Urinary incontinence after radical retropubic prostatectomy is not related to patient body mass index

Association between Presurgical Weight Status and Urinary and Sexual Function in Prostate Cancer Patients Treated by Radical Prostatectomy: A Prospective Cohort Study

OBJECTIVE

To prospectively examine the influence of weight status on urinary and sexual function in clinically localized prostate cancer patients treated by radical prostatectomy (RP).

METHODS

The Prostatectomy, Incontinence and Erectile dysfunction study recruited patients at 2 US institutions between 2011 and 2014. At baseline, height and weight were measured, and urinary and sexual function were collected by the modified Expanded Prostate Cancer Index Composite-50. This index was repeated at the 5-week, 6-month, and 12-month postsurgical assessments and compared to baseline using linear generalized estimating equations. Logistic equations were used to evaluate the likelihood of functional recovery at the 6- and 12-month assessments.

RESULT

Presurgery, nonobese patients (68.8% of 407 patients) had similar urinary function as those with obesity (P = .217), but better sexual function (P = .006). One year after surgery, 50.5% and 28.9% patients had recovered to baseline levels for urinary and sexual function, respectively. Recovery was not, however, uniform by obesity. Compared to those with obesity, nonobese patients had better urinary function at the 6- (P < .001) and 12-month postsurgical assessments (P = .011) and were more likely to recover their function by the 6-month assessment (OR = 2.55, 95% CI = 1.36-4.76). For sexual function, nonobese patients had better function at the 6- (P = .028) and 12-month (P = .051) assessments, but a similar likelihood of recovery 1-year postsurgery.

CONCLUSION

Nonobese prostate cancer patients had better and likely earlier recovery in urinary function postsurgery, and better sexual function both pre- and postsurgery. These findings support the potential for tailored presurgical counseling about RP side-effects and prehabilitation to improve these side-effects.

Very Early Continence After Radical Prostatectomy and Its Influencing Factors

Introduction and Objectives: Surgical techniques such as preservation of the full functional-length of the urethral sphincter (FFLU) have a positive impact on postoperative continence rates. Thereby, data on very early continence rates after radical prostatectomy (RP) are scarce. The aim of the present study was to analyze very early continence rates in patients undergoing FFLU during RP.

Materials and Methods: Very early-continence was assessed by using the PAD-test within 24 h after removal of the transurethral catheter. The PAD-test is a validated test that measures the amount of involuntary urine loss while performing predefined physical activities within 1 h (e.g., coughing, walking, climbing stairs). Full continence was defined as a urine loss below 1 g. Mild, moderate, and severe incontinence was defined as urine loss of 1–10 g, 11–50 g, and >50 g, respectively.

Results: 90 patients were prospectively analyzed. Removal of the catheter was performed on the 6th postoperative day. Proportions for no, mild, moderate and severe incontinence were 18.9, 45.5, 20.0, and 15.6%, respectively. In logistic regression younger age was associated with significant better continence (HR 2.52, p = 0.04), while bilateral nerve-sparing (HR 2.56, p = 0.057) and organ-confined tumor (HR 2.22, p = 0.078) showed lower urine loss, although the effect was statistically not significant. In MVA, similar results were recorded.

Conclusion: Overall, 64.4% of patients were continent or suffered only from mild incontinence at 24 h after catheter removal. In general, reduced urine loss was recorded in younger patients, patients with organ-confined tumor and in patients with bilateral nerve sparing. Severe incontinence rates were remarkably low with 15.6%.

Impact of Obesity on Long-Term Urinary Incontinence after Radical Prostatectomy: A Meta-Analysis

Obesity is a known risk factor for prostate cancer progression and may contribute to poor treatment outcomes. However, little is known concerning the relationship between obesity (body mass index [BMI] ⩾ 30) and the urinary incontinence (UI) of patients after radical prostatectomy (RP). The goal of this study was to focus on the prevalence and duration of UI after RP with specific attention to the BMI. Subsequently, trials were identified in a literature search of PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting BMI, study characteristics, and outcome data including the relationship between BMI and urinary incontinence data were included. Finally, four studies comprising 6 trials with 2890 participants were included. The results showed that obesity increased UI risk at 12 months in patients who underwent robotic-assisted laparoscopic radical prostatectomy (RLRP) (odds ratio [OR] 2.43, 95% confidence interval [CI] [1.21, 4.88], P = 0.01). When stratified by the surgical methods, the pooled results showed that obesity increased UI risk at 24 months in patients who underwent RLRP (OR 2.00, 95% CI [1.57, 2.56], P < 0.001). However, in patients who underwent laparoscopic radical prostatectomy (LRP), the pooled results showed that obesity does not increase UI risk at 24 months (OR 1.13, 95% CI [0.74, 1.72], P = 0.58). This is the first study to include obesity as the primary independent variable. Outcomes indicate that obesity (BMI ≥ 30) may increase the UI risk at 12 and 24 months after RLRP. Well-designed randomized controlled trials with strict control of confounders are needed to make results comparable.

[Quality of life after robotic prostatectomy: Impact of BMI and age on urinary incontinence]

INTRODUCTION

Data evaluating risk factors for urinary incontinence (UI) and quality of life (QoL) after robotic-assisted radical prostatectomy are scarce. The objective of our study was to explore the impact of age and body mass index (BMI) on postoperative incontinence, and the impact of such incontinence and urinary symptoms on QoL.

MATERIAL AND METHODS

Two hundred and seventy two patients undergoing robotic-assisted radical prostatectomy answered the questionnaires ICIQ-UI short-form (evaluating UI) and EORTC QoL PR25 (evaluating QoL) in the preoperative setting, then at 1, 3, 12 et 24 months after surgery. Data regarding bother due to UI and urinary symptoms were extrapolated and calculated from the EORT PR25 questionnaire. The modification of ICIQ, of the bother from UI and of urinary symptoms was compared between the preoperative and the early (1-3 months) and late postoperative period (12-24 months). Differences of these scores were explored across non-obese and obese patients, as well as across different age groups. Chi-squared and logistic regression models were performed to test the association between BMI, age and ICIQ score, the bother from UI and urinary symptom score.

RESULTS

Median age was 64 years and median BMI was 26.4kg/m². After surgery, all scores (ICIQ, bother from UI and urinary symptoms) were significantly modified and worsened compared to preoperative values; in particular, median ICIQ passed from 1 to 10, 20% of patients were highly bothered by their urinary symptoms (compared to 2% in the preoperative setting) and the urinary score symptom passed from 8% to 33%. We observed a progressive amelioration of all scores of late controls (12-24 months), with a significantly improved QoL. Across BMI groups, we did not observe any significant difference in terms of modification of ICIQ, of the bother from UI or of urinary symptoms. Moreover, on multivariate logistic regression, BMI was not a risk factor for UI at neither 1 month (P>0.35) nor 12 months (P=0.35). On the other hand, age was significantly associated to an increased risk of UI in the immediate postoperative period on multivariate analysis (P<0.001). Indeed, the rate of patients with an ICIQ≥1 in the immediate postoperative period was higher in men>60 years old compared to younger men<60 years (96% vs 78%, P<0.001). When exploring the QoL scores, we did not observe any significant association between age and QoL, with the exception of an inversion correlation between age and urinary symptoms at 1 month after surgery (P=0.01).

CONCLUSION

In this study, after robotic-assisted radical prostatectomy, older men appear to be at increased risk of immediate postoperative incontinence when compared to their younger counterparts, although their QoL is less likely to be bothered. BMI instead was not significantly associated to either urinary incontinence nor to QoL scores as bother form UI and urinary symptoms.

LEVEL OF EVIDENCE

4.

Metabolic syndrome in the development and progression of prostate cancer

Prostate cancer (PCa) is the most common noncutaneous malignancy and second leading cause of cancer-specific mortality for men in the United States. There is a wide spectrum of aggressiveness ranging from biologically significant to indolent disease, which has led to an interest in the identification of risk factors for its development and progression. Emerging evidence has suggested an association between metabolic syndrome (MetS) and PCa. MetS represents a cluster of metabolic derangements that confer an increased risk of cardiovascular disease and type 2 diabetes mellitus. Its individual components include obesity, dyslipidemias, high blood pressure, and high fasting glucose levels. MetS has become pervasive and is currently associated with a high socioeconomic cost in both industrialized and developing countries throughout the world. The relationship between MetS and PCa is complex and yet to be fully defined. A better understanding of this relationship will facilitate the development of novel therapeutic targets for the prevention of PCa and improvement of outcomes among diagnosed men in the future. In this review, we evaluate the current evidence on the role of MetS in the development and progression of PCa. We also discuss the clinical implications on the management of PCa and consider the future direction of this subject.

The effect of BMI on clinicopathologic and functional outcomes after open radical prostatectomy

OBJECTIVES

To analyze the effect of body mass index (BMI) on pathologic and functional outcomes after open radical retropubic prostatectomy.

PATIENTS AND METHODS

We retrospectively analyzed 2,471 patients who underwent RP. Clinicopathologic and patient characteristics were compared with respect to patients' BMI (normal weight: BMI < 25 kg/m(2) [n = 795], overweight: BMI ≥ 25 kg/m(2) and < 30 kg/m(2) [n = 1305], and obese: BMI ≥ 30 kg/m(2) [n = 371]). Multivariable logistic and linear regression models were used to quantify the effect of BMI on pathologic and functional outcomes.

RESULTS

Compared with normal weight patients, overweight and obese patients demonstrated higher pathologic Gleason grade and higher pathologic T stage, without any difference in preoperative prostate-specific antigen levels. Overweight and obese men were less likely to have a negative surgical margin (odds ratio (OR) 0.74 [confidence interval (CI) 0.65-0.84, P<0.001] for overweight men and OR 0.66 [CI 0.49-0.89, P<0.01] for obese men) and had a lower rate of postoperative erectile function (OR 0.60 [CI 0.48-0.76, P<0.001] for overweight patients and OR 0.34 [CI 0.27-0.44, P<0.001] for obese patients). Moreover, duration of surgery and intraoperative blood loss increased significantly with an increase in BMI. When using BMI as a continuous variable, the same trends were demonstrated. However, a lower rate of continence was not evident for overweight or obese men.

CONCLUSIONS

In contrast to many other studies, in this cohort of patients with prostate cancer, BMI was an independent risk factor for most analyzed pathologic and functional outcomes after radical prostatectomy, including negative surgical margin, potency, duration of surgery, and intraoperative blood loss.

Factors predicting early return of continence after radical prostatectomy

Success of radical prostatectomy is measured by control of cancer and return of urinary and sexual function. Urinary incontinence is generally considered the greatest impairment in immediate postoperative urinary function. Multiple factors are associated with earlier return of urinary continence after radical prostatectomy. These factors can be divided into those known prior to surgery, and therefore possibly not modifiable, and factors that can be controlled during surgery or surgical planning. In addition, various postoperative maneuvers can help hasten urinary continence. This article examines the effect of known factors related to early return of urinary continence after radical prostatectomy.

Risk of urinary incontinence following prostatectomy: the role of physical activity and obesity

PURPOSE

Urinary incontinence is one of the most commonly reported and distressing side effects of radical prostatectomy for prostate carcinoma. Several studies have suggested that symptoms may be worse in obese men but to our knowledge no research has addressed the joint effects of obesity and a sedentary lifestyle. We evaluated the association of obesity and lack of physical activity with urinary incontinence in a sample of men who had undergone radical prostatectomy.

MATERIALS AND METHODS

Height and weight were abstracted from charts, and obesity was defined as body mass index 30 kg/m(2) or greater. Men completed a questionnaire before surgery that included self-report of vigorous physical activity. Men who reported 1 hour or more per week of vigorous activities were considered physically active. Men reported their incontinence to the surgeon at their urology visits. Information on incontinence was abstracted from charts at 6 and 58 weeks after surgery.

RESULTS

At 6 weeks after surgery 59% (405) of men were incontinent, defined as any pad use. At 58 weeks after surgery 22% (165) of men were incontinent. At 58 weeks incontinence was more prevalent in men who were obese and physically inactive (59% incontinent). Physical activity may offset some of the negative consequences of being obese because the prevalence of incontinence at 58 weeks was similar in the obese and active (25% incontinent), and nonbese and inactive (24% incontinent) men. The best outcomes were in men who were nonobese and physically active (16% incontinent). Men who were not obese and were active were 26% less likely to be incontinent than men who were obese and inactive (RR 0.74, 95% CI 0.52-1.06).

CONCLUSIONS

Pre-prostatectomy physical activity and obesity may be important factors in post-prostatectomy continence levels. Interventions aimed at increasing physical activity and decreasing weight in patients with prostate cancer may improve quality of life by offsetting the negative side effects of treatment.

Dietary intervention in the management of prostate cancer

PURPOSE OF REVIEW

This review integrates recent reports related to the dietary management of prostate cancer with the existing body of science in an effort to best inform practicing clinicians.

RECENT FINDINGS

Dietary factors are hypothesized to play a significant role in prostate cancer, and have proven to be important in managing prevalent comorbidities in this patient population (cardiovascular disease, diabetes, and osteoporosis). Data regarding diet and prostate cancer are accumulating and randomized controlled trials are underway which will ultimately yield evidence on which to base recommendations regarding dietary regimens, functional foods, and supplement use. Until that time, most data derive from epidemiologic studies that have limitations in showing cause and effect. During the past year, the greatest and most consistent strides have been made in the area of energy balance, with data consistently showing that overweight and obesity are associated with progressive disease and increased overall mortality.

SUMMARY

To date, the strongest evidence regarding diet and prostate cancer relates to energy balance. Urologists aspiring to best clinical practice should encourage their patients to achieve a healthful body weight through regular exercise and a healthful plant-based diet rich in fruits, vegetables, and whole grains. Advocating functional foods or supplements explicitly for cancer control purposes would currently be premature.

The impact of obesity on prostate cancer

Increasing prevalence of obesity in many parts of the world emphasizes the importance of learning more about the relationship between obesity and prostate cancer (PC). The present paper reviews the impact of obesity on PC using knowledge obtained from the available literature. Search of published literature in PUBMED database. Adipose tissue constitutes an active endocrine and metabolic organ which may be relevant in the development and progression of PC by different potential mechanisms. Furthermore, obesity could have an impact on the outcome of different treatment modalities for PC, both functionally as anatomically. Obesity is a growing problem, however, the exact role in the development and progression of PC has not been elucidated. Regarding the optimal treatment of PC in obese patients, comparative prospective studies are needed.