1
|
Determining the component-based operative time learning curve for robotic-assisted radical prostatectomy. Curr Urol 2022; 16:240-245. [PMID: 36714228 PMCID: PMC9875207 DOI: 10.1097/cu9.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/04/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives To determine the learning curve (LC) of total operative time and the discrete components of the robotic-assisted radical prostatectomy (RARP) for a recent robotic fellowship-trained urologic surgeon. Materials and methods We performed a retrospective analysis of RARP procedures performed by a single new attending surgeon from August 2015 to April 2019. Patients' demographics and operative details were assessed. Total operative time was divided and prospectively recorded in 7 parts: (a) docking robot, (b) dissecting seminal vesicles (SVs) (c) dissecting endopelvic fascia (EPF), (d) incising bladder neck (BN), (e) completing the dissection, (f) lymph node dissection, and (g) urethrovesical anastomosis (UVA) and robot undocking. Cumulative sum analysis was used to ascertain the LC for total operative time and the 7 parts of the procedure. Results One hundred twenty consecutive RARPs were performed. The LC was overcome at 25 cases for total operative time, 13 cases for docking the robot, 33 cases for dissecting SVs, 31 cases for dissecting EPF, 46 cases for incising BN, 38 cases for prostate dissection, 25 cases for lymph node dissection, and 52 cases for UVA. Total operative time was decreased 22.8% (p < 0.0001) and time for robot docking, dissecting SVs, dissecting EPF, incising BN, completing prostate dissection, lymph node dissection, and UVA were decreased 16.7%, 30.5%, 29.5%, 36.2%, 37.3%, 32.2%, and 26.9%, respectively (all p < 0.05). Conclusions We observed a 25-case LC for a fellowship-trained urologist to achieve stable operative performance of RARP surgery. Procedural components demonstrated variable LCs including the UVA that required upward of 52 cases.
Collapse
|
2
|
Yao HH, Bazo A, Ball K, Terry TR, Walton TJ. Utilisation of anatomic grading of nerve-spare during robot-assisted radical prostatectomy to prognosticate erectile function recovery. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine if a precise 5-point nerve-spare (NS) scoring system at the time of robot-assisted radical prostatectomy (RARP) correlates with post-operative erectile function recovery (EFR). Patients and methods: From 2014 to 2018, 277 patients underwent RARP by a single surgeon. NS quality was recorded as: grade 1, non-NS; grade 2, <50%; grade 3, 50%; grade 4, 75%; grade 5, ⩾95%. EFR rates were compared using Fisher’s exact test or Pearson’s chi-square test at 3–24 months, grouped based on the degree of NS: 1 = bilateral full NS (grade 5); 2 = bilateral NS with one good NS (⩾grade 4); 3 = unilateral good NS; 4 = incremental NS (grade 3); 5 = partial neurovascular bundle (NVB) resection (grade 2); 6 = complete NVB resection (grade 1). Results: At 24 months, EFR defined as Sexual Health Inventory for Men (SHIM) score ⩾17 was 75%, 55%, 41%, 23%, 12% and 0% for groups 1–6, respectively ( p = 0.001). EFR defined as spontaneous erection sufficient for intercourse with or without PDE5i was 60%, 58%, 40%, 33%, 0% and 11% for groups 1–6, respectively ( p < 0.001). Conclusion: A precise anatomic NS scoring system at RARP allows good prognostication of EFR, which may inform patient counselling and erectile dysfunction management. Level of evidence: 4
Collapse
Affiliation(s)
- Henry H Yao
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
- Eastern Health Clinical School, Monash University, Australia
| | - Alvaro Bazo
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| | - Kathryn Ball
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| | - Timothy R Terry
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| | - Thomas J Walton
- Department of Urology, Nottingham University Hospitals NHS Trust, UK
| |
Collapse
|
3
|
Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter? Cancers (Basel) 2021; 14:cancers14010013. [PMID: 35008178 PMCID: PMC8749855 DOI: 10.3390/cancers14010013] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Prostate cancer is the second most common noncutaneous malignancy in men. Prostatectomy is a commonly used treatment modality for selected patients. The prostate’s ill-defined borders and its vicinity with vital structures complicate the wide excision of the organ, resulting in positive margins of resection. Neoplastic infiltration of margins of resection in prostatectomy specimens affects patients’ prognosis. The surgical technique and surgeons’ expertise affect the incidence of margin positivity. The location and the extent of positive margins diversify the risk of recurrence, with basal infiltration and multifocal foci of positive margins behaving more aggressively. Pathologists are encouraged to thoroughly report the status of margins of resection, as they provide important information for patients’ prognosis and enable the clinician to decide upon the most appropriate subsequent therapeutic steps. Abstract Prostate cancer is the second most common malignancy in men, and prostatectomy is the treatment of choice for most patients with at least low risk of progression. The presence of positive margins in the radical prostatectomy specimen is considered an adverse pathologic feature, and may prompt additional therapeutic intervention in the patients. The absence of a distinct capsule around the prostate and intraoperative manipulations that aim to minimize postoperative adverse effects, complicate its wide removal. Proper handling of the specimen during the gross processing is essential for accurate determination of the status of margins or resection. Positive margins, defined as the presence of neoplastic glands in the highlighted-with-ink margin of resection, range from 6–38%. The surgical technique, surgeon’s expertise and tumor (i.e., grade and stage) and patients’ (i.e., BMI) characteristics affect the rate of margin positivity. Extensive or multifocal and nonanterior/nonapical positive margins are linked with higher recurrence rates, especially in organ-confined disease, underscoring the need for treating these patients more aggressively. In summary, detailed description of the status of the margins should be performed in every pathology report to determine patients’ prognosis and the most appropriate therapeutic plan.
Collapse
|
4
|
Jurys T, Burzynski B, Potyka A, Paradysz A. Post-Radical Prostatectomy Erectile Dysfunction Assessed Using the IIEF-5 Questionnaire - A Systematic Literature Review. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 34:55-64. [PMID: 38595677 PMCID: PMC10903601 DOI: 10.1080/19317611.2021.1936333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 04/11/2024]
Abstract
Erectile dysfunction is common postoperative complication after radical prostatectomy. The aim of this study is to evaluate erectile dysfunction among the population of men who have undergone radical prostatectomy. Finally, 21 articles are included in the current qualitative analysis. The results suggest that recovery in potency occurs after 12 months after surgery, and that different adjuvant treatment can be used to accelerate recovery and increase effectiveness. However, conclusions are not derived from all the selected articles, but are rather based on those which present clear numerical scores according to the IIEF-5 questionnaire.
Collapse
Affiliation(s)
- Tomasz Jurys
- Doctoral School, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Bartlomiej Burzynski
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Potyka
- Institute of Education and Communication Research, Silesian University of Technology in Gliwice, Gliwice, Poland
| | - Andrzej Paradysz
- Department of Urology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| |
Collapse
|
5
|
Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study. Curr Urol 2021; 15:111-114. [PMID: 34168530 PMCID: PMC8221013 DOI: 10.1097/cu9.0000000000000016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background: To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction. Materials and methods: Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months. Results: Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05). Conclusions: Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.
