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Chen HY, Liu JM, Shao IH, Liu KL, Lin CF, Chang CW, Lin CC, Wu CT. Modified three-layer vesicourethral reconstruction in robot-assisted radical prostatectomy can change cystography pattern and improve early recovery of continence. J Surg Oncol 2024; 129:1332-1340. [PMID: 38606522 DOI: 10.1002/jso.27636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND OBJECTIVES To determine early continence outcomes after three-layer vesicourethral reconstruction during robot-assisted radical prostatectomy (RARP) and the role of postoperative cystography pattern. METHODS Between May 2015 and January 2019, a total of 170 consecutive patients with localized prostate cancer who underwent RARP, were divided into one- and three-layer groups based on the method of vesicourethral reconstruction. Continent status, preoperative, intraoperative, postoperative, clinicopathological variables, and cystography parameters were analyzed. The patients were followed up for at least 12 months. RESULTS Of the 170 consecutive patients, 85 with one-layer vesicourethral anastomosis, and 85 with three-layer reconstruction. The continence rates immediately after catheter removal, 4, 12, and 24 weeks after RARP were 47.1%, 75.3%, 92.9%, and 98.8% in the three-layer group; compared to 15.3%, 60%, 78.8%, and 90.6% in the one-layer group, respectively. In the multivariate analysis, three-layer reconstruction was the only independent variable with a 42% risk reduction of postprostatectomy incontinence (hazard ratio (HR): 0.58, 95% confidence interval (CI) = 0.42-0.80, p = 0.001). Cystography in the three-layer group revealed less anastomotic leakage, less sharp bladder neck angle, and higher bladder neck level category. CONCLUSIONS Three-layer anatomical reconstruction demonstrated promising early continence outcomes, and postoperative cystography revealed a specific pattern more associated with continence.
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Affiliation(s)
- Hung-Yi Chen
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jui-Ming Liu
- Department of Surgery, Division of Urology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - I-Hung Shao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuan-Lin Liu
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Feng Lin
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ching-Wen Chang
- Division of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Cheng-Chia Lin
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chun-Te Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Xiang P, Du Z, Guan D, Yan W, Wang M, Guo D, Liu D, Liu Y, Ping H. Is there any difference in urinary continence between bilateral and unilateral nerve sparing during radical prostatectomy? A systematic review and meta-analysis. World J Surg Oncol 2024; 22:66. [PMID: 38395861 PMCID: PMC10885481 DOI: 10.1186/s12957-024-03340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
CONTEXT In men with prostate cancer, urinary incontinence is one of the most common long-term side effects of radical prostatectomy (RP). The recovery of urinary continence in patients is positively influenced by preserving the integrity of the neurovascular bundles (NVBs). However, it is still unclear if bilateral nerve sparing (BNS) is superior to unilateral nerve sparing (UNS) in terms of post-RP urinary continence. The aim of this study is to systematically compare the differences in post-RP urinary continence outcomes between BNS and UNS. METHODS The electronic databases of PubMed and Web of Science were comprehensively searched. The search period was up to May 31, 2023. English language articles comparing urinary continence outcomes of patients undergoing BNS and UNS radical prostatectomy were included. Meta-analyses were performed to calculate pooled relative risk (RR) estimates with 95% confidence intervals for urinary continence in BNS and UNS groups at selected follow-up intervals using a random-effects model. Sensitivity analyses were performed in prospective studies and robotic-assisted RP studies. RESULTS A meta-analysis was conducted using data from 26,961 participants in fifty-seven studies. A meta-analysis demonstrated that BNS improved the urinary continence rate compared to UNS at all selected follow-up points. RRs were 1.36 (1.14-1.63; p = 0.0007) at ≤ 1.5 months (mo), 1.28 (1.08-1.51; p = 0.005) at 3-4 mo, 1.12 (1.03-1.22; p = 0.01) at 6 mo, 1.08 (1.05-1.12; p < 0.00001) at 12 mo, and 1.07 (1.00-1.13; p = 0.03) at ≥ 24 mo, respectively. With the extension of the follow-up time, RRs decreased from 1.36 to 1.07, showing a gradual downward trend. Pooled estimates were largely heterogeneous. Similar findings were obtained through sensitivity analyses of prospective studies and robotic-assisted RP studies. CONCLUSION The findings of this meta-analysis demonstrate that BNS yields superior outcomes in terms of urinary continence compared to UNS, with these advantages being sustained for a minimum duration of 24 months. It may be due to the real effect of saving the nerves involved. Future high-quality studies are needed to confirm these findings.
