlier continence recovery after RARP with respect to all the other shapes (hazard ratio [HR] = 1.23, 95% CI: 1.05-1.43, p = 0.005). The estimated HR remained unchanged after adjusting by age, BMI, CCI, bladder neck-sparing, nerve-sparing, and presence of median lobe (HR = 1.17, 95% CI: 1.00-1.38, p = 0.046). Cox model showed an association with BMI (HR = 0.97, 95% CI: 0.95-0.99, p = 0.03), bladder neck-sparing (HR = 1.45, 95% CI: 1.24-1.70, p < 0.001), and nerve-sparing (HR = 1.27, 95% CI: 1.11-1.46, p = 0.001). Conclusions: Our multi-institutional study confirmed that prostatic apical shape has a significant impact on time-to-continence after RARP.
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Affiliation(s)
- Marco Carilli
- Urology Unit, San Carlo di Nancy Hospital-GVM Care and Research, Rome, Italy
| | - Valerio Iacovelli
- Urology Unit, San Carlo di Nancy Hospital-GVM Care and Research, Rome, Italy
| | - Marco Sandri
- Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Italy
| | - Valerio Forte
- Radiology Unit, San Carlo di Nancy Hospital-GVM Care and Research, Rome, Italy
| | - Paolo Verze
- Urology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II," Naples, Italy
| | - Gianluigi Califano
- Urology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II," Naples, Italy
| | - Francesco Di Bello
- Urology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University of Naples "Federico II," Naples, Italy
| | | | - Riccardo Bertolo
- Department of Urology, AOUI Verona, University of Verona, Verona, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Anna Cadenar
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | - Sofia Giudici
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi University Hospital, University of Florence, Florence, Italy
| | | | | | | | | | - Antonio Luigi Pastore
- Urology Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Sapienza University of Rome, Latina, Italy
| | - Yazan Al Salhi
- Urology Department of Medico-Surgical Sciences and Biotechnologies, ICOT, Sapienza University of Rome, Latina, Italy
| | - Silvia Secco
- Department of Urology, ASST Niguarda Hospital, Milan, Italy
| | - Giulio Patruno
- Department of Urology, San Giovanni Addolorata Hospital, Rome, Italy
| | | | - Antonio Celia
- Department of Urology, S. Bassiano Hospital, Bassano del Grappa (VI), Vicenza, Italy
| | - Tommaso Silvestri
- Department of Urology, S. Bassiano Hospital, Bassano del Grappa (VI), Vicenza, Italy
| | - Matteo Vittori
- Urology Unit, San Carlo di Nancy Hospital-GVM Care and Research, Rome, Italy
| | - Chiara Cipriani
- Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Pierluigi Bove
- Robotic and Minimally-Invasive Urology Unit, AOU Policlinico Tor Vergata, Rome, Italy
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Yu C, Zhang Q, Quan J, Zhang D, Wang S. Transvesical robot-assisted radical prostatectomy for recalcitrant bladder neck contracture after holmium laser enucleation of prostate: initial experience and clinical outcomes. World J Urol 2025; 43:117. [PMID: 39934441 DOI: 10.1007/s00345-025-05494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 01/31/2025] [Indexed: 02/13/2025] Open
Abstract
PURPOSE To evaluate the feasibility and clinical efficacy of transvesical robotic assisted radical prostatectomy (TvRARP) for the treatment of recurrent recalcitrant bladder neck contracture (rBNC) after holmium laser enucleation of prostate (HoLEP). METHODS In this retrospective study, 8 patients diagnosed with rBNC were enrolled for TvRARP. The patients' preoperative data median age: 73 years (Interquartile range (IQR) 72-74), median body mass index (BMI): 29.8 kg/m² (IQR 20.5-31.5), median prostate volume: 29 ml (IQR 25-45.3), median peak urinary flow (Qmax): 4.15 ml/s (IQR 3.65-4.35), median post-void residual urine (PVR): 190 ml (IQR 145-220), median International Prostate Symptom Score (IPSS): 31 (IQR 29.8-32.5), and median quality of life (QoL): 5 (IQR 5-6) were collected. All patients were excluded from prostate tumors through PSA testing or magnetic resonance imaging (MRI). The surgical outcomes and perioperative complications were evaluated. All patients received follow-up for a minimum of 6 months postoperatively, and their post-operative data were subsequently collected and analyzed. RESULTS The median surgical time was 123 min (IQR 119-130), and the median intraoperative blood loss was 50 ml (IQR 50-62.5). The median hospital stay was 7.5 days (IQR 7-8). No severe intraoperative complications occurred, nor did any major postoperative complications arise. All patients achieved continence at postoperative 3 months. All patients achieved treatment success, as evidenced by the successful passage of a 17Fr cystoscope into the bladder or a postoperative uroflow rate exceeding 15 ml/sec. At the 6-month postoperative assessment, the Qmax significantly improved from 4.15 ml/s (IQR 3.65-4.35) to 17.7 ml/s (IQR 17.5-18.6) (p < 0.05). The PVR notably reduced from 190 ml (IQR 145-220) to 17.5 ml (IQR 13.8-36.3) (p < 0.05). The IPSS improved significantly postoperatively, decreasing from 31 (IQR 29.8-32.5) to 10.5 (IQR 9.8-12) (p < 0.05), while the QoL score improved dramatically from 5 (IQR 5-6) to 1 (IQR 1-1) (p < 0.001). Additionally, the OAB-V8 score demonstrated significant improvement after the surgery, decreasing from 17 (IQR 11.8-23.5) to 7.5 (IQR 6.8-9.5) (p < 0.05). CONCLUSION TvRARP is a valid and safe alternative for the treatment of rBNC with an acceptable risk of intraoperative and postoperative complications. It also is a reasonable approach providing promising success rates and continence outcomes. Long-term functional results require further investigation.
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Affiliation(s)
- Chong Yu
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158, Hangzhou, Zhejiang, 310014, China
| | - Qi Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158, Hangzhou, Zhejiang, 310014, China
| | - Jing Quan
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158, Hangzhou, Zhejiang, 310014, China
| | - Dahong Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158, Hangzhou, Zhejiang, 310014, China.
| | - Shuai Wang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Shangtang Road 158, Hangzhou, Zhejiang, 310014, China.
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Ragusa A, Prata F, Iannuzzi A, Tedesco F, Cacciatore L, Rocca A, Caccia P, Bogea C, Marelli M, Civitella A, Scarpa RM, Muto G, Papalia R. Safety and feasibility of "three arms settings" robot-assisted radical prostatectomy using the Hugo RAS system: surgical set-up in a double-center large case series. World J Urol 2024; 42:517. [PMID: 39259253 DOI: 10.1007/s00345-024-05210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/06/2024] [Indexed: 09/12/2024] Open
Abstract
PURPOSE Robot-assisted laparoscopic radical prostatectomy (RARP) is the most common robotic procedures performed in urologic oncology. The Hugo Robot-Assisted Surgery (RAS) System (Medtronic, USA©) has recently been launched on the market and is characterized by the modularity of four different independent arm carts. The aim of this study is to describe and evaluate safety and feasibility of three-arms setting for RARP using the Hugo RAS™ System in a large case series. METHODS Between October 2022 and December 2023, a large case series of patients from two tertiary referral center who underwent RARP through HUGO™ RAS were prospectively enrolled. Informed written consent was obtained before the procedure and a three-arms setting was used in every case. Follow-up was scheduled according to EAU guidelines. RESULTS A total of 86 patients were included in this study and underwent RARP with Hugo™ RAS System. Median Console time time was 114 min (IQR, 75-150), median docking time 4 min (IQR, 3-5). Lymphadenectomy was successfully performed when indicated in 19 patients (22.1%). A vesicourethral anastomosis using the modified Van Velthoven technique was successfully achieved in all cases. No post-operative complications > Clavien II up to 30 post-operative days were reported. In all patients, catheter was removed on the 7th postoperative day. CONCLUSION We conducted the first large case series of RARP through the novel Hugo™ RAS System using a three-arms configuration. This innovative robotic platform showed an easily accessible docking system, providing excellent perioperative outcomes.
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Affiliation(s)
- Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessandro Rocca
- Department of Urology, GVM - Maria Pia Hospital, Torino, 10132, Italy
| | - Paolo Caccia
- Department of Urology, GVM - Maria Pia Hospital, Torino, 10132, Italy
| | - Catalina Bogea
- Department of Urology, GVM - Maria Pia Hospital, Torino, 10132, Italy
| | - Monica Marelli
- Department of Urology, GVM - Maria Pia Hospital, Torino, 10132, Italy
| | - Angelo Civitella
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giovanni Muto
- Department of Urology, GVM - Maria Pia Hospital, Torino, 10132, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Kuroda K, Hamamoto K, Kawamura K, Masunaga A, Kobayashi H, Horiguchi A, Ito K. The International Consultation on Incontinence Questionnaire Short Form as a Substitute for 1-Hour Pad Weight Testing in the Evaluation of Urinary Incontinence in Patients With Pelvic Organ Prolapse Undergoing Surgery. Int Neurourol J 2024; 28:215-224. [PMID: 39363412 PMCID: PMC11450242 DOI: 10.5213/inj.2448234.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/25/2024] [Indexed: 10/05/2024] Open
Abstract
PURPOSE Stress urinary incontinence is a postoperative complication occurring in patients with pelvic organ prolapse (POP). Although the 1-hour pad test measures the degree of urinary incontinence qualitatively and quantitatively, some elderly women undergoing POP surgery do not have the daily activities of living to perform the pad test. Therefore, we examined whether the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) could be used as an alternative tool for pad tests. METHODS We retrospectively evaluated 132 patients with POP. In our hospital, 57 patients were treated by laparoscopic sacrocolpopexy (LSC), whereas 75 were treated by transvaginal mesh surgery (TVM). We measured the changes in symptoms preand postoperatively using the ICIQ-SF and 1-hour pad weight testing, and investigated the correlation between the total plus component question scores of the ICIQ-SF and 1-hour pad weight. RESULTS The preoperative ICIQ total scores in all patients decreased significantly as the amount of leakage on the 1-hour pad weight decreased. The component question scores also decreased significantly with decreasing levels of 1-hour pad weight. The LSC and TVM groups had decreased ICIQ-SF total and component question scores as pad weight decreased. At 12 months postoperatively, the ICIQ total scores in all patients significantly declined as the amount of leakage on the 1-hour pad weight decreased. In the LSC group, the ICIQ-SF total and component question scores also decreased with decreased pad weight, but the differences were not always significant between ICIQ scores and pad weight. In the TVM group, the ICIQ-SF total and component question scores also significantly decreased as the pad weight decreased. CONCLUSION The ICIQ-SF could be an appropriate substitute for the 1-hour pad weight testing in predicting the severity of urinary incontinence. In the future, we hope to predict the level of urine leakage based on the ICIQ-SF score.
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Affiliation(s)
- Kenji Kuroda
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
| | - Koetsu Hamamoto
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
| | - Kazuki Kawamura
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
| | - Ayako Masunaga
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
| | - Hiroaki Kobayashi
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Tokorozawa, Japan
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Fonseca J, Moraes-Fontes MF, Sousa I, Oliveira F, Froes G, Gaivão A, Palmas A, Rebola J, Muresan C, Santos T, Dias D, Varandas M, Lopez-Beltran A, Ribeiro R, Fraga A. Membranous urethral length is the single independent predictor of urinary continence recovery at 12 months following Retzius-sparing robot-assisted radical prostatectomy. J Robot Surg 2024; 18:230. [PMID: 38809307 PMCID: PMC11136784 DOI: 10.1007/s11701-024-01986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
The influence of anatomical parameters on urinary continence (UC) after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) remains uncharted. Our objective was to evaluate their association with UC at 3, 6 and 12 months post-operatively. Data from patients who underwent RS-RARP were prospectively collected. Continence was defined as no pad use. Anatomic variables were measured on preoperative magnetic resonance imaging (MRI). Regression analyses were performed to identify predictors of UC at each time point. We included 158 patients with a median age of 60 years, most of whom had a localized tumor (≤ cT2). On multivariate analyses, at 3 months post-surgery, urinary incontinence (UI) rises with age, odds ratio (OR) 1.07 [95% confidence interval (CI) 1.004-1.142] and with prostate volume (PV), OR 1.029 (95% CI 1.006-1.052); it reduces with longer membranous urethral length (MUL), OR 0.875 (95% CI 0.780-0.983) and with higher membranous urethral volume (MUV), OR 0.299 (95% CI 0.121-0.737). At 6 months, UI rises with PV, OR 1.033 (95% CI 1.011-1.056) and decreases with MUV, OR 0.1504 (95% CI 0.050-0.444). Significantly, at 12 months post-surgery, the only predictor of UI is MUL, OR 0.830 (95% CI 0.706-0.975), establishing a threshold associated with a risk of UI of 5% (MUL > 15 mm) in opposition to a risk of 25% (MUL < 10 mm). This single institutional study requires external validation. To our knowledge, this is the first prospective cohort study supporting MUL as the single independent predictor of UC at 12 months post-surgery. By establishing MUL thresholds, we enable precise patient counseling.
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Affiliation(s)
- Jorge Fonseca
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal.
| | | | - Inês Sousa
- Unidade de Investigação Clínica, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Francisco Oliveira
- Serviço de Medicina Nuclear, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Gonçalo Froes
- Faculté de Médecine Et Médecine Dentaire, Université Catholique de Louvain, Brussels, Belgium
| | - Ana Gaivão
- Serviço de Imagiologia, Centro Clínico Champalimaud, Champalimaud Foundation, Lisbon, Portugal
| | - Artur Palmas
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal
| | - Jorge Rebola
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal
| | - Ciprian Muresan
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal
| | - Tiago Santos
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal
| | - Daniela Dias
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal
| | - Mário Varandas
- Unidade de Próstata, Centro Clínico Champalimaud, Champalimaud Foundation, Av. Brasília, 1400-038, Lisboa, Portugal
| | - Antonio Lopez-Beltran
- Department of Morphological Sciences, Córdoba University Medical School, Córdoba, Spain
| | - Ricardo Ribeiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
| | - Avelino Fraga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, Porto, Portugal
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Wang F, Chen J, Wang W, Li M, Peng C, Pan S, Zhan C, Zhao K, Li Y, Zhang L, Xu G, Jin J. Quantitative Analysis of Quality of Life and Exploration of Influencing Factors in Patients Undergoing Radical Prostatectomy. Urology 2023; 181:105-111. [PMID: 37586423 DOI: 10.1016/j.urology.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To quantify and evaluate the quality of life of patients undergoing radical prostatectomy using the FACT-P scoring system, and to explore the predictive factors for postoperative quality of life. METHODS Clinical data of 249 patients who underwent radical prostatectomy in our hospital from January 2021 to October 2022 were analyzed. According to the surgical method and whether the subjective quality of life of the patient decreased significantly, the patients were divided into groups, and the predictive factors for changes in subjective quality of life after surgery were analyzed. RESULTS A total of 192 cases were finally obtained (45 cases of fascia internal approach, 147 cases of traditional radical prostatectomy), and patients who underwent fascia internal approach (FACT-P: 110.15 ± 10.55) had better postoperative quality of life than those who underwent extra-fascial radical prostatectomy (FACT-P: 102.30 ± 6.75) (P < .01). One hundred fourteen patients reported a decrease in subjective quality of life, while 78 did not. The preoperative FACT-P score was an independent predictive factor (OR=0.719, P < .01), and when the preoperative score was <116 points, the possibility of no decrease in quality of life after surgery was higher. CONCLUSION Fascia internal approach should be performed as much as possible for suitable surgical patients, and for patients with a preoperative FACT-P score ≥116 points, the possibility of a decrease in quality of life after surgery should be fully communicated.
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Affiliation(s)
- Feiyang Wang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jiajun Chen
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - Weihao Wang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Mengyao Li
- Department of Pathology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Chao Peng
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Shouhua Pan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Chuanchuan Zhan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Keyuan Zhao
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Yulei Li
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Lulu Zhang
- Scientific Research Center,Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Gang Xu
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jing Jin
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
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Kadono Y, Nohara T, Kawaguchi S, Makino T, Naito R, Kadomoto S, Iwamoto H, Yaegashi H, Shigehara K, Izumi K, Mizokami A. Comparison of postoperative urinary continence and incontinence types between conventional and Retzius-sparing robot-assisted radical prostatectomy. Neurourol Urodyn 2023. [PMID: 37096807 DOI: 10.1002/nau.25193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
AIMS This study aimed to investigate the postoperative urinary continence rate and incontinence types compared over time between conventional robot-assisted radical prostatectomy (C-RARP) and Retzius-sparing RARP (RS-RARP). METHODS All 61 cases were selected from the C-RARP and RS-RARP by propensity score matching, and the pad scale, 24-h pad weight test, and International consultation on incontinence questionnaire-short form (ICIQ-SF) were followed-up over time up to 12 months. RESULTS The probability of urinary continence per pad scale evaluation differed according to how it was defined: the continence rate 12 months after C-RARP and RS-RARP were 94% and 95% for 1 pad/day, 85% and 92% for 1 security pad/day, 61% and 85% for no pad use, respectively, which were all significantly better with RS-RARP. The results of the 24-h pad weight test were significantly better with RS-RARP at both 3 and 12 months, with median C-RARP versus RS-RARP values of 5 versus 1 g and 2 versus 0 g, respectively. In terms of types of urinary incontinence, the rates of postoperative stress urinary incontinence (SUI) increased in both procedures but to a lesser extent in RS-RARP. Other types of urinary incontinence, such as urge incontinence and terminal dribbling, did not differ significantly before and after surgery and between the two procedures. CONCLUSIONS Postoperative urinary continence was better with RS-RARP than with C-RARP per all follow-up parameters until 12 months postoperatively. Postoperative SUI was significantly lower with RS-RARP than with C-RARP, which was considered the main reason for better postoperative urinary continence with RS-RARP.
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Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Song QX, Li J, Shen K, Peng Z, Qiu X, Zhu H, Gu Y, Xu W, Wang J, Zhu Y, Pan J, Dong B, Xue W. The application of "S.I.S" technique improves long-term continence after robotic radical prostatectomy. Neurourol Urodyn 2023; 42:650-661. [PMID: 36705067 DOI: 10.1002/nau.25131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
AIMS To propose a novel S.I.S technique during the robotic-assisted radical prostatectomy (RARP), encompassing pubourethral suspension, posterior wall intensification, and bladder neck stripping, and to present functional and oncological outcomes with a special focus on long-term continence. METHODS From January 1, 2018, to December 31, 2019, consecutive patients who underwent RARP were retrospectively investigated and separated into the S.I.S group and the conventional group. Preoperative patient characteristics, tumor status, and perioperative parameters were collected, followed by the assessment of self-reported status on continence, using an International Consultation on Incontinence Modular Questionnaire-urinary incontinence short form (ICIQ-UI-SF). Statistical comparisons were performed on variables between the two surgery groups, and multivariate logistic regression analysis was used to determine predictive factors for postoperative incontinence severity. RESULTS A total of 602 subjects were analyzed with a median follow-up of 24 months. There was no significant difference regarding baseline characteristics and perioperative parameters, except for a more advanced tumor stage in the S.I.S group. The application of the S.I.S technique did not jeopardize the positive surgical margin rate at the bladder neck or long-term tumor control. Notably, the patient-reported degree of incontinence was significantly reduced with the assistance of S.I.S technique, as evidenced by the diminished severe-to-very severe cases. On multivariate analysis, both preoperative body mass index and use of S.I.S modification were independent predictive factors for the long-term incontinence severity. CONCLUSIONS The application of S.I.S technique during RARP is feasible and superior compare with the conventional approach, with a significantly alleviated long-term incontinence severity, without compromising cancer control.
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Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Shen
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zehong Peng
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xudong Qiu
- The Graduate School, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanjing Zhu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyuan Gu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxin Xu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieying Wang
- Department of Clinical Center for Investigation, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahua Pan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baijun Dong
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Gu Z, Zheng Z, Zhang W, Mao S, Wang S, Geng J, Yao X. The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy. Front Surg 2023; 9:1071093. [PMID: 36684134 PMCID: PMC9852533 DOI: 10.3389/fsurg.2022.1071093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose This study aimed to develop a nomogram to predict the recovery of immediate urinary continence in laparoscopic radical prostatectomy (LRP) patients. Methods A prediction model was developed based on a dataset of 154 LRP patients. Immediate urinary continence was defined as free from using pads within 7 days after the removal of the urinary catheter. The least absolute shrinkage and selection operator regression (LASSO) model was applied to screen the features. Multivariate logistic regression analysis was used to establish prediction model integrating the features selected from the LASSO regression analysis. Receiver operating curve (ROC), calibration and decision curve analysis (DCA) were used to assess the model's discrimination, calibration and clinical utility. Results The identified features of the prediction model included age, body mass index (BMI) and three pelvic anatomic parameters measured by MRI: membranous urethral length (MUL), intravesical prostatic protrusion length (IPPL) and puborectalis muscle width (PMW). The nomogram showed good discrimination with an are under the curve(AUC) of 0.914 (95% CI, 0.865-0.959, p < 0.001). Moreover, good calibration was showed in the model. Lastly, DCA showed that the nomogram was clinically useful. Conclusion The developed novel nomogram that can predict the possibility for post-prostatectomy patients to recover immediate urinary continence could be used as a counseling tool to explain urinary incontinence to patients after LRP.
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Affiliation(s)
- Zhuoran Gu
- Department of Urology, Shanghai Tenth People's Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Zongtai Zheng
- Department of Urology, Shanghai Tenth People's Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Wentao Zhang
- Department of Urology, Shanghai Tenth People's Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Shiyu Mao
- Department of Urology, Shanghai Tenth People's Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Shuai Wang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiang Geng
- Department of Urology, Shanghai Tenth People's Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People's Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
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10
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Bakula M, Hudolin T, Kolar Mitrovic H, Kastelan Z. Urethral pressure profile before radical prostatectomy as a predictor of early postoperative continence. Neurourol Urodyn 2022; 41:1431-1439. [PMID: 35670263 DOI: 10.1002/nau.24978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/09/2022] [Accepted: 05/21/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Urinary incontinence (UI) is one of the most common complications of radical prostatectomy (RP). Impaired urethral sphincter function is generally considered to be the most important contributing factor for UI; however, the mechanism of onset and recovery of urinary continence has not been fully elucidated. The objective of this research was to evaluate preoperative functional urethral length (FUL) and maximum urethral closure pressure (MUCP) as early continence recovery predictors after open retropubic RP (ORRP). METHODS The research was conducted on a group of 43 patients with localized prostate cancer (PCa) in the period from July 2019 to May 2021. The urodynamic method of urethral pressure profile (UPP) was used to assess FUL and MUCP, and correlate with the postprostatectomy continence recovery. The severity of UI and bothersome were assessed using fully validated International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF) and number of pads used in 24 h. Patients were interviewed about the use of urinary pads and asked to fill out the ICIQ-UI SF before and 2, 8, 16 and 24 weeks after ORRP. RESULTS The median value of FUL (mm) and MUCP (cmH2O) was 69 (28-94) and 76 (16-223), respectively. Correlation and linear regression showed a statistically significant negative correlation between preoperative values of FUL and MUCP with ICIQ symptom score and the number of pads used per day at the four observed time intervals (p < 0.05). Such a result showed that patients with higher preoperative FUL and MUCP values were more likely to recover urinary continence earlier. A value of 65 mm for FUL and 80 cmH2 O for MUCP proved to be the cut-off values for continence recovery in 24 weeks after ORRP. CONCLUSION Preoperatively evaluated FUL and MUCP seem to be valuable prognostic factors for early continence recovery after ORRP. Further investigation on a larger patient cohort is needed to evaluate the role of UPP in the preoperative management of patients with PCa.
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Affiliation(s)
- Mirko Bakula
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Tvrtko Hudolin
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia.,Department of Urology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Helena Kolar Mitrovic
- Department of Rheumatology and Rehabilitation, University Hospital Center Zagreb, Zagreb, Croatia
| | - Zeljko Kastelan
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia.,Department of Urology, University of Zagreb School of Medicine, Zagreb, Croatia
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11
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Pedraza AM, Wagaskar V, Parekh S, Tewari A. Technical advances in nerve-sparing and continence preservation. Curr Opin Urol 2022; 32:204-210. [PMID: 34954705 DOI: 10.1097/mou.0000000000000958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Urinary incontinence and erectile dysfunction are common after radical prostatectomy. These side effects greatly impact patients' quality of life. Therefore, surgical techniques and technology tools are constantly being developed to optimize trifecta outcomes. Here we focus on advances in nerve-sparing (NS) and continence preservation. RECENT FINDINGS New surgical techniques dedicated to preservation rather than reconstruction have been developed to improve urinary continence (UC) and NS. On the other hand, intraoperative assessment of prostatic and periprostatic structures has shown promising outcomes toward NS whereas avoiding omission of extracapsular extension (ECE). Likewise, neural regeneration strategies are under research to improve return of erectile function and UC. SUMMARY Superb outcomes after Robot-Assisted Radical Prostatectomy require a proper balance between NS and risk of ECE. Detailed anatomic knowledge together with an accurate surgical planning are cornerstone for tailoring the approach in each case.
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Affiliation(s)
- Adriana M Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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12
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Liu A, Gao Y, Huang H, Yang X, Lin W, Chen L, Xu D. A Combined Technology to Protect the Anatomic Integrity of Distal Urethral Sphincter Complex in Radical Prostatectomy Improves Early Urinary Continence Recovery Without Sacrifice of Oncological Outcomes. Front Oncol 2021; 11:711093. [PMID: 34422663 PMCID: PMC8374866 DOI: 10.3389/fonc.2021.711093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose Our primary aim was to present a combined technique to protect the anatomic integrity of distal urethral sphincter complex (DUSC) during minimally invasive radical prostatectomy (RP) and discuss its impact on urinary continence (UC) recovery. The second aim was to define the learning curve of the combined technique. Methods We conducted a non-randomized retrospective study. There were 314 consecutive patients who received RP by the same urologist surgeon with more than 2,000 prior cases in Shanghai Ruijin Hospital between March 2017 and April 2020. Included in this study were 263 patients with clinical T1–T2 stage. We modified a combined RP (Comb-RP) technique including endopelvic fascia no-incising technique, dorsal venous complex (DVC) no-ligation technique, intrafascial dissection technique, and anterior reconstruction technique so as to preserve the anatomic integrity of DUSC. The patients were assigned to two groups: a Comb-RP group and a conventional RP (Conv-RP) group. Continence rates were assessed every 3 months after removal of the catheter. UC was defined as 0 pad per day. Peri-operative variables of the patient including operation time, estimated blood lost (EBL), positive surgical margin (PSM), and postoperative complications were also collected. Scatter-graphs of learning curves were drawn using locally weighted scatterplot smoothing (LOWESS). Results RP was accomplished smoothly in all 263 cases. The pad-free UC rates in Conv-RP group and Comb-RP group were 17.3 vs. 27.8% (P = 0.048) at the removal of the catheter, 35.8 vs. 50.0% (P = 0.027) at 1 month, 60.5 vs. 76.1% (P = 0.012) at 3 months, 87.7 vs. 96.5% (P = 0.022) at 6 months, and 94.7 vs. 97.7% (P = 0.343) at 12 months. Kaplan–Meier analysis showed significantly higher and faster continence recovery in the Comb-RP group (mean 4.9 vs. 2.6 months, Log Rank P = 0.001). There was no significant difference in PSM rate between the Comb-RP and Conv-RP group (31.1 vs. 31.2%, P =0.986). The learning curves of peri-operative variables, oncological and functional outcomes achieved the lowest point or plateau at the 20th–60th cases. Conclusions The anatomic integrity and intact pelvic floor interplay of DUSC is important for its function. Our combined technique was a safe and feasible technique for improving early UC in RP with no significantly increased PSM rate and no significant difference in long-term UC.
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Affiliation(s)
- Ao Liu
- Department of Urinary, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Gao
- Department of Urinary, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hai Huang
- Department of Urinary, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoqun Yang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenhao Lin
- Department of Urinary, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Chen
- Department of Urinary, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urinary, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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13
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Deng W, Zhang C, Jiang H, Li Y, Zhu K, Liu X, Chen L, Liu W, Guo J, Zhou X, Fu B, Wang G. Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up. Front Oncol 2021; 11:641887. [PMID: 33937043 PMCID: PMC8082308 DOI: 10.3389/fonc.2021.641887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the perioperative, functional, and oncological outcomes of transvesical robot-assisted radical prostatectomy (T-RARP) and posterior robot-assisted radical prostatectomy (P-RARP) for localized prostate cancer. Materials and Methods We analyzed the data of 96 patients who underwent T-RARP or P-RARP for localized prostate cancer between January 2017 and June 2019 in a retrospective fashion. Results No significant differences in the baseline characteristics existed between the T-RARP and P-RARP arms. Both interventions were successfully performed without open conversion in either group. T-RARP was associated with a slightly more operative time (135.3 vs. 127.3 min) and estimated blood loss (105.2 vs. 94.2 mL) than P-RARP, but the differences were not significant (both p > 0.05). The likelihood of transfusion, ≤Grade II, and >Grade II postoperative complications, pT3a disease and positive surgical margins in the T-RARP group was comparable with that in the P-RARP group. No significant differences were noted between these two arms in terms of UC at the removal of catheter and nocturia (p = 0.750 and p = 0.684, respectively), and all included patients recovered UC at 3 months postoperatively. The median International Index of Erectile Function-5 score in both groups remains comparable before and after RARP. The patients in the T-RARP and P-RARP groups had a similar biochemical recurrence-free survival (p = 0.387). Conclusions Both T-RARP and P-RARP by experienced hands are feasible for well-selected patients with prostate cancer, obtaining similar outcomes in terms of perioperative results, UC and erectile function, and oncological control within short-term follow-up.
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Affiliation(s)
- Wen Deng
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Cheng Zhang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Jiang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ke Zhu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ju Guo
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Gongxian Wang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
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14
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Faria EF, Maciel CVM, Berger A, Mitre A, Dauster B, Freitas CH, Fraga C, Chade D, Dall'Oglio M, Carvalho F, Campos F, Carvalhal GF, Lemos GC, Guimarães G, Zampolli H, Alves JR, Manzano JP, Fortes MA, Rocha MFH, Rubinstein M, Luz M, Romanelli P, Coelho R, Rocha R, Machado RD, Dos Reis RB, Zequi S, Guida R, Muglia V, Tobias-Machado M. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus. J Robot Surg 2021; 15:829-839. [PMID: 33426578 DOI: 10.1007/s11701-020-01186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.
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Affiliation(s)
| | | | - André Berger
- Hospital Moinhos de Vento, Porto Alegre , RS, Brazil
| | - Anuar Mitre
- University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Daher Chade
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
| | | | | | - Franz Campos
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | - Murilo Luz
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
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15
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Schifano N, Capogrosso P, Tutolo M, Dehò F, Montorsi F, Salonia A. How to Prevent and Manage Post-Prostatectomy Incontinence: A Review. World J Mens Health 2020; 39:581-597. [PMID: 33151045 PMCID: PMC8443978 DOI: 10.5534/wjmh.200114] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/25/2020] [Accepted: 08/14/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To provide an overview of the currently available evidence relating to the prevention and management strategies of urinary incontinence (UI) after radical prostatectomy (RP). MATERIALS AND METHODS A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning post-RP UI. The search strategy included these words: urinary continence; urinary continence recovery; urinary incontinence; radical prostatectomy; and prostate cancer. RESULTS Post-RP UI still represents a challenging issue for both urologic patients and clinicians. A complete preoperative assessment of the risk factors associated with post-RP UI aids both in counseling those patients with a higher estimated likelihood of postoperative UI and in identifying those who would probably benefit from preventive strategies in the preoperative and in the intraoperative settings. Over the last decades different surgical strategies based on either the "preservation" or the "reconstruction" of the anatomical elements responsible for urinary continence (UC) led to an overall improvement of postoperative functional outcomes. Finally, several therapeutic strategies should be evaluated for the postoperative UI management. Artificial urinary sphincter implantation represents the gold standard for treatment, notwithstanding its wide adoption is limited due to high costs and significant risk of surgical revision. In this context, male sling positioning seems the most promising strategy, in particular in mild and moderate post-RP UI. CONCLUSIONS To enhance the likelihood of obtaining an optimal UC recovery after RP, it is here strongly suggested to intervene throughout the overall clinical management process thus including the pre-, intra- and postoperative settings.
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Affiliation(s)
- Nicolò Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.
| | - Manuela Tutolo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.,University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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16
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Almeras C, Tollon C, Salin A, Beauval JB, Loison G, Gautier JR, Ploussard G. Subsphincteric Anastomosis During Laparoscopic Robot-Assisted Radical Prostatectomy and Its Positive Impact on Continence Recovery. J Endourol 2020; 34:1235-1241. [PMID: 32674608 PMCID: PMC7757522 DOI: 10.1089/end.2020.0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: To assess the interest of a new sphincter preserving anastomosis technique for continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods: We performed a monocentric single-operator study on 187 consecutive RALP. Patients were divided into two groups: Group 1 (standard anastomosis, until December 2017) and Group 2 (subsphincteric anastomosis [SSA], since January 2018). The SSA consisted in respecting the sphincteric sleeve during the anastomosis suturing only the internal layer of the urethra with the bladder and thereby avoiding the loss of sphincteric length induced by the suture. Pre-, intra-, and postoperative data were prospectively collected and compared. Criteria of continence were as follows: no pad use and complete absence of leakage at catheter removal at 1 month and 1 year. Results: The two groups were comparable in terms of prostate-specific antigen, gland volume, and Gleason score. In Group 2 (SSA), we observed a complete continence recovery in 75.6% at catheter removal (p = 0.0000035), in 82.9% at 1 month (p = 0.000092), and in 97.5% at 1 year (p = 0.028), independently of bladder neck preservation (p = 0.388). There was also a significant difference between the two groups concerning urinary reeducation requirement (p = 0.0006), pad use, and urinary quality of life (p = 0.0000002). No anastomosis complication was reported. Conclusions: The SSA significantly improved the rates of immediate, early, and 1-year continence recovery after RALP. These results need further study among larger numbers of patients.
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Affiliation(s)
- Christophe Almeras
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
| | - Christophe Tollon
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
| | - Ambroise Salin
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
| | - Jean-Baptiste Beauval
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
| | - Guillaume Loison
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
| | - Jean Romain Gautier
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
| | - Guillaume Ploussard
- Department of Urology Uro.Sud, RGDS la Croix du Sud Clinic, Quint Fonsegrives/Toulouse, France
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17
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Daily Pad Usage Versus the International Consultation on Incontinence Questionnaire Short Form for Continence Assessment Following Radical Prostatectomy. Int Neurourol J 2020; 24:156-162. [PMID: 32615678 PMCID: PMC7332826 DOI: 10.5213/inj.1938116.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Continence assessment is an essential component of follow-up after radical prostatectomy (RP). Several methods exist to assess the severity of urinary incontinence (UI). Our study examined the relationship and degree of agreement between International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and the number of pads used in a 24-hour period in the assessment of UI following RP. Methods Continence was prospectively assessed in 746 men from a Spanish urology clinic 12 months after RP using the ICIQ-SF and pad usage. The relationship between ICIQ-SF scores and pad usage was assessed using Spearman rank correlation coefficients. The Jonckheere-Terpstra trend test was used to determine whether the ICIQ-SF score and the component question scores increased with increasing pad usage. The Bonferroni-corrected pairwise Wilcoxon rank-sum test was used to determine which pairs of pad usage levels differed. The weighted kappa was used to evaluate the agreement between pad usage levels and ICIQ-SF questions. Results The continence rate was 82% using the “no pad usage” definition of continence versus 78% using the definition of an ICIQ-SF score of 0 (P<0.001). Strong positive correlations were observed between the number of pads and the ICIQ-SF total and component question scores (rs>0.85, P<0.001). The ICIQ-SF total and component question scores increased significantly with increasing pad usage (P<0.001). The ICIQ-SF scores (P<0.018) for all pairs of pad usage levels (0, 1, 2, or 3 or more) differed significantly. The agreement between the ICIQ-SF leakage amount question and pad usage was very good (rs=0.861, P<0.001). Conclusions At 12 months post-RP, 24-hour pad usage was closely correlated with ICIQ-SF, although the continence rate differed depending on the definition used. Higher levels of pad usage were associated with higher questionnaire scores, more leakage, and poor quality of life (interference with everyday life).
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Zhou X, Fu B, Zhang C, Liu W, Guo J, Chen L, Lei E, Zhang X, Wang G. Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes. BJU Int 2020; 126:300-308. [PMID: 32402143 PMCID: PMC7497005 DOI: 10.1111/bju.15111] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To describe in detail the techniques for transvesical robot-assisted radical prostatectomy (RARP) using the da Vinci Si/Xi system (Intuitive Surgical, Sunnyvale, CA, USA) and to evaluate functional and oncological outcomes in 35 patients with prostate cancer. PATIENTS AND METHODS Thirty-five patients with localized prostate cancer were enrolled for transvesical RARP. The patients' preoperative data (mean ± sd age 63.4 ± 8.1 years, body mass index 28.6 ± 5.3 kg/m2 , total prostate-specific antigen 10.8 ± 4.9 ng/mL and prostate volume 30.6 ± 14.4 mL, and median [interquartile range {IQR}] biopsy Gleason score 6 [6-7], and International Index of Erectile Function [IIEF]-5 score 18 [16-20]) were collected. Preoperative assessment revealed 28 cases of cT2a and seven cases of cT2b disease. All patients were continent preoperatively (defined as no pad required or one dry pad per day as a precaution). Surgical results and peri-operative complications were assessed. All patients were followed up for at least 12 months postoperatively. RESULTS The mean operating time was 150 ± 35 min. Estimated blood loss was 100 ± 45 mL. Urinary infection was noted in one patient and managed with levofloxacin. Another patient complained of nocturia on postoperative day 14, which was relieved with solifenacin succinate. Urethral catheters were removed on postoperative day 7. Thirty-two patients achieved immediate urinary continence, with three patients returning to full continence on postoperative day 14. Postoperative pathology confirmed 24 pT2a cases, nine pT2b cases and two pT2c cases (median [IQR] Gleason score 6 [6-7]). Positive surgical margins were found in four patients (11.4%). No urethral stricture or urinary leakage was noted on urethrocystography taken 3 months after surgery. Urodynamic studies were performed preoperatively and 6 months after surgery: median (IQR) maximum urinary flow 12.2 (10.2-14.9) vs 13.7 (10.1-15.0) mL/s; bladder capacity 385.3 (351.3-410.2) vs 370.2 (330.1-395.4) mL; and voiding phase detrusor contractility 38.5 (27.8-42.3) vs 35.6 (28.3-41.3) mmH2 O, respectively. During a minimum of 12 months of follow-up, no biochemical recurrence was noted in any patient. The median (IQR) IIEF-5 score was 17 (16-19). CONCLUSIONS The transvesical approach is a valid alternative to RARP in selected patients, providing promising postoperative urinary continence. Long-term functional and oncological results require further investigation.
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Affiliation(s)
- Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ju Guo
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Enjun Lei
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Yang B, Zhang F, Xiao C, Lu J, Ma L, Huang Y. Impact of Preoperative Magnetic Resonance Imaging Anatomic Features on Urinary Continence Recovery after Laparoscopic Radical Prostatectomy. Urol Int 2020; 104:239-246. [PMID: 32155646 DOI: 10.1159/000506021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the impact of preoperative magnetic resonance imaging anatomic features on urinary continence recovery after laparoscopic radical prostatectomy (LRP). METHODS We retrospectively analyzed 150 consecutive prostate cancer patients who underwent LRP between July 2015 and June 2018 in our institution. Patients reporting freedom from using safety pad (0 pads/day) were defined as urinary continent. We evaluated the association of urinary continence recovery after LRP and the perioperative variables, including age, prostatic volume (PV), intravesical prostatic protrusion length (IPPL), membranous urethral length (MUL), and neurovascular bundle (NVB) sparing status. Kaplan-Meier and log-rank tests were used to compare urinary continence rates between groups. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent predictors for urinary continence recovery. RESULTS 60.6% (91/150), 83.3% (125/150), and 96.0% (144/150) of the patients experienced urinary continence recovery at 3, 6, and 12 months, respectively. There was significant difference in PV, IPPL, MUL, and NVB sparing between groups stratified by urinary continence status at 3, 6, and 12 months. Kaplan-Meier curves of urinary continence rates showed significant differences between groups stratified by PV (<50 mL vs. ≥50 mL, p < 0.001), IPPL (<5 mm vs. ≥5 mm, p < 0.001), MUL (≥15 mm vs. <15 mm, p < 0.001), and NVB sparing status (yes vs. no, p = 0.003), respectively. On univariate analysis, PV, IPPL, MUL, and NVB sparing were significantly associated with urinary continence recovery (all, p < 0.05). On multivariate analysis, only IPPL (HR = 0.94, p = 0.003) and MUL (HR = 1.10, p < 0.001) were independent predictors for urinary continence recovery. CONCLUSION Patients with larger IPPL and shorter MUL have higher chances of delayed recovery of urinary continence after LRP. IPPL and MUL were reliable morphometric parameters for predicting urinary continence.
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Affiliation(s)
- Bin Yang
- Department of Urology, Peking University Third Hospital, Beijing, China,
| | - Fan Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Chunlei Xiao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Beijing, China
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Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8122068. [PMID: 31771310 PMCID: PMC6947283 DOI: 10.3390/jcm8122068] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3–4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52–5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10–3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13–9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72–1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21–1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.
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Nyarangi-Dix JN, Görtz M, Gradinarov G, Hofer L, Schütz V, Gasch C, Radtke JP, Hohenfellner M. Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer. BMC Urol 2019; 19:113. [PMID: 31718600 PMCID: PMC6852736 DOI: 10.1186/s12894-019-0550-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background Retzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort. Methods Prospectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery. Results 3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out. Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP. 84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%. 34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT. Conclusions RsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.
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Affiliation(s)
- Joanne Nyaboe Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Magdalena Görtz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Georgi Gradinarov
- Ruprecht-Karls University of Heidelberg, Medical Faculty, Heidelberg, Germany
| | - Luisa Hofer
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Viktoria Schütz
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Claudia Gasch
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Machioka K, Kadono Y, Naito R, Nakashima K, Iijima M, Kawaguchi S, Shigehara K, Nohara T, Izumi K, Mizokami A. Evaluating urinary incontinence before and after radical prostatectomy using the international consultation on incontinence questionnaire-short form. Neurourol Urodyn 2019; 38:726-733. [PMID: 30576037 DOI: 10.1002/nau.23907] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/23/2018] [Indexed: 11/07/2022]
Abstract
AIMS To evaluate urinary incontinence using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), daily pad use, and 24-h pad weight test before and after radical prostatectomy (RP) chronologically, and the correlation between them. METHODS ICIQ-SF and questions on daily pad use provided subjective, and 24-h pad weight test for objective evaluation. RESULTS In total, 258 cases were recruited. The continence rate at 12 months after RP was 67% for no pad use, 87% for security 1 pad/day, and 94% for 1 pad/day. The median ICIQ-SF total score before and at 1, 3, 6, and 12 months after RP was 0, 10, 7, 5, and 4, respectively. Incontinence patterns differed when comparing ICIQ-SF results pre- and post-RP. Significant correlation existed between the ICIQ-SF total score, 24-h pad weight test, and daily pad use; however, point distribution on each scatter plot varied widely. Comparing results before and at 12 months after RP revealed complete recovery for 35% of patients from the ICIQ-SF total score, 67% from daily pad use, and 64% from the 24-h pad weight test. A combination of all 3 showed a recovery of preoperative levels in 29% of patients. CONCLUSIONS ICIQ-SF was effective and convenient for evaluating UI, including the pattern of UI, after RP. Significant correlation, but wide variations, among ICIQ-SF, daily pad use, and the 24-h pad weight test existed. The best evaluation method would be the one that can compare UI status pre- and post-RP using the ICIQ-SF and 24-h pad weight test.
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Affiliation(s)
- Kazuaki Machioka
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazufumi Nakashima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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