Collapse
|
6
|
Implementation of Intraoperative Frozen Section During Radical Prostatectomy: Short-term Results from a German Tertiary-care Center. Eur Urol Focus 2021; 7:95-101. [DOI: 10.1016/j.euf.2019.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/02/2019] [Accepted: 03/11/2019] [Indexed: 02/08/2023]
|
7
|
Stroberg P, Ljunggren C, Sherif A. Sustainable long-term results on postoperative sexual activity after radical prostatectomy when a clinical sexologist is included in the sexual rehabilitation process. A retrospective study on 7 years postoperative outcome. Cent European J Urol 2020; 73:551-557. [PMID: 33552583 PMCID: PMC7848825 DOI: 10.5173/ceju.2020.0079r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/25/2020] [Accepted: 09/06/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this study was to perform a retrospective evaluation of long-term sustainability of a postoperative combined penile and sexual rehabilitation program involving a clinical sexologist (CS) for preoperative fully potent men undergoing daVinci robotic radical prostatectomy (dVRP) regardless of whether preservation of the neurovascular bundles was performed or not. Material and methods The study included 79 preoperatively potent and sexually active patients (aged 45–74 years, mean 61) that had undergone a dVRP due to localized prostate cancer and during the 1st postoperative year participated in a combined penile and sexual rehabilitation program involving a CS. The subjects were followed up with the same interview and questionnaires at approximately 1, 3 and 7 years postoperatively. The interview and questionnaires addressed erectile function (EF), erectile dysfunction (ED) treatment, frequency of penetrating sexual activity, patient’s perceptions of sexual life (LISAT-8). Results One year postoperatively, 84% of patients were sexually active with penetrating sex, 15% with unassisted normal erections. 45% found their postoperative sexual life satisfactory (LISAT-8, question #6). Three years postoperatively, 76 patients were evaluable, 73% were sexually active with penetrating sex, 19% with unassisted normal erections. Furthermore, 56% of patients found their postoperative sexual life to be satisfactory. Seven years postoperatively, 74 patients were evaluable, 74% were sexually active with penetrating sex, 44% with unassisted normal erections. A total of 59% of patients found their postoperative sexual life to be satisfactory. The reasons for not having penetrating sex were diverse. Conclusions Involvement of a CS in a postoperative combined penile and sexual rehabilitation program appears to improve the possibility of an acceptable sexual life and function one year after surgery. These results appear to be sustainable in the long-term.
Collapse
Affiliation(s)
- Peter Stroberg
- Umea Universitet Medicinska Fakulteten, Surgical and Perioperative Sciences, Urology and Andrology, Umea, Sweden.,Lanssjukhuset Ryhov, Department of Urology, Jonkoping, Sweden
| | | | - Amir Sherif
- Umea Universitet Medicinska Fakulteten, Surgical and Perioperative Sciences, Urology and Andrology, Umea, Sweden
| |
Collapse
|
8
|
Mullins BT, Basak R, Broughman JR, Chen RC. Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: Analysis of a population-based prospective cohort. Cancer 2019; 125:3657-3665. [PMID: 31256432 PMCID: PMC6763377 DOI: 10.1002/cncr.32288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/27/2019] [Accepted: 04/29/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although patients with prostate cancer face many treatment options, to the authors' knowledge the comparative effects of different surgical and radiotherapy (RT) options on sexual function are unclear. METHODS In the current study, a population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited throughout North Carolina in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. All men were enrolled prior to treatment and followed prospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. This analysis compares the sexual dysfunction scores of the PCSI among patients who received external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. Propensity scores were used to balance patient characteristics across groups, and multiple imputation was used for missing data. RESULTS EBRT and brachytherapy resulted in similar PCSI scores through 24 months. Compared with those receiving EBRT, patients treated with EBRT with ADT and RP with or without nerve sparing were found to have worse PCSI scores at all posttreatment time points. Preservation of useful sexual function at 24 months was associated with treatment type, baseline score, and age. Predicted preservation rates were 14.1% to 70.7% for EBRT, 8.4% to 52.3% for EBRT with ADT, 4.7% to 45.3% for nerve-sparing RP, and 4.8% to 34.5% for non-nerve-sparing RP. CONCLUSIONS The findings of the current study indicate that RT alone results in the best preservation of sexual function, and brachytherapy provides similar outcomes. RT with ADT and nerve-sparing RP yielded similar outcomes, whereas patients treated with non-nerve-sparing RP experienced the worst sexual function. These results help patients to make decisions among the specific types of surgery and RT they face based on each individual's diagnosis.
Collapse
Affiliation(s)
- Brandon T Mullins
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ramsankar Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James R Broughman
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
9
|
Geuna S, Muratori L, Fregnan F, Manfredi M, Bertolo R, Porpiglia F. Strategies to improve nerve regeneration after radical prostatectomy: a narrative review. MINERVA UROL NEFROL 2018; 70:546-558. [PMID: 30037210 DOI: 10.23736/s0393-2249.18.03157-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peripheral nerves are complex organs that spread throughout the entire human body. They are frequently affected by lesions not only as a result of trauma but also following radical tumor resection. In fact, despite the advancement in surgical techniques, such as nerve-sparing robot assisted radical prostatectomy, some degree of nerve injury may occur resulting in erectile dysfunction with significant impairment of the quality of life. The aim of this review was to provide an overview on the mechanisms of the regeneration of injured peripheral nerves and to describe the potential strategies to improve the regeneration process and the functional recovery. Yet, the recent advances in bio-engineering strategies to promote nerve regeneration in the urological field are outlined with a view on the possible future regenerative therapies which might ameliorate the functional outcome after radical prostatectomy.
Collapse
Affiliation(s)
- Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy - .,Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, Turin, Italy -
| | - Luisa Muratori
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, Turin, Italy
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi (NICO), Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Bertolo
- Department of Oncology, University of Turin, Orbassano, Turin, Italy.,Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|
10
|
Wang F, Rudin C, Mccormick TH, Gore JL. Modeling recovery curves with application to prostatectomy. Biostatistics 2018; 20:549-564. [DOI: 10.1093/biostatistics/kxy002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/22/2017] [Indexed: 11/14/2022] Open
Abstract
Summary
In many clinical settings, a patient outcome takes the form of a scalar time series with a recovery curve shape, which is characterized by a sharp drop due to a disruptive event (e.g., surgery) and subsequent monotonic smooth rise towards an asymptotic level not exceeding the pre-event value. We propose a Bayesian model that predicts recovery curves based on information available before the disruptive event. A recovery curve of interest is the quantified sexual function of prostate cancer patients after prostatectomy surgery. We illustrate the utility of our model as a pre-treatment medical decision aid, producing personalized predictions that are both interpretable and accurate. We uncover covariate relationships that agree with and supplement that in existing medical literature.
Collapse
Affiliation(s)
- Fulton Wang
- Department of EECS, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, USA
| | - Cynthia Rudin
- Department of Computer Science, Duke University, LSRC D342, Research Drive, Durham, NC, USA
| | - Tyler H Mccormick
- Department of Statistics and Department of Sociology, University of Washington, Seattle, WA, USA
| | - John L Gore
- Department of Urology, University of Washington, 959 NE Pacific St, Seattle, WA, USA
| |
Collapse
|
11
|
Seikkula H, Janssen P, Tutolo M, Tosco L, Battaglia A, Moris L, Van den Broeck T, Albersen M, De Meerleer G, Van Poppel H, Everaerts W, Joniau S. Comparison of Functional Outcome after Extended versus Super-Extended Pelvic Lymph Node Dissection during Radical Prostatectomy in High-Risk Localized Prostate Cancer. Front Oncol 2017; 7:280. [PMID: 29214148 PMCID: PMC5702642 DOI: 10.3389/fonc.2017.00280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/06/2017] [Indexed: 11/23/2022] Open
Abstract
Background Urinary continence and erectile function (EF) are best preserved when meticulous dissection of prostate and nerve sparing technique are used during radical prostatectomy (RP). However, extent of lymph node dissection (LND) may also adversely affect functional results. Objective To determine whether performing a super-extended LND (seLND) has a significant effect on recovery of urinary continence and EF after RP. Design, setting, and participants All patients who underwent RP from January 2007 until December 2013 were handed questionnaires assessing continence and EF. All patients in whom at least an extended LND (eLND) was performed were selected. This search yielded 526 patients. 172 of these patients had filed out 2 or more questionnaires and were included in our analysis. Outcome measurements and statistical analysis All questionnaires were reviewed. We used Kaplan–Meier analyses and multivariate Cox analysis to assess the difference in recovery of continence and EF over time for eLND/seLND. Primary endpoints were full recovery of continence (no loss of urine) and full recovery of EF (successful intercourse possible). Patients who did not reach the endpoint when the last questionnaire was filled out were censored at that time. Median follow-up was 12.43 months for continence, and 18.97 months for EF. Results and limitations Patients undergoing seLND have a lower chance of regaining both urinary continence [hazard ratio (HR) 0.59, 95% CI 0.39–0.90, p = 0.026] and EF (HR 0.28, 95% CI 0.13–0.57, p = 0.009). Age at surgery had a significant influence on both continence and EF in multivariate analysis. Major limitation of the study was that no formal preoperative assessment of continence and potency was done. Conclusion Extending the LND template beyond the eLND template may cause at least a significant delay in recovery of urinary continence and leads to less recovery of EF.
Collapse
Affiliation(s)
- Heikki Seikkula
- Department of Urology, Central Finland Hospital District, Jyväskylä, Finland.,Department of Urology, University Hospital, Turku, Finland
| | - Pieter Janssen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lorenzo Tosco
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
12
|
Altok M, Achim MF, Matin SF, Pettaway CA, Chapin BF, Davis JW. A decade of robot-assisted radical prostatectomy training: Time-based metrics and qualitative grading for fellows and residents. Urol Oncol 2017; 36:13.e19-13.e25. [PMID: 28964658 DOI: 10.1016/j.urolonc.2017.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES As modern urology residency and fellowship training in robot-assisted surgery evolves toward standardized curricula (didactics, dry/wet-laboratory exercises, and surgical assistance), additional tools are needed to evaluate on-console performance. At the start of our robotics program in 2006, we set-up a time- and quality-based evaluation program and aim to consolidate this data into a simple set of metrics for self-evaluation. MATERIALS AND METHODS Using our index procedure of robot-assisted radical prostatectomy (RARP), we prospectively collected data on 2,215 cases over 10 years from 6 faculty surgeons and 94 trainees (43 urologic oncology fellows and 51 urology residents). The steps of the operation were divided into 11 consistent steps, and the metrics included time to completion and quality using a 6-level grading system. Time metrics were consolidated into quartiles for benchmarking. RESULTS The median times for trainees to complete each step were 15% to 120% higher than those of the staff (P<0.001). Each step can be presented with quartile-based time metrics by pooled trainee and staff results. Steps performed by trainees were carefully chosen for a high success rate, and on our Likert-like scale were graded 4 to 5 in more than 95% of cases. There were no grade 0 (very poor) cases, and grades 1 (multiple technical errors) and 2 (could not be completed but without safety issues) were rare (<1%). CONCLUSIONS RARP training can be evaluated with a time-based metric that allows a quartile-based comparison to a large experience of trainees and staff. As a trainee progress through a rotation, these benchmarks can assist in prioritizing the need for more attention to a basic step vs. progression to more advanced steps.
Collapse
Affiliation(s)
- Muammer Altok
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Mary F Achim
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | | | - Brian F Chapin
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - John W Davis
- Department of Urology, MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
13
|
Hamidi N, Altinbas NK, Gokce MI, Suer E, Yagci C, Baltaci S, Turkolmez K. Preliminary results of a new tool to evaluate cavernous body fibrosis following radical prostatectomy: penile elastography. Andrology 2017; 5:999-1006. [DOI: 10.1111/andr.12408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022]
Affiliation(s)
- N. Hamidi
- Department of Urology; Atatürk Training and Research Hospital; Ankara Turkey
| | - N. K. Altinbas
- Department of Radiology; Ankara University School of Medicine; Ankara Turkey
| | - M. I. Gokce
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| | - E. Suer
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| | - C. Yagci
- Department of Radiology; Ankara University School of Medicine; Ankara Turkey
| | - S. Baltaci
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| | - K. Turkolmez
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| |
Collapse
|
14
|
O'Callaghan ME, Raymond E, Campbell J, Vincent AD, Beckmann K, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti K. Tools for predicting patient-reported outcomes in prostate cancer patients undergoing radical prostatectomy: a systematic review of prognostic accuracy and validity. Prostate Cancer Prostatic Dis 2017; 20:378-388. [DOI: 10.1038/pcan.2017.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/20/2017] [Accepted: 03/30/2017] [Indexed: 11/09/2022]
|
15
|
Caillet K, Lipsker A, Alezra E, De Sousa P, Pignot G. [Surgical approach and sexual outcomes after radical prostatectomy]. Prog Urol 2017; 27:283-296. [PMID: 28392432 DOI: 10.1016/j.purol.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 01/23/2017] [Accepted: 03/07/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Radical prostatectomy is curative surgical treatment of choice for localized prostate cancer. The objectives are cancer control, preservation of continence and preservation of sexuality, the combination of the three constituting the Trifecta. OBJECTIVE The objective of this study was to assess, through the analysis of the literature, the sexual outcomes according to surgical approach: radical prostatectomy by laparotomy (PRL), laparoscopic radical prostatectomy (PRLa) and laparoscopic robot-assisted radical prostatectomy (PRLaRA), when nerve sparing was practiced. METHODS An exhaustive and retrospective review of literature was conducted using the Pubmed search with the following keywords: "Prostatic Neoplasms" [Mesh], "Prostatectomy" [Mesh], "Erectile Dysfunction" [Mesh], "Robotics" [Mesh], "Laparoscopy" [Mesh], Nerve sparing. SELECTION CRITERIA The selected articles were prospective or retrospective series including more than 200 patients, randomized trials and meta-analyses published between 1990 and 2014. RESULTS A total of 21 prospective studies (6 on PRL, 4 on PRLa and 11 on PRLaRA), 12 retrospective studies (6 on PRL, 1 on PRLa and 5 on PRLaRA), 2 randomized controlled trial and 3 meta-analyses were selected from 1992 to 2013. There was no evidence of the superiority of one surgical approach compared to others in terms of sexuality. LIMITS Articles with level 1 of scientific evidence have discordant results, due to heterogeneity in the assessment criteria of postoperative sexual function. CONCLUSION According to our knowledge, there is currently no difference in terms of sexual outcomes between PRL, PRLA and PRLaRA approaches.
Collapse
Affiliation(s)
- K Caillet
- Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France.
| | - A Lipsker
- Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - E Alezra
- Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - P De Sousa
- Service d'urologie-transplantation, université de Picardie-Jules-Verne, CHU Amiens-Picardie, avenue René-Laennec, 80054 Amiens cedex 1, France
| | - G Pignot
- Service d'urologie, chirurgie oncologique 2, institut Paoli-Calmettes, 232, boulevard de Sainte Marguerite, 13009 Marseille, France
| |
Collapse
|
16
|
Ljunggren C, Ströberg P. Improvement in sexual function after robot-assisted radical prostatectomy: A rehabilitation program with involvement of a clinical sexologist. Cent European J Urol 2015; 68:214-20. [PMID: 26251748 PMCID: PMC4526602 DOI: 10.5173/ceju.2015.484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION To prospectively evaluate if the inclusion of a clinical sexologist in a penile and sexual rehabilitation program improves sexual function one year after prostate cancer surgery. MATERIAL AND METHODS Twelve months after da Vinci Radical Prostatectomy (dVRP) for prostate cancer, 28 fully potent (IIEF-5 >21) and sexually active men (ages 47-69 years, mean 61) who, in 2008, were enrolled in a prospectively monitored penile rehabilitation program (reference group) were compared with 79 fully potent (IIEF-5 >21) and sexually active men (ages 45-74 years, mean 61) enrolled in 2009 (study group); whose program differed by the inclusion of evaluation and treatment by a clinical sexologist. RESULTS Twelve months after dVRP, seventeen patients in the reference group (61%) were sexually active with regular penetrating sexual activity compared to sixty-six (84%) in the study group (p = 0.02). These findings were independent of whether they had undergone a nerve sparing or non-nerve sparing procedure. Almost 94% (74 patients) in the study group had at some time been able to perform penetrating sexual activity; 14 patients required additional visits to the clinical sexologist beyond the routine follow-up, 9 for short-term cognitive behavior therapy. CONCLUSIONS Inclusion of a clinical sexologist in a penile and sexual rehabilitation program appears to improve the ability to have regular sexual activity with penetrating sex one year after da Vinci Robotic Radical Prostatectomy.
Collapse
Affiliation(s)
| | - Peter Ströberg
- Department of Urology, Länssjukuset Ryhov, Jönköping, Sweden
| |
Collapse
|
17
|
Kang SG, Schatloff O, Haidar AM, Samavedi S, Palmer KJ, Cheon J, Patel VR. Does surgeon subjective nerve sparing score predict recovery time of erectile function following robot-assisted radical prostatectomy? J Sex Med 2015; 12:1490-6. [PMID: 25689342 DOI: 10.1111/jsm.12844] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION During robot-assisted radical prostatectomy (RARP), the quality of nerve sparing (NS) was usually classified by laterality of NS (none, unilateral, and bilateral) or degree of NS (none, partial, and full). Recently, side-specific NS have been more frequently performed, but previous NS grading system might not reflect the differential NS in each side. AIM Herein, we assessed whether a subjective NS score (NSS) incorporating both degree of NS and NS laterality can predict the time to potency recovery following RARP. METHODS Data were analyzed from 1,898 patients who had left and right neurovascular bundle sparing quality scores and at least one year of follow-up after RARP was performed between January 2008 and October 2011. MAIN OUTCOME MEASURES Cox proportional hazard method analyses were used to determine predictive factors for early recovery. Multivariate linear regression models were used to assess subjective NSS in an effort to predict time to potency recovery. Subjective NSSs were compared to a model based on the three grades according to laterality and degree. RESULTS Time to potency recovery showed a statistically significant difference in favor of higher NSS by the Cox proportional hazard regression analysis (NSS 0 vs. NSS 5-6, 7-8, and 9-10; P < 0.01). The regression model indicated that the statistical significance of the subjective NSS covering the differential NS is not different from that of the conventional three-grade scales, while it has a higher R(2). The regression equation with subjective NSS was as follows: Log (Time) = 5.163 - (0.035 × SHIM Score) + 0.028 Age - (0.101 × Subjective NSS). CONCLUSION The subjective NSS can reflect NS degree for each side based on the visual cues. Regression model can be used to help inform the patient about the time to postoperative potency regain, which is an important patient concern following RARP.
Collapse
Affiliation(s)
- Sung Gu Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Oscar Schatloff
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA.,University of Central Florida School of Medicine, Orlando, FL, USA
| | - Abdul Muhsin Haidar
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA.,University of Central Florida School of Medicine, Orlando, FL, USA
| | - Srinivas Samavedi
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA.,University of Central Florida School of Medicine, Orlando, FL, USA
| | - Kenneth J Palmer
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA.,University of Central Florida School of Medicine, Orlando, FL, USA
| | - Jun Cheon
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Vipul R Patel
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA.,University of Central Florida School of Medicine, Orlando, FL, USA
| |
Collapse
|
18
|
Kim JH, Lee SW. Current status of penile rehabilitation after radical prostatectomy. Korean J Urol 2015; 56:99-108. [PMID: 25685296 PMCID: PMC4325125 DOI: 10.4111/kju.2015.56.2.99] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/12/2014] [Indexed: 12/23/2022] Open
Abstract
Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
Collapse
Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Wook Lee
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Strine AC, Rice KR, Masterson TA. Metabolic syndrome in the development and progression of prostate cancer. World J Clin Urol 2014; 3:168-183. [DOI: 10.5410/wjcu.v3.i3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/12/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
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.
Collapse
|
20
|
Shi MJ, Yang J, Meng XY, Li S, Liu T, Fang ZH, Cao R, Wang XH. Comparison of functional outcomes after retropubic, laparoscopic and robot-assisted radical prostatectomy: A meta-analysis. World J Meta-Anal 2014; 2:107-126. [DOI: 10.13105/wjma.v2.i3.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/10/2014] [Accepted: 06/18/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the 6-mo and 12-mo functional outcomes after retropubic, laparoscopic and robot-assisted laparoscopic radical prostatectomy retropubic radical prostatectomy (RRP) laparoscopic radical prostatectomy (LRP); robot-assisted laparoscopic prostatectomy (RARP).
METHODS: A literature search was conducted using the PubMed, EMBASE, The Cochrane Library and the Web of Knowledge databases updated to March, 2014 for relevant published studies. After data extraction and quality assessment via the Newcastle-Ottawa Scale or the Cochrane collaboration’s tool for assessing risk of bias, meta-analysis was performed using RevMan 5.1. Either a random-effects model or a fixed-effects model was used. Potential publication bias was assessed using visual inspection of the funnel plots, and verified by the Egger linear regression test.
RESULTS: Thirty-seven studies were identified in total: 14 articles comparing LRP with RRP, 12 articles comparing RARP with RRP, and 11 articles comparing RARP with LRP. For urinary continence, a statistically significant advantage was observed in RARP compared with LRP or RRP both at 6 mo [odds ratio (OR) = 1.93; P < 0.01, OR = 2.23; P < 0.05, respectively] and 12 mo (OR = 1.47; P < 0.01, OR = 2.93; P < 0.01, respectively) postoperatively. The continence recovery rates after LRP and RRP, with obvious heterogeneity (6-mo: I2 = 74%; 12-mo: I2 = 75%), were equivalent (6-mo: P = 0.52; 12-mo: P = 0.75). In terms of potency recovery, for the first time, we ranked the three surgical approaches into a superiority level: RARP > LRP > RRP, with a statistically significant difference at 12 mo [RARP vs LRP (OR = 1.99; P < 0.01); RARP vs RRP (OR = 2.66; P < 0.01); LRP vs RRP (OR = 1.34; P < 0.05)], respectively. Meta-regression and subgroup analyses according to adjustment of the age, body mass index, prostate volume, Gleason score or prostate-specific antigen did not vary significantly.
CONCLUSION: Current evidence suggests that minimally invasive approaches (RARP or LRP) are effective procedures for functional recovery. However, more high-quality randomized control trials investigating the long-term functional outcomes are needed.
Collapse
|
21
|
Turner GA, Harris CA, Eglinton TW, Wakeman CJ, Kueppers F, Dixon L, Dobbs BR, Frizelle FA. Cystoprostatectomy versus prostatectomy alone for locally advanced or recurrent pelvic cancer. ANZ J Surg 2014; 86:54-8. [PMID: 25113257 DOI: 10.1111/ans.12808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is minimal published data evaluating the oncological outcome of rectal resection with prostatectomy alone versus rectal resection with cystoprostatectomy in patients undergoing pelvic exenteration for locally advanced or recurrent pelvic cancer. This study aims to evaluate the oncological and functional outcomes of performing rectal resection with prostatectomy alone compared with rectal resection with cystoprostatectomy in patients undergoing pelvic exenteration. METHODS Consecutive patients undergoing pelvic exenteration for locally advanced or recurrent pelvic cancer between 1998 and 2012 were identified from a prospectively maintained database. Patients undergoing rectal resection with prostatectomy alone were compared with a control group who underwent rectal resection with cystoprostatectomy and urostomy formation. The primary outcome was overall survival. Secondary outcomes analysed in the prostatectomy group included completeness of resection, continence and erectile function. RESULTS Eleven rectal resections with prostatectomy were compared with 20 rectal resections with cystoprostatectomy. R0 resection was achieved in 73 and 65% respectively. There was no difference in overall survival (P = 0.40). Urinary continence was achieved in 36% of prostatectomy alone patients, while 27% experienced mild incontinence. Erectile function was poor, with only one patient able to maintain normal erections. CONCLUSION In appropriately selected patients with invasive pelvic tumours, rectal resection with prostatectomy alone provides adequate oncological outcomes. The ability to achieve an R0 resection was not compromised and overall survival is comparable with cystoprostatectomy. Urinary function is reasonable in most patients, although sexual function is compromised in almost all.
Collapse
Affiliation(s)
- Greg A Turner
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Craig A Harris
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Tim W Eglinton
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Chris J Wakeman
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Frank Kueppers
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Liane Dixon
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Bruce R Dobbs
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Frank A Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| |
Collapse
|
22
|
A comparison of different oral therapies versus no treatment for erectile dysfunction in 196 radical nerve-sparing radical prostatectomy patients. Int J Impot Res 2014; 27:1-5. [DOI: 10.1038/ijir.2014.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/05/2014] [Accepted: 06/13/2014] [Indexed: 11/08/2022]
|
23
|
Haskins AE, Han PKJ, Lucas FL, Bristol I, Hansen M. Development of clinical models for predicting erectile function after localized prostate cancer treatment. Int J Urol 2014; 21:1227-33. [DOI: 10.1111/iju.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 06/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Amy E Haskins
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Paul KJ Han
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Frances L Lucas
- Center for Outcomes Research and Evaluation; Maine Medical Center; Portland Maine USA
| | - Ian Bristol
- Department of Radiation Oncology; Maine Medical Center; Portland Maine USA
| | - Moritz Hansen
- Division of Urology; Maine Medical Center; Portland Maine USA
| |
Collapse
|
24
|
|
25
|
Ryu JK, Cho KS, Kim SJ, Oh KJ, Kam SC, Seo KK, Shin HS, Kim SW. Korean Society for Sexual Medicine and Andrology (KSSMA) Guideline on Erectile Dysfunction. World J Mens Health 2013; 31:83-102. [PMID: 24044105 PMCID: PMC3770856 DOI: 10.5534/wjmh.2013.31.2.83] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/20/2013] [Accepted: 06/04/2013] [Indexed: 11/20/2022] Open
Abstract
In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.
Collapse
Affiliation(s)
- Ji Kan Ryu
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Teloken PE, Mulhall JP. Erectile Function Following Prostate Cancer Treatment: Factors Predicting Recovery. Sex Med Rev 2013; 1:91-103. [PMID: 27784588 DOI: 10.1002/smrj.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prostate cancer represents the most common nonskin malignancy encountered in men, and the excellent long-term survival achieved in the majority of patients has allowed more attention to be given to the side effects associated with its treatment. Erectile function is one of the main concerns of patients when considering treatment options for prostate cancer. Not surprisingly, post-treatment sexual function is closely related to outcome satisfaction and has long-lasting effects on quality of life. Radical prostatectomy is currently the most commonly employed therapy for prostate cancer. Conflicting rates of erectile dysfunction have been reported after surgery, owing not only to different surgical techniques but also because of dissimilar patient populations and definitions. Providing accurate information to individual patients in regards to their chances of recuperating the ability to have intercourse after treatment is important not only because it allows patients to make informed decisions but also because it has the potential to reduce treatment dissatisfaction. This article mainly focuses on discussing predictors of erectile function after radical prostatectomy. Patient factors, surgical aspects, including comparisons between open, laparoscopic, and robotic approaches, and postoperative management issues that impact sexual outcomes are evaluated. Prediction models combining multiple factors are described. The definition and chronology of erectile function recovery and impact of sexual function on quality of life after surgery are also discussed. Teloken PE and Mulhall JP. Erectile function following prostate cancer treatment: Factors predicting recovery. Sex Med Rev 2013;1:91-103.
Collapse
Affiliation(s)
- Patrick E Teloken
- Department of Urology, Sir Charles Gaidner Hospital, Perth, Australia
| | - John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
27
|
Kaiho Y, Yamashita S, Arai Y. Optimization of sexual function outcome after radical prostatectomy using phosphodiesterase type 5 inhibitors. Int J Urol 2013; 20:285-9. [DOI: 10.1111/iju.12071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 12/09/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Yasuhiro Kaiho
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Shinichi Yamashita
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai; Japan
| | - Yoichi Arai
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai; Japan
| |
Collapse
|
28
|
Kimura M, Bañez LL, Polascik TJ, Bernal RM, Gerber L, Robertson CN, Donatucci CF, Moul JW. Sexual bother and function after radical prostatectomy: predictors of sexual bother recovery in men despite persistent post-operative sexual dysfunction. Andrology 2012; 1:256-61. [PMID: 23413138 DOI: 10.1111/j.2047-2927.2012.00036.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/27/2012] [Accepted: 09/26/2012] [Indexed: 11/26/2022]
Abstract
Changes in sexual bother (SB) following radical prostatectomy (RP) negatively affect health-related quality of life (HRQoL) of prostate cancer survivors. However, post-operative SB tends to be neglected whereas sexual function (SF) is thoroughly assessed in clinical practice and few studies have focused on and evaluated patients' SB. We retrospectively reviewed 2 345 consecutive patients who underwent RP between 2001 and 2009 at a single institution. SF and SB were assessed using Expanded Prostate Cancer Index Composite (EPIC) questionnaires. We stratified our cohort by SB recovery and post-operative SF status, including a subset of men who recovered SB despite persistent post-RP sexual dysfunction. Multivariable logistic regression analyses were conducted to identify factors for men who have SB recovery. Of 319 eligible patients, 133 (41.7%) recovered their SB at a mean of 20 months after RP. Among the 133 men who demonstrated SB recovery, 109 had post-operative sexual dysfunction. Patients with SB recovery despite post-RP sexual dysfunction were more likely to be old (p = 0.004), to have higher clinical T stage (p < 0.001), to have more non-nerve-sparing RP (p < 0.001), to have lower pre-operative EPIC-SF/SB scores (p < 0.001), to have more extracapsular extension (p = 0.031) and to be PDE5i non-users after surgery (p < 0.001). In multivariable analysis, predictors for this subset were lower comorbidity (OR 0.62, p = 0.043), higher clinical cancer stage (OR 2.35, p = 0.026), worse pre-operative SF (OR 0.98, p = 0.010), SB (OR 0.98, p < 0.010) and no PDE5i use (OR 0.37, p = 0.002); age was not related (OR 0.99, p = 0.555). As SB can influence patients' overall HRQoL, expectations of SB recovery should be provided to patients in the same way that SF recovery is presented. This study may help clinicians to discuss SB with patients and assess their potential for SB recovery following RP.
Collapse
Affiliation(s)
- M Kimura
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Teloken PE, Nelson CJ, Karellas M, Stasi J, Eastham J, Scardino PT, Mulhall JP. Defining the impact of vascular risk factors on erectile function recovery after radical prostatectomy. BJU Int 2012; 111:653-7. [PMID: 22758405 DOI: 10.1111/j.1464-410x.2012.11321.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Erectile function recovery after radical prostatectomy is affected by surgical technique and patient factors. Age and preoperative erectile function are the 2 patient factors that have been consistently shown to impact postoperative erectile function. The presence of vascular risk factors preoperatively seems to negatively impact erectile function recovery after radical prostatectomy independently from age, preoperative erectile function and surgical technique. OBJECTIVE To examine whether vascular risk factors (VRFs) affect erectile function (EF) recovery after radical prostatectomy (RP). PATIENTS AND METHODS From our prospective database we identified patients with clinically localised prostate cancer who had undergone RP and had preoperative information on EF and VRFs (hypertension, hypercholesterolaemia, diabetes mellitus, coronary artery disease [CAD], and cigarette smoking), surgeon-graded nerve-sparing status, and EF data collected between 24 and 30 months after RP. RESULTS In all, 984 patients were included in the analyses. The frequency of the VRFs was as follows: hypertension (38%), hypercholesterolaemia (36%), diabetes mellitus (7%), CAD (5%), and cigarette smoking (37%). On univariate analysis, EF between 24 and 30 months was associated with age (r = 0.37, P < 0.001), EF before RP (r = 0.41, P < 0.001), NSS (r = 0.35, P < 0.001), and VRFs (0-2 vs >3 VRFs; r = 0.15, P = 0.003). On multivariable analysis all variables remained statistically significant, and accounted for 28% of the total variance in EF between 24 and 30 months after RP. CONCLUSIONS The presence of VRFs seems to adversely affect EF recovery after RP independently of other factors. This observation might be useful for improving patient counselling before treatment and to support the development of new treatment strategies for erectile dysfunction after RP.
Collapse
|
30
|
Suardi N, Moschini M, Gallina A, Gandaglia G, Abdollah F, Capitanio U, Bianchi M, Tutolo M, Passoni N, Salonia A, Hedlund P, Rigatti P, Montorsi F, Briganti A. Nerve-sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery. BJU Int 2012; 111:717-22. [DOI: 10.1111/j.1464-410x.2012.11315.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nazareno Suardi
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Marco Moschini
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Andrea Gallina
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Giorgio Gandaglia
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Firas Abdollah
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Umberto Capitanio
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Marco Bianchi
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Manuela Tutolo
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Niccolò Passoni
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Andrea Salonia
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Petter Hedlund
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Patrizio Rigatti
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Francesco Montorsi
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| | - Alberto Briganti
- Urological Research Institute, Department of Urology; University Vita-Salute San Raffaele; Milan; Italy
| |
Collapse
|
31
|
Erectile dysfunction after radical prostatectomy: the impact of nerve-sparing status and surgical approach. Int J Impot Res 2012; 24:155-60. [PMID: 22551824 DOI: 10.1038/ijir.2012.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The core question of the study was whether the nerve-sparing status and surgical approach affected the patients' sexual life in the first year after surgery. In addition, determinants of erectile function (EF) and the extent of sexual activity were investigated. We conducted a multicentric, longitudinal study in seven German hospitals before, 3, 6 and 12 months after radical prostatectomy (RP). A total of 329 patients were asked to self-assess the symptoms associated with erectile dysfunction (ED). These symptoms were assessed using the International Index of Erectile Function and EORTC QLQ-PR25 questionnaires. A multiple regression model was used to test the influence of clinical, socio-demographic and quality-of-life-associated variables on the patients' EF 1 year after RP. Before surgery, 39% of patients had a severe ED (complete impotence). At 3, 6 and 12 months after surgery, it was 80, 79 and 71%, respectively. Although the surgical approach had no significant effect on EF, patients who had undergone nerve-sparing surgery had significantly lower ED rates. Nevertheless, 1 year after RP, 66% of these patients had severe ED. Age, nerve-sparing status and the burden of urinary symptoms had the greatest impact on the patients' EF. Regardless of nerve-sparing status and surgical approach, postsurgical improvement of EF does not mean a full convalescence of presurgical EF. Instead, it may rather reduce the degree of postsurgical ED in time. Consequently, urologists should disclose to the patient that ED is a likely side effect of RP.
Collapse
|
32
|
Gallina A, Ferrari M, Suardi N, Capitanio U, Abdollah F, Tutolo M, Bianchi M, Saccà A, Salonia A, Rigatti P, Montorsi F, Briganti A. Erectile Function Outcome after Bilateral Nerve Sparing Radical Prostatectomy: Which Patients May Be Left Untreated? J Sex Med 2012; 9:903-8. [DOI: 10.1111/j.1743-6109.2011.02622.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
33
|
Briganti A, Di Trapani E, Abdollah F, Gallina A, Suardi N, Capitanio U, Tutolo M, Passoni N, Salonia A, DiGirolamo V, Colombo R, Guazzoni G, Rigatti P, Montorsi F. Choosing the best candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy. J Sex Med 2011; 9:608-17. [PMID: 22189164 DOI: 10.1111/j.1743-6109.2011.02580.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Controversy exists regarding the ideal candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy (BNSRP). AIM To test the effect of penile rehabilitation according to preoperative patient characteristics. METHODS We included 435 consecutive patients treated with BNSRP between 2004 and 2008. Preoperative age, International Index of Erectile Function (IIEF) and Charlson Comorbidity Index (CCI) were used to subdivide patients into three groups according to foreseen risk of erectile dysfunction (ED) after surgery: low (age ≤65, IIEF-erectile function (EF) ≥26, CCI ≤1; N = 184), intermediate (age 66-69 or IIEF-EF 11-25, CCI ≤1; N = 115), and high (age ≥70 or IIEF-EF ≤10 or CCI ≥2; N = 136). The Kaplan-Meier method was used to test the difference in EF recovery rates among patients left untreated after surgery (N = 193), those receiving on-demand phosphodiesterase type 5 inhibitors (PDE5-I; N = 147), and those treated with chronic use of PDE5-I (taken every day or every other day for 3-6 months; N = 95). The same analyses were repeated within each risk category. MAIN OUTCOME MEASURE Erectile function (EF) was evaluated using the International Index of Erectile Function (IIEF). Recovery of EF after BNSRP was defined as an IIEF-EF domain score ≥22. RESULTS No difference in terms of EF recovery was found between patients receiving on-demand vs. daily PDE5-I (P = 0.09) in the overall population. Similarly, comparable efficacy of the two treatment schedules (on-demand vs. chronic) was demonstrated in patients with low and high risk of ED (all P ≥ 0.8). Conversely, daily therapy with PDE5-I showed significantly higher efficacy for the EF recovery rate compared with the on-demand PDE5-I administration schedule in patients with intermediate risk of ED (3-year EF recovery: 74% vs. 52%, respectively; P = 0.02). CONCLUSION The ideal candidates for penile rehabilitation after surgery are patients at intermediate risk of ED.
Collapse
Affiliation(s)
- Alberto Briganti
- Urological Research Institute, Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Alemozaffar M, Regan MM, Cooperberg MR, Wei JT, Michalski JM, Sandler HM, Hembroff L, Sadetsky N, Saigal CS, Litwin MS, Klein E, Kibel AS, Hamstra DA, Pisters LL, Kuban DA, Kaplan ID, Wood DP, Ciezki J, Dunn RL, Carroll PR, Sanda MG. Prediction of erectile function following treatment for prostate cancer. JAMA 2011; 306:1205-14. [PMID: 21934053 PMCID: PMC3831607 DOI: 10.1001/jama.2011.1333] [Citation(s) in RCA: 230] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Sexual function is the health-related quality of life (HRQOL) domain most commonly impaired after prostate cancer treatment; however, validated tools to enable personalized prediction of erectile dysfunction after prostate cancer treatment are lacking. OBJECTIVE To predict long-term erectile function following prostate cancer treatment based on individual patient and treatment characteristics. DESIGN Pretreatment patient characteristics, sexual HRQOL, and treatment details measured in a longitudinal academic multicenter cohort (Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment; enrolled from 2003 through 2006), were used to develop models predicting erectile function 2 years after treatment. A community-based cohort (community-based Cancer of the Prostate Strategic Urologic Research Endeavor [CaPSURE]; enrolled 1995 through 2007) externally validated model performance. Patients in US academic and community-based practices whose HRQOL was measured pretreatment (N = 1201) underwent follow-up after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer. Sexual outcomes among men completing 2 years' follow-up (n = 1027) were used to develop models predicting erectile function that were externally validated among 1913 patients in a community-based cohort. MAIN OUTCOME MEASURES Patient-reported functional erections suitable for intercourse 2 years following prostate cancer treatment. RESULTS Two years after prostate cancer treatment, 368 (37% [95% CI, 34%-40%]) of all patients and 335 (48% [95% CI, 45%-52%]) of those with functional erections prior to treatment reported functional erections; 531 (53% [95% CI, 50%-56%]) of patients without penile prostheses reported use of medications or other devices for erectile dysfunction. Pretreatment sexual HRQOL score, age, serum prostate-specific antigen level, race/ethnicity, body mass index, and intended treatment details were associated with functional erections 2 years after treatment. Multivariable logistic regression models predicting erectile function estimated 2-year function probabilities from as low as 10% or less to as high as 70% or greater depending on the individual's pretreatment patient characteristics and treatment details. The models performed well in predicting erections in external validation among CaPSURE cohort patients (areas under the receiver operating characteristic curve, 0.77 [95% CI, 0.74-0.80] for prostatectomy; 0.87 [95% CI, 0.80-0.94] for external radiotherapy; and 0.90 [95% CI, 0.85-0.95] for brachytherapy). CONCLUSION Stratification by pretreatment patient characteristics and treatment details enables prediction of erectile function 2 years after prostatectomy, external radiotherapy, or brachytherapy for prostate cancer.
Collapse
Affiliation(s)
- Mehrdad Alemozaffar
- Urology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. Lancet Oncol 2011; 12:891-9. [DOI: 10.1016/s1470-2045(11)70162-0] [Citation(s) in RCA: 269] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Abstract
Prostatitis and benign prostatic hyperplasia (BPH) are common prostatic diseases. Furthermore, the incidence of prostate cancer has recently shown a rapid increase, even in Korea. Pain caused by prostatitis may induce sexual dysfunction, including erectile dysfunction and ejaculatory disturbance. And BPH itself, or treatments for BPH, may affect sexual function. In addition, with increased detection of localized prostate cancer, surgical treatments and radiation therapy have also increased, and the treatments may cause sexual dysfunction. Aging is also an important factor in the deterioration of the quality of life of men. Deterioration of quality of life caused by prostate diseases may be affected not only by the prostate diseases themselves but also by the sexual dysfunction caused by the prostate diseases secondarily. Thus, consideration of these points at the time of treatment of prostate disease is required. Therapies suitable to each condition should be selected with an understanding of the close association of prostate diseases and associated sexual dysfunction with the quality of life of males.
Collapse
Affiliation(s)
- Sae Woong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
37
|
Woo JC, Bae WJ, Kim SJ, Kim SD, Sohn DW, Hong SH, Lee JY, Hwang TK, Sung YC, Kim SW. Transplantation of muscle-derived stem cells into the corpus cavernosum restores erectile function in a rat model of cavernous nerve injury. Korean J Urol 2011; 52:359-63. [PMID: 21687398 PMCID: PMC3106171 DOI: 10.4111/kju.2011.52.5.359] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/21/2011] [Indexed: 12/23/2022] Open
Abstract
Purpose Muscle-derived stem cells (MDSCs) harvested from skeletal muscles have the advantage of providing easier access and do not pose the immunogenic risks of embryonic stem cells. We investigated the effect of intracavernosal transplantation of MDSCs on erectile function in rats with bilateral cavernous nerve injury. Materials and Methods Adult male white rats underwent experimentation in 3 groups: group I, sham operation; group II, bilateral cavernous nerve injury; group III, bilateral cavernous nerve injury with MDSC injection. MDSCs were harvested from the femoral muscle of rats and were then injected into the cavernosum. Survival of MDSCs and measurement of erectile function was studied after 4 weeks. We checked the intracavernosal pressure (ICP) and obtained penile tissue. The expression of cyclic guanosine monophosphate (cGMP) was analyzed. Results Four weeks after transplantation, PKH-26-labeled MDSCs were identified in the cavernosal tissues of group III. Peak ICP and the drop rate of group II were 52±8.7 mmHg and 34±6.5 mmHg/min, respectively, whereas peak ICP and the drop rate of group III were 97±15.6 mmHg and 17±4.9 mmHg/min, respectively, showing that erectile function improved after MDSC transplantation (p<0.05). The expression of cGMP was significantly lower in group II (21.9±5.8 fmol/well) than in group I and group III (70.2±10.3 and 58.9±10.5 fmol/well, respectively). Conclusions In a cavernous nerve injury rat model, intracavernosal transplantation of MDSCs showed acceptable survival of MDSCs as well as improvement of erectile function.
Collapse
Affiliation(s)
- Jang Chun Woo
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Briganti A, Gallina A, Suardi N, Capitanio U, Tutolo M, Bianchi M, Salonia A, Colombo R, Di Girolamo V, Martinez‐Salamanca JI, Guazzoni G, Rigatti P, Montorsi F. What Is the Definition of a Satisfactory Erectile Function After Bilateral Nerve Sparing Radical Prostatectomy? J Sex Med 2011; 8:1210-7. [DOI: 10.1111/j.1743-6109.2010.02179.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
39
|
Salomon L, Azria D, Bastide C, Beuzeboc P, Cormier L, Cornud F, Eiss D, Eschwège P, Gaschignard N, Hennequin C, Molinié V, Mongiat Artus P, Moreau JL, Péneau M, Peyromaure M, Ravery V, Rebillard X, Richaud P, Rischmann P, Rozet F, Staerman F, Villers A, Soulié M. Recommandations en Onco-Urologie 2010 : Cancer de la prostate. Prog Urol 2010; 20 Suppl 4:S217-51. [PMID: 21129644 DOI: 10.1016/s1166-7087(10)70042-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, Melegari S, Palmer KJ, Patel VR. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol 2010; 24:2003-15. [PMID: 20942686 DOI: 10.1089/end.2010.0295] [Citation(s) in RCA: 205] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted radical prostatectomy (RARP) currently available in the literature. METHODS A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms "prostatectomy" and "Outcome Assessment (Health Care)" and text words "retropubic," "robotic," and "laparoscopic." Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. RESULTS We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. CONCLUSION RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.
Collapse
Affiliation(s)
- Rafael F Coelho
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, Florida, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
The role of radiation therapy in prostate cancer after radical prostatectomy: when and why? Curr Opin Support Palliat Care 2010; 4:135-40. [DOI: 10.1097/spc.0b013e32833c6cd5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
42
|
Moskovic DJ, Alphs H, Nelson CJ, Rabbani F, Eastham J, Touijer K, Guillonneau B, Scardino PT, Mulhall JP. Subjective characterization of nerve sparing predicts recovery of erectile function after radical prostatectomy: defining the utility of a nerve sparing grading system. J Sex Med 2010; 8:255-60. [PMID: 20727065 DOI: 10.1111/j.1743-6109.2010.01972.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Radical prostatectomy (RP) is a common technique for managing prostate cancer. Concern regarding functional outcomes in patients prompted the development of nerve sparing to improve recovery of erectile function. AIM To assess if a cumulative nerve damage grading system is a more precise predictor of recovery of erectile function as compared to the current "all-or-none" grading system. METHODS Baseline demographic, medical history, and International Index of Erectile Function (IIEF)-erectile function domain (EFD) scores were collected. At the time of RP, patients were assigned a nerve sparing score (NSS) by their surgeon for each neurovascular bundle (left and right) to assess the quality of intraoperative nerve sparing (1-complete preservation, 4-complete resection). Patients completed IIEF questionnaires at 24 months after RP. MAIN OUTCOME MEASURES Group comparisons and multiple regression analyses were used to test the association between the NSS and IIEF-EFD scores for patients with preoperative EFD scores ≥ 24. RESULTS A total of 173 patients were included in this analysis. Mean age for patients was 59, and 62% of patients had at least one comorbidity. Baseline EFD scores were comparable between all NSS assignments. At 24 months, EFD scores were reduced by 7.2, 11.6, 13.9, and 15.4 points for patients with NSS grades of 2, 3, 4, and 5-8, respectively (P < 0.01). Multivariate analysis demonstrated lower NSS predicted recovery of erectile function at 24 months (P = 0.001), as did age (P = 0.001) and baseline EFD score (P = 0.02). CONCLUSION Our data support the adoption of a subjectively assigned NSS to more precisely predict erectile function outcomes and suggest that even minor nerve trauma significantly impairs the recovery of erectile function after procedures classically regarded as having achieved bilateral nerve sparing. Further studies are needed to identify the optimal NSS system.
Collapse
Affiliation(s)
- Daniel J Moskovic
- Urology Service, Department of Psychiatry and Behavioral Services, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Briganti A, Gallina A, Suardi N, Capitanio U, Tutolo M, Bianchi M, Passoni N, Salonia A, Colombo R, Di Girolamo V, Guazzoni G, Rigatti P, Montorsi F. Predicting erectile function recovery after bilateral nerve sparing radical prostatectomy: a proposal of a novel preoperative risk stratification. J Sex Med 2010; 7:2521-31. [PMID: 20487236 DOI: 10.1111/j.1743-6109.2010.01845.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION No multivariable model is currently available for the prediction of erectile function (EF) recovery after bilateral nerve sparing radical prostatectomy (BNSRP). AIM The aim of this study was to develop a novel preoperative risk stratification aimed at assessing the probability of EF recovery after BNSRP. MAIN OUTCOME MEASURE The International Index of Erectile Function (IIEF) was used to evaluate EF after BNSRP. METHODS This study included 435 patients treated with retropubic BNSRP between 2004 and 2008 at a single Institution. Preoperative data, including age, IIEF, Charlson comorbidity index (CCI), and body mass index (BMI) were available for all patients. Moreover, all patients were assessed postoperatively every 3 months and were asked to complete the IIEF during each visit. Cox regression models tested the association between preoperative predictors (age at surgery, preoperative IIEF-EF domain score, CCI, BMI) and EF recovery. Independent predictors of EF recovery were then used to stratify patients into three groups according to the risk of erectile dysfunction (ED) after surgery: low (age <or= 65 years, IIEF-EF >or= 26, CCI <or= 1; n = 184), intermediate (age 66-69 years or IIEF-EF 11-25,CCI <or= 1; n = 115), and high (age >or= 70 years or IIEF-EF <or= 10 or CCI >or= 2; n = 136). Kaplan-Meier curves assessed the time to EF recovery (defined as IIEF-EF score >or= 22). Predictive accuracy of our proposed classification was quantified using the AUC method. RESULTS Of 435 patients, 242 (55.6%) received phosphodiesterase type 5 inhibitors (PDE5-I) either on demand or every day for a period of 3-6 months. Overall, EF recovery rate was 58% at 3-year follow-up. Patients treated with PDE5-I had significantly higher 3-year EF recovery rate as compared with patients left untreated after surgery (73 vs. 37%; P < 0.001). Except for BMI (P = 0.7), all preoperative covariates showed a significant association with EF recovery (all P <or= 0.04). The 3-year EF recovery rate significantly differed between the three groups, being 85, 59, and 37% in patients with low, intermediate, and high risk of postoperative ED, respectively (P < 0.001). Multivariable Cox regression analysis confirmed a highly significant association between the risk classification and EF recovery (P < 0.001). The proposed patient stratification tool showed a 69.1% accuracy. Similar results were achieved when patients were stratified according to the use of ED treatment after surgery (all P < 0.001). CONCLUSIONS We report the first preoperative risk stratification tool aimed at assessing the probability of EF recovery after BNSRP. It is based on routinely available baseline data such as patient age, preoperative erectile function, and comorbidity profile.
Collapse
Affiliation(s)
- Alberto Briganti
- Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Katz D, Bennett NE, Stasi J, Eastham JA, Guillonneau BD, Scardino PT, Mulhall JP. Chronology of Erectile Function in Patients with Early Functional Erections Following Radical Prostatectomy. J Sex Med 2010; 7:803-9. [DOI: 10.1111/j.1743-6109.2009.01516.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Sadovsky R, Basson R, Krychman M, Morales AM, Schover L, Wang R, Incrocci L. Cancer and Sexual Problems. J Sex Med 2010; 7:349-73. [DOI: 10.1111/j.1743-6109.2009.01620.x] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
46
|
Wagner L, Faix A, Cuzin B, Droupy S. Dysfonctions sexuelles après prostatectomie totale. Prog Urol 2009; 19 Suppl 4:S168-72. [DOI: 10.1016/s1166-7087(09)73367-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
47
|
Mottet N, Lebret T, Patard JJ, Pfister C, Rigaud J, Salomon L, Soulié M. La chirurgie des cancers des patients âgés présente-t-elle des particularités ? Prog Urol 2009; 19 Suppl 3:S93-5. [DOI: 10.1016/s1166-7087(09)73351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Davis JW, Kamat A, Munsell M, Pettaway C, Pisters L, Matin S. Initial experience of teaching robot-assisted radical prostatectomy to surgeons-in-training: can training be evaluated and standardized? BJU Int 2009; 105:1148-54. [PMID: 19874300 DOI: 10.1111/j.1464-410x.2009.08997.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To measure the time and subjective quality of individual steps of robot-assisted radical prostatectomy (RARP), as RARP performed by trainees has recently become the most common technique of RP in the USA, and although outcomes from expert surgeons are reported, limited data are available to document training experiences. PATIENTS AND METHODS The patients studied were from a prospective cohort of 178 participants (124 with training data). Transperitoneal RARP was performed by one faculty surgeon and one assistant from a rotation of four urological oncology fellows and three residents. RARP was divided into 11 steps, and staff times were recorded for each step. Trainee times and quality scores were recorded for each step, the later defined as grade A equal to staff (A+, no verbal coaching); B, minor corrections; and C, major corrections. Short-term outcomes were recorded to assess the safety of the training. RESULTS The mean (range) console time/case of trainees was 40 (10-123) min. The median console time for a complete case by faculty and by trainees (pooled group) was 128 and 231 min, respectively, an increase in 81%. Individual trainee-performed steps increased in time (compared to staff) by a median range of 50-177%, and the incidence of quality grades < A of 9-100%. Trainee quality grades for basic tissue-dissection steps were higher than for advanced tissue dissection and suturing. There was no downgrading for a major correction. Analysis of short-term outcomes suggested acceptable results in a training environment. The study is limited by no available validated training measurement tools, and a low frequency of beginner trainees advancing to more difficult steps during the rotation. CONCLUSIONS During the initial exposure of trainees to RARP of <40 cases, we measured time and subjective quality grading of basic steps, and introduction to advanced steps. Training requires more procedure time, but does not appear to diminish expected outcomes.
Collapse
Affiliation(s)
- John W Davis
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Pathologic analysis of capsular and incisional denudation and positive margin status in the development of a robot-assisted laparoscopic prostatectomy program. J Robot Surg 2009; 3:137. [PMID: 27638369 DOI: 10.1007/s11701-009-0148-4] [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: 04/07/2009] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study is to explore the use of pathologically confirmed capsular incision and denudation as a measure of adequacy of extirpation following robot-assisted laparoscopic prostatectomy (RALP). All patients who underwent RALP at the George Washington University Medical Center during the first 2 years of inception of the robotic prostatectomy program were included. All pathologic specimens were reviewed by a single pathologist. One hundred twenty-eight men who underwent RALP during the first 2 years were identified. Sixty-four patients underwent RALP during the first year (group 1) and all pathologic specimens were reviewed retrospectively. Sixty-four patients underwent RALP during the second year (group 2) after revision of our operative technique and all pathologic specimens were reviewed prospectively. Of patients in group 1, 18 (28%) had a positive surgical margin (PSM), and 18 (28%) with negative surgical margins were found to have capsular incision or denudation. In group 1, 32 (50%) patients had evidence of iatrogenic capsular violation. Group 2 consisted of 13 (20%) patients with a PSM and 9 (14%) margin-negative patients with capsular incision or denudation. Group 2 had a total of 22 (34%) patients with evidence of iatrogenic capsular violation. Overall reduction in positive margins was not statistically significant between the groups. Improvement in capsular incision/denudation rate and overall capsular violation between the two groups was statistically significant (P < 0.03 and <0.0055). Surgical margin status alone underestimates the overall quality of surgical resection after RALP because not all capsular violations result in a PSM. Surgeon-guided pathologic review in addition to intraoperative experience may improve oncologic success during the RALP learning curve.
Collapse
|
50
|
Müller A, Parker M, Waters BW, Flanigan RC, Mulhall JP. Penile Rehabilitation Following Radical Prostatectomy: Predicting Success. J Sex Med 2009; 6:2806-12. [DOI: 10.1111/j.1743-6109.2009.01401.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|