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Affiliation(s)
- Peng Xiang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Zhen Du
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Di Guan
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Wei Yan
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Mingdong Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Danyang Guo
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Dan Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Yuexin Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Hao Ping
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Furrer MA, Sathianathen N, Gahl B, Wuethrich PY, Giannarini G, Corcoran NM, Thalmann GN. Functional Impact of Neuro-Vascular Bundle Preservation in High Risk Prostate Cancer without Compromising Oncological Outcomes: A Propensity-Modelled Analysis. Cancers (Basel) 2023; 15:5839. [PMID: 38136384 PMCID: PMC10741934 DOI: 10.3390/cancers15245839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Nerve sparing (NS) is a surgical technique to optimize functional outcomes of radical prostatectomy (RP). However, it is not recommended in high risk (HR) cases because of the risk of a positive surgical margin that may increase the risk of cancer recurrence. In the last two decades there has been a change of perspective to the effect that in well-selected cases NS could be an oncologically safe option with better functional outcomes. Therefore, we aim to compare the functional outcomes and oncological safety of NS during RP in men with HR disease. A total of 1340 patients were included in this analysis, of which 12% (n = 158) underwent non-NSRP and 39% (n = 516) and 50% (n = 666) uni- and bilateral NSRP, respectively. We calculated a propensity score and used inverse probability of treatment weighting (IPTW) to balance the baseline characteristics of Pca patients undergoing non-NSRP and those having uni- and bilateral NSRP, respectively. NS improved functional outcomes; after IPTW, only 3% of patients having non-NSRP reached complete erectile function recovery (without erectile aid) at 24 months, whereas 22% reached erectile function recovery (with erectile aid), while 87% were continent. Unilateral NS increased the probability of functional recovery in all outcomes (OR 1.1 or 1.2, respectively), bilateral NS slightly more so (OR 1.1 to 1.4). NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73-1.34, p = 0.09), and there was no difference in survival for men who underwent NSRP (HR 0.65, 95%CI 0.39-1.08). There was no difference in cancer-specific survival (0.56, 95%CI 0.29-1.11). Our study found that NSRP significantly improved functional outcomes and can be safely performed in carefully selected patients with HR-PCa without compromising long term oncological outcomes.
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Affiliation(s)
- Marc A. Furrer
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland;
- Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, 4600 Olten, Switzerland
- Bürgerspital Solothurn, 4500 Solothurn, Switzerland
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (N.S.); (N.M.C.)
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Niranjan Sathianathen
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (N.S.); (N.M.C.)
| | - Brigitta Gahl
- Clinical Trials Unit Bern, University of Bern, 3010 Bern, Switzerland;
| | - Patrick Y. Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Niall M. Corcoran
- Department of Urology, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC 3050, Australia; (N.S.); (N.M.C.)
- Department of Urology, Western Health, St. Albans, VIC 3021, Australia
| | - George N. Thalmann
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland;
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Chung JW, Kim SW, Kang HW, Ha YS, Choi SH, Lee JN, Kim BS, Kim HT, Kim TH, Yoon GS, Kwon TG, Chung SK, Yoo ES. Efficacy of modified radical prostatectomy technique for recovery of urinary incontinence in high-grade prostate cancer. MINERVA UROL NEFROL 2020; 72:605-614. [PMID: 32298065 DOI: 10.23736/s0393-2249.20.03633-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was conducted to evaluate predictive factors of urinary continence recovery after radical prostatectomy (RP) for high-grade prostate cancer (PCa). METHODS A total of 241 patients with high-grade (Gleason Score 8 or 9) PCa who underwent RP in a single Korean center between January 2011 and May 2018 were retrospectively reviewed. Urinary continence was defined as no pads use. Urinary continence was evaluated at 1, 3, 6, and 12 months after RP. Univariate and multivariate analyses were performed to determine the predictive factors of urinary continence recovery after RP. RESULTS The mean age was 67.6±6.4 years, and the mean PSA was 18.7±21.1 ng/dL. A total of 197 (81.7%) patients underwent nerve-sparing RP, and 198 patients (82.2%) were continent 1 year after RP. Multivariate analysis showed that the age (odds ratio [OR]=1.091 [1.015-1.172], P=0.018), Body Mass Index (BMI) (OR=1.227 [1.057-1.424], P=0.007), and modified surgical technique (OR=0.109 [0.044-0.267], P<0.001) were independent factors for predicting urinary continence recovery after RP. CONCLUSIONS Younger age, low BMI, and modified surgery were independent predictors of urinary continence recovery after RP in patients with high-grade PCa. These findings may help surgeons to give pre- and postoperative advice to patients with high-grade PCa about urinary continence recovery after RP.
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Affiliation(s)
- Jae W Chung
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Sang W Kim
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Ho W Kang
- Department of Urology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, South Korea
| | - Yun S Ha
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Seock H Choi
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Jun N Lee
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Bum S Kim
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Hyun T Kim
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Tae H Kim
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Ghil S Yoon
- Department of Pathology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Tae G Kwon
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea.,Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, South Korea
| | - Sung K Chung
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Eun S Yoo
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea -
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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.
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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
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Tsikis ST, Nottingham CU, Faris SF. The Relationship Between Incontinence and Erectile Dysfunction After Robotic Prostatectomy: Are They Mutually Exclusive? J Sex Med 2017; 14:1241-1247. [DOI: 10.1016/j.jsxm.2017.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/19/2017] [Accepted: 08/01/2017] [Indexed: 12/01/2022]
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7
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Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review. Eur Urol 2017; 71:936-944. [DOI: 10.1016/j.eururo.2016.09.031] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/16/2016] [Indexed: 11/18/2022]
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8
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Pavlovich CP, Rocco B, Druskin SC, Davis JW. Urinary continence recovery after radical prostatectomy - anatomical/reconstructive and nerve-sparing techniques to improve outcomes. BJU Int 2017; 120:185-196. [PMID: 28319318 DOI: 10.1111/bju.13852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In an editorial board-moderated debate format, two experts in prostate cancer surgery are challenged with presenting the key strategies in radical prostatectomy that improve urinary functional outcomes. Dr Bernardo Rocco was tasked with arguing the facts that support the anatomical preservation and reconstruction steps that improve urinary continence. Drs Christian Pavlovich and Sasha Druskin were tasked with arguing the facts supporting neurovascular bundle and high anterior release surgical planes that improve urinary continence. Associate Editor John Davis moderates the debate, and outlines the current status of validated patient questionnaires that can be used to evaluate urinary continence, and recent work that allows measuring what constitutes a 'clinically significant' difference that either or both of these surgical techniques could influence. A review of raw data from a publication from Dr Pavlovich's team demonstrates how clinically relevant differences in patient-reported outcomes can be correlated to technique. A visual atlas is presented from both presenting teams, and Dr Davis demonstrates further reproducibility of technique. A linked video on this concept is available as a supplementary file.
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Affiliation(s)
- Christian P Pavlovich
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernardo Rocco
- Ospedale Policlinico e Nuovo Ospedale Civile, S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Sasha C Druskin
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Reeves F, Preece P, Kapoor J, Everaerts W, Murphy DG, Corcoran NM, Costello AJ. Preservation of the neurovascular bundles is associated with improved time to continence after radical prostatectomy but not long-term continence rates: results of a systematic review and meta-analysis. Eur Urol 2015; 68:692-704. [PMID: 25454614 DOI: 10.1016/j.eururo.2014.10.020] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT The aetiology of urinary incontinence following radical prostatectomy (RP) is incompletely understood. In particular, it is unclear whether there is a relationship between neurovascular bundle (NVB) sparing and post-RP urinary continence. OBJECTIVE To review systematically the association of NVB sparing in RP with postoperative urinary continence outcomes and synthesise the results in a meta-analysis. EVIDENCE ACQUISITION This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. PubMed, Medline, and Cochrane Central Register of Controlled Trials were searched (December 2013), yielding 3413 unique records. A total of 27 longitudinal cohort studies were selected for inclusion. Studies were evaluated using a predefined criteria adapted from the Cochrane Tool to Assess Risk of Bias in Cohort Studies. EVIDENCE SYNTHESIS Data from 13 749 participants in 27 studies were synthesised in a meta-analysis. An assessment of the study methodology revealed a high risk of bias due to differences in baseline characteristics, outcome assessment, and the likely presence of unreported confounding factors such as meticulous apical dissection. Meta-analysis demonstrated that nerve sparing (NS) compared with non-nerve sparing (NNS) resulted in improved early urinary continence rates up to 6 mo postoperatively. Beyond this time, no significant difference was observed. This effect was seen most clearly for bilateral NS compared with NNS. A sensitivity analysis of prospective cohort studies revealed consistent results. CONCLUSIONS This analysis demonstrates an association between NS and improved urinary continence outcomes up to 6 mo postoperatively. NS in men with poor preoperative erectile function should be considered in the context of oncologic risk stratification because it may improve time to continence recovery. The underlying cause of the relationship between NS and continence is unknown. It may represent preservation of the intrapelvic somatic nerves supplying the rhabdosphincter or the influence of other confounding factors. Future research should be directed towards improving understanding of the anatomy of urinary continence and the pathophysiology of post-RP incontinence. PATIENT SUMMARY We found that avoiding damage to the nerves around the prostate improves urinary continence in the first 6 mo after surgery. After this time, there is no difference in continence between men who had these nerves removed and those who had them saved. This finding could be due to a true effect of saving these nerves or to a number of other factors affecting the research.
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Affiliation(s)
- Fairleigh Reeves
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia.
| | - Patrick Preece
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia
| | - Jada Kapoor
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia
| | - Wouter Everaerts
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia
| | - Declan G Murphy
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia; Epworth Prostate Centre, Epworth Healthcare, Melbourne, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Niall M Corcoran
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia; Epworth Prostate Centre, Epworth Healthcare, Melbourne, Australia; Department of Urology, Frankston Hospital, Melbourne, Australia
| | - Anthony J Costello
- Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia; Epworth Prostate Centre, Epworth Healthcare, Melbourne, Australia
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10
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Hamilton ZA, Kane CJ. Nerve-sparing Technique During Radical Prostatectomy and its Effect on Urinary Continence. Eur Urol 2015; 69:590-591. [PMID: 26320380 DOI: 10.1016/j.eururo.2015.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 11/15/2022]
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11
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Cotero VE, Kimm SY, Siclovan TM, Zhang R, Kim EM, Matsumoto K, Gondo T, Scardino PT, Yazdanfar S, Laudone VP, Tan Hehir CA. Improved Intraoperative Visualization of Nerves through a Myelin-Binding Fluorophore and Dual-Mode Laparoscopic Imaging. PLoS One 2015; 10:e0130276. [PMID: 26076448 PMCID: PMC4468247 DOI: 10.1371/journal.pone.0130276] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/19/2015] [Indexed: 11/18/2022] Open
Abstract
The ability to visualize and spare nerves during surgery is critical for avoiding chronic morbidity, pain, and loss of function. Visualization of such critical anatomic structures is even more challenging during minimal access procedures because the small incisions limit visibility. In this study, we focus on improving imaging of nerves through the use of a new small molecule fluorophore, GE3126, used in conjunction with our dual-mode (color and fluorescence) laparoscopic imaging instrument. GE3126 has higher aqueous solubility, improved pharmacokinetics, and reduced non-specific adipose tissue fluorescence compared to previous myelin-binding fluorophores. Dosing and kinetics were initially optimized in mice. A non-clinical modified Irwin study in rats, performed to assess the potential of GE3126 to induce nervous system injuries, showed the absence of major adverse reactions. Real-time intraoperative imaging was performed in a porcine model. Compared to white light imaging, nerve visibility was enhanced under fluorescence guidance, especially for small diameter nerves obscured by fascia, blood vessels, or adipose tissue. In the porcine model, nerve visualization was observed rapidly, within 5 to 10 minutes post-intravenous injection and the nerve fluorescence signal was maintained for up to 80 minutes. The use of GE3126, coupled with practical implementation of an imaging instrument may be an important step forward in preventing nerve damage in the operating room.
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Affiliation(s)
- Victoria E. Cotero
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Simon Y. Kimm
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Tiberiu M. Siclovan
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Rong Zhang
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Evgenia M. Kim
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Kazuhiro Matsumoto
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Tatsuo Gondo
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Peter T. Scardino
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Siavash Yazdanfar
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Vincent P. Laudone
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Cristina A. Tan Hehir
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
- * E-mail:
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12
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Eisemann N, Nolte S, Schnoor M, Katalinic A, Rohde V, Waldmann A. The ProCaSP study: quality of life outcomes of prostate cancer patients after radiotherapy or radical prostatectomy in a cohort study. BMC Urol 2015; 15:28. [PMID: 25885890 PMCID: PMC4404598 DOI: 10.1186/s12894-015-0025-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study describes and compares health-related quality of life (HRQOL) of prostate cancer patients who received either radical prostatectomy (nerve-sparing, nsRP, or non-nerve-sparing, nnsRP) or radiotherapy (external RT, brachytherapy, or both combined) for treatment of localised prostate cancer. Methods The prospective, multicenter cohort study included 529 patients. Questionnaires included the IIEF, QLQ-C30, and PORPUS-P. Data were collected before (baseline), three, six, twelve, and twenty-four months after treatment. Differences between groups’ baseline characteristics were assessed; changes over time were analysed with generalised estimating equations (GEE). Missing values were treated with multiple imputation. Further, scores at baseline and end of follow-up were compared to German reference data. Results The typical time trend was a decrease of average HRQOL three months after treatment followed by (partial) recovery. RP patients experienced considerable impairment in sexual functioning. The covariate-adjusted GEE identified a significant - but not clinically relevant - treatment effect for diarrhoea (b = 7.0 for RT, p = 0.006) and PORPUS-P (b = 2.3 for nsRP, b = 2.2 for RT, p = 0.045) compared to the reference nnsRP. Most of the HRQOL scores were comparable to German norm values. Conclusions Findings from previous research were reproduced in a specific setting of a patient cohort in the German health care system. According to the principle of evidence-based medicine, this strengthens the messages regarding treatment in prostate cancer and its impacts on patients’ health-related quality of life. After adjustment for baseline HRQOL and other covariates, RT patients reported increased symptoms of diarrhoea, and nnsRP patients decreased prostate-specific HRQOL. RP patients experienced considerable impairment in sexual functioning. These differences should be taken into account by physicians when choosing the best therapy for a patient. Electronic supplementary material The online version of this article (doi:10.1186/s12894-015-0025-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nora Eisemann
- Institute of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Sandra Nolte
- Medical Clinic, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Maike Schnoor
- Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Alexander Katalinic
- Institute of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany. .,Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
| | - Volker Rohde
- Medical Practice of Urology, Auguststr. 4, 23611, Bad Schwartau, Germany. .,Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany.
| | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany.
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Steineck G, Bjartell A, Hugosson J, Axén E, Carlsson S, Stranne J, Wallerstedt A, Persson J, Wilderäng U, Thorsteinsdottir T, Gustafsson O, Lagerkvist M, Jiborn T, Haglind E, Wiklund P. Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery. Eur Urol 2015; 67:559-68. [DOI: 10.1016/j.eururo.2014.10.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
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14
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Superior Functional Outcome after Radical Cystectomy and Orthotopic Bladder Substitution with Restrictive Intraoperative Fluid Management: A Followup Study of a Randomized Clinical Trial. J Urol 2015; 193:173-8. [DOI: 10.1016/j.juro.2014.07.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 11/22/2022]
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15
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Kranz J, Deserno O, Fischer K, Anheuser P, Reisch B, Steffens J. [Radical prostatectomy in a certified prostate cancer center: medical treatment and outcome]. Urologe A 2014; 53:1350-7. [PMID: 25163826 DOI: 10.1007/s00120-014-3604-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Open radical prostatectomy (RPE) is a standardized surgical technique with good oncologic/functional results. Nevertheless, the postoperative quality of life can be affected significantly by urinary incontinence and erectile dysfunction. Consequently, data of postoperative health-related quality of life come increasingly into public interest. MATERIALS AND METHODS This paper aims to evaluate the quality of care after radical RPE at a certified prostate cancer center. The oncological outcome, rate of complications, reintervention and transfusions as well as the rate of continence and potency of a total collective of nearly 400 patients was obtained in a standardized manner between January 2008 and June 2012 using the clinic's internal tumor documentation system and commonly used, validated questionnaires. Due to consistent methodology, partial results can finally be compared with data prior to establishment of the prostate cancer center. RESULTS This study is the first German report demonstrating an improvement of treatment results in a certified prostate cancer center. The rate of complications, reintervention, transfusions, and R1 status were significantly lower than in the precenter era. The evaluation of potency is sobering compared to current published literature, whereas satisfactory results were obtained for continency. DISCUSSION Evaluation of the data contributes to the quality of treatment and outcome of certified prostate cancer centers and allows reliable decision-making and honest patient education in the future.
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Affiliation(s)
- J Kranz
- Zertifiziertes Prostatakarzinom-Zentrum, Klinik für Urologie und Kinderurologie, St.-Antonius Hospital, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Straße 8, 52249, Eschweiler, Deutschland,
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Hinata N, Murakami G, Miyake H, Tanaka K, Abe SI, Fujimiya M, Takenaka A, Fujisawa M. Urethral sphincter fatigue after robot-assisted radical prostatectomy: descriptive questionnaire-based study and anatomic basis. Urology 2014; 84:144-8. [PMID: 24785988 DOI: 10.1016/j.urology.2014.01.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/10/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the hypothesis that preservation of the neurovascular bundle (NVB) contributes to the recovery from sphincter fatigue symptoms after robot-assisted radical prostatectomy (RARP) and to examine the sarcolemmal localization of neuronal nitric oxide synthase (nNOS) and nNOS-positive nerves supplying striated muscles in the pelvic floor. METHODS Whether preservation of the NVB influences early continence or sphincter fatigue symptoms was examined in 211 consecutive patients undergoing RARP. Continence and sphincter fatigue symptoms were assessed at 1, 3, and 6 months after surgery. An anatomic study was performed using semiserial sections obtained from 14 male cadavers. The association of continence rate and sphincter fatigue symptoms with preservation of the NVB was assessed by the chi-square test. RESULTS There was a significant difference across the bilateral, unilateral, and non-nerve-sparing groups with regard to sphincter fatigue symptoms at 1 month (P=.0004) and 3 months (P=.0326) postoperatively. Sarcolemmal nNOS was detected in the rhabdosphincter (mean, 0.57 per 10 muscle fibers) and levator ani (mean, 1.13 per 10 fibers), with fibers originating from periprostatic nNOS-positive nerves. CONCLUSION Postoperative sphincter fatigue was reduced by NVB preservation, suggesting that decreased sphincter fatigue may contribute to improvement of continence after RARP. As a background, existence of sarcolemmal nNOS and nNOS-positive nerve terminals arising from the NVB was confirmed in male pelvic floor striated muscles.
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Affiliation(s)
- Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Gen Murakami
- Department of Internal Medicine, Iwamizawa Kojin-kai Hospital, Iwamizawa, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazushi Tanaka
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shin-ichi Abe
- Department of Anatomy, Tokyo Dental College, Chiba, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, Sappro, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Do we need the nerve sparing radical prostatectomy techniques (intrafascial vs. interfascial) in men with erectile dysfunction? Results of a single-centre study. World J Urol 2014; 33:301-7. [DOI: 10.1007/s00345-014-1302-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/08/2014] [Indexed: 12/25/2022] Open
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Tan GY, El Douaihy Y, Te AE, Tewari AK. Scientific and technical advances in continence recovery following radical prostatectomy. Expert Rev Med Devices 2014; 6:431-53. [DOI: 10.1586/erd.09.19] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaye DR, Hyndman ME, Segal RL, Mettee LZ, Trock BJ, Feng Z, Su LM, Bivalacqua TJ, Pavlovich CP. Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy. Urology 2013; 82:1348-53. [DOI: 10.1016/j.urology.2013.06.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/01/2013] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
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Lepor H. Editorial comment. Urology 2013; 82:1353-4. [PMID: 24094662 DOI: 10.1016/j.urology.2013.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Herbert Lepor
- Department of Urology, NYU School of Medicine, NYU Urology Associates, New York, NY
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Pavlovich CP. Reply: To PMID 24094657. Urology 2013; 82:1354. [PMID: 24094661 DOI: 10.1016/j.urology.2013.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christian P Pavlovich
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD
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Lent V, Schultheis H, Strauß L, Laaser M, Buntrock S. Belastungsinkontinenz nach Prostatektomie in der Versorgungswirklichkeit. Urologe A 2013; 52:1104-9. [DOI: 10.1007/s00120-013-3201-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cotero VE, Siclovan T, Zhang R, Carter RL, Bajaj A, LaPlante NE, Kim E, Gray D, Staudinger VP, Yazdanfar S, Tan Hehir CA. Intraoperative fluorescence imaging of peripheral and central nerves through a myelin-selective contrast agent. Mol Imaging Biol 2013; 14:708-17. [PMID: 22488576 PMCID: PMC3492698 DOI: 10.1007/s11307-012-0555-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Purpose Patients suffer from complications as a result of unintentional nerve damage during surgery. We focus on improving intraoperative visualization of nerves through the use of a targeted fluorophore and optical imaging instrumentation. Procedure A myelin-targeting fluorophore, GE3111, was synthesized, characterized for its optical and myelin-binding properties using purified myelin basic protein, and evaluated in mice. Additionally, a compact instrument was adapted to visualize nerves. Results GE3111 was synthesized using a versatile methodology. Its optical properties were sensitive to the local environment both in vitro and in vivo. Following intravenous injection, central and peripheral nerves were visualized, with the kinetics of nerve uptake modifiable depending on the formulation. Fluorescence polarization showed specific and strong binding to purified myelin basic protein. Nerves were visualized in vivo using a dedicated compact imaging device requiring less than 2.5 mW/cm2 of illumination at 405 nm. Conclusions Fluorescence imaging of nerves through myelin showed a potential for use in image-guided surgery. Intraoperative nerve imaging is an example where contrast agent and instrument development come together as a result of clinical need. Electronic supplementary material The online version of this article (doi:10.1007/s11307-012-0555-1) contains supplementary material, which is available to authorized users.
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How Can the Autonomic Nervous System Contribute to Urinary Continence Following Radical Prostatectomy? A “Boson-like” Conundrum. Eur Urol 2013; 63:445-7. [DOI: 10.1016/j.eururo.2012.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/16/2012] [Indexed: 11/22/2022]
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Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence After Robot-assisted Laparoscopic Radical Prostatectomy. Eur Urol 2013; 63:438-44. [DOI: 10.1016/j.eururo.2012.07.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022]
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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
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Prota C, Gomes CM, Ribeiro LHS, de Bessa J, Nakano E, Dall'Oglio M, Bruschini H, Srougi M. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. Int J Impot Res 2012; 24:174-8. [PMID: 22573231 DOI: 10.1038/ijir.2012.11] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Erectile dysfunction (ED) and urinary incontinence are common complications following radical prostatectomy (RP). Although pelvic-floor biofeedback training (PFBT) may improve urinary continence following RP, its effects on the recovery of potency are unknown. Fifty-two patients selected for RP were prospectively randomized for a treatment group (n=26) receiving PFBT once a week for 3 months and home exercises or a control group (n=26), in which patients received verbal instructions to contract the pelvic floor. Erectile function (EF) was evaluated with the International Index of Erectile Function-5 (IIEF-5) before surgery and 1, 3, 6 and 12 months postoperatively. Patients were considered potent when they had a total IIEF-5 score>20. Continence status was assessed and defined as the use of no pads. Groups were comparable in terms of age, body mass index, diabetes, pathological tumor stage and neurovascular bundle preservation. A significant reduction in IIEF-5 scores was observed after surgery in both groups. In the treatment group, 8 (47.1%) patients recovered potency 12 months postoperatively, as opposed to 2 (12.5%) in the control group (P=0.032). The absolute risk reduction was 34.6% (95% confidence interval (CI): 3.8-64%) and the number needed to treat was 3 (95% CI: 1.5-17.2). A strong association between recovery of potency and urinary continence was observed, with continent patients having a 5.4 higher chance of being potent (P=0.04). Early PFBT appears to have a significant impact on the recovery of EF after RP. Urinary continence status was a good indicator of EF recovery, with continent patients having a higher chance of being potent.
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Affiliation(s)
- C Prota
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Lepor H. Radical prostatectomy for long-term functional and oncologic outcomes. Eur Urol 2012; 61:676-8. [PMID: 22257423 DOI: 10.1016/j.eururo.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/03/2012] [Indexed: 12/01/2022]
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Ko YH, Coelho RF, Chauhan S, Sivaraman A, Schatloff O, Cheon J, Patel VR. Factors Affecting Return of Continence 3 Months After Robot-Assisted Radical Prostatectomy: Analysis From a Large, Prospective Data by a Single Surgeon. J Urol 2012; 187:190-4. [DOI: 10.1016/j.juro.2011.09.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Young Hwii Ko
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Rafael F. Coelho
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
- Hopital Israelita Albert Einstein, Sao Paulo, SP, Brazil
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Sanket Chauhan
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
| | - Ananthakrishnan Sivaraman
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
| | - Oscar Schatloff
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
| | - Jun Cheon
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Vipul R. Patel
- Global Robotics Institute, Florida Hospital Celebration Health, Celebration, and University of Central Florida School of Medicine, Orlando, Florida
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Gacci M, Carini M, Simonato A, Imbimbo C, Gontero P, Briganti A, De Cobelli O, Fulcoli V, Martorana G, Nicita G, Mirone V, Carmignani G. Factors predicting continence recovery 1 month after radical prostatectomy: results of a multicenter survey. Int J Urol 2011; 18:700-8. [PMID: 21834853 DOI: 10.1111/j.1442-2042.2011.02826.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the factors associated with continence recovery 1 month after radical prostatectomy (RP) and to identify the correlation between these factors. METHODS In total, 2408 men treated with RP for prostate cancer (PCa) were enrolled in the present multicenter prospective study. Clinical (age, body mass index) and urological (catheterization or transurethral resection of the prostate) records, quality of life (QOL) scores determined using various instruments (including the International Index of Erectile Function [IIEF] and University of California Los Angeles, Prostate Cancer Index [UCLA-PCI]), PCa characteristics (clinical stage [cT], prostate-specific antigen, biopsy Gleason score), surgical features (surgical approach, nerve and bladder neck sparing, catheterization), and pathologic outcomes (pT, pN+, Gleason score, positive surgical margins) were recorded. Continence status prior to surgery and at 1 month after RP was assessed and classified as followed: (i) full continence; (ii) 0-1 pads/day; or (iii) >1 pad/day. Only patients determined to have full continence prior to surgery were included in the analysis. Data were evaluated using Spearman's correlation analysis and multivariate logistic regression. RESULTS Data from 1972 patients with full continence preoperatively and complete postoperative data were analyzed. At 1 month after RP, 644 patients (32.7%) were fully continent, 810 (41.1%) were using 0-1 pads/day, and 518 (26.3%) were using >1 pad/day. Univariate analysis indicated that clinical and urological data, QOL, PCa characteristics, surgical features, and pathologic outcomes were determinants for continence recovery. Multivariate analysis indicated that preoperative sexual activity (UCLA-PCI Sexual Function P = 0.005; IIEF P = 0.040), bladder neck sparing (P = 0.003), catheterization time (P = 0.007), and catheter diameter (P = 0.046) were associated with 1 month continence recovery. CONCLUSIONS Age and nerve sparing are not significant predictors of continence recovery 1 month after RP. Preoperative erectile function can predict post-prostatectomy incontinence. Bladder neck preservation has a significant effect on early continence recovery after RP.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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Fu Q, Moul JW, Sun L. Contemporary radical prostatectomy. Prostate Cancer 2011; 2011:645030. [PMID: 22110994 PMCID: PMC3200259 DOI: 10.1155/2011/645030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 02/17/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.
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Affiliation(s)
- Qiang Fu
- Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, P.O. Box 3707, Durham, NC 27710, USA
| | - Judd W. Moul
- Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, P.O. Box 3707, Durham, NC 27710, USA
| | - Leon Sun
- Division of Urology, Department of Surgery, Duke Prostate Center, Duke University Medical Center, P.O. Box 3707, Durham, NC 27710, USA
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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]
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Choi WW, Freire MP, Soukup JR, Yin L, Lipsitz SR, Carvas F, Williams SB, Hu JC. Nerve-sparing technique and urinary control after robot-assisted laparoscopic prostatectomy. World J Urol 2010; 29:21-7. [DOI: 10.1007/s00345-010-0601-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/28/2010] [Indexed: 11/24/2022] Open
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The effect of mirodenafil on the penile erection and corpus cavernosum in the rat model of cavernosal nerve injury. Int J Impot Res 2010; 22:291-7. [PMID: 20861845 PMCID: PMC2959156 DOI: 10.1038/ijir.2010.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Impotence is one of the common complications after the radical prostatectomy. One of the main reasons of this complication is due to the dysfunction of the veins in corpus cavernosum. Recent studies have shown that the erectile function is improved after the long-term therapy of phosphodiesterase type 5 inhibitor among patients with post-prostatectomy erectile dysfunction. In this study, we evaluated the effects of mirodenafil on the penile erection and corpus cavernosum tissues in the rat model of cavernosal nerve injury. Rats were divided into four groups: (1) control group, (2) bilateral cavernosal nerve injury group, (3) mirodenafil 10 mg therapy group after the nerve injury and (4) mirodenafil 20 mg therapy group after the nerve injury. After we identified the nerve from the pelvic nerve complex on the lateral side of the prostate, the rats in the control group were sutured without causing any nerve injury and in other groups we damaged the nerve by compressing it with a vessel clamp. Then, 10 and 20 mg kg−1 of mirodenafil were orally administered to two experimental groups. After 8 weeks, the intracavernosal pressure (ICP) was recorded. The immunohistochemical staining and western blot were performed, and the effect of mirodenafil on the expression of cyclic guanosine monophosphate (cGMP) was evaluated through enzyme-linked immunosorbent assay. The ICP of nerve-injured group was decreased compared with the control group; however, the ICP of the mirodenafil-administered groups was improved compared with the nerve-injured group. The Masson's trichrome staining confirmed that the smooth muscle (SM) component was increased in the mirodenafil-administered groups. The nitric oxide synthase expression and cGMP of mirodenafil-administered groups was increased compared with the nerve-injured group. Long-term therapy of mirodenafil may improve the erectile function after the radical prostatectomy by preserving the SM content and inhibiting the fibrosis of the corpus cavernosum.
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Kumar A, Nitti VW. Contemporary Incidence of Postprostatectomy Incontinence and Impact on Health-related Quality of Life. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0058-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ruiz-Aragón J, Márquez-Peláez S, Luque Romero L. Disfunción eréctil en pacientes intervenidos de cáncer de próstata. Revisión sistemática de la literatura médica. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gautam G, Rocco B, Patel VR, Zorn KC. Posterior Rhabdosphincter Reconstruction During Robot-assisted Radical Prostatectomy: Critical Analysis of Techniques and Outcomes. Urology 2010; 76:734-41. [DOI: 10.1016/j.urology.2010.01.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 12/17/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Parker WR, Wang R, He C, Wood Jr DP. Five year Expanded Prostate cancer Index Composite-based quality of life outcomes after prostatectomy for localized prostate cancer. BJU Int 2010; 107:585-90. [DOI: 10.1111/j.1464-410x.2010.09579.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reiter MA, Haferkamp A, Hohenfellner M. [Prevention of postoperative urinary stress incontinence]. Urologe A 2010; 49:489-97. [PMID: 20376651 DOI: 10.1007/s00120-010-2267-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Postoperative stress incontinence following operative treatment of prostate cancer represents a considerable percentage of overall male incontinence. Postoperative incontinence following radical prostatectomy ranges between 2.9 and 87% depending on author and patient characteristics. Especially patient-related factors such as body mass index, age, size of prostate, preoperative incontinence, and concomitant diseases as well as classification of incontinence and modality of data collection influence postoperative continence rates. However, recent publications demonstrate the important impact of different operative techniques with regard to postoperative continence.The preservation of the muscular urethral sphincter is of particular importance. Nevertheless, the preservation of further anatomical structures contributes to postoperative continence. Preservation of bladder neck, nerve sparing, and reconstruction of the vesicourethral junction are operative techniques to prevent postoperative incontinence. In the last decade different modifications of the operative technique have been investigated regarding specific effects on postoperative continence. The interpretation of these studies investigating these operative techniques showed improvement in early continence with shorter period of time to continence. Long-term follow-up revealed no significant advantages for these modifications with regard to continence compared to the standard procedure. To evaluate the long-term effects of certain modifications to prevent incontinence, randomized and well powered studies are necessary. It seems to be most likely that a combination of these preventive modifications will lead to improved postoperative continence rates.
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Affiliation(s)
- M A Reiter
- Urologische Klinik, Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
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Gacci M, Simonato A, Masieri L, Gore JL, Lanciotti M, Mantella A, Rossetti MA, Serni S, Varca V, Romagnoli A, Ambruosi C, Venzano F, Esposito M, Montanaro T, Carmignani G, Carini M. Urinary and sexual outcomes in long-term (5+ years) prostate cancer disease free survivors after radical prostatectomy. Health Qual Life Outcomes 2009; 7:94. [PMID: 19912640 PMCID: PMC2784440 DOI: 10.1186/1477-7525-7-94] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 11/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After long term disease free follow up (FUp) patients reconsider quality of life (QOL) outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP). METHODS 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA <or= 0.2 ng/mL) at the follow up >or= 5 years were recruited.Urinary (UF) and Sexual Function (SF), Urinary (UB) and Sexual Bother (SB) were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp), tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score), nerve sparing (NS) procedure, and hormonal treatment (HT).We calculated the differences between 93 NS-RP without HT (group A) and 274 non-NS-RP or NS-RP with HT (group B). We evaluated the correlation between function and bother in group A according to follow-up duration. RESULTS Time since prostatectomy had a negative effect on SF and a positive effect SB (both p < 0.001). Elderly men at follow up experienced worse UF and SF (p = 0.02 and p < 0.001) and better SB (p < 0.001).Higher stage PCa negatively affected UB, SF, and SB (all: p <or= 0.05). NS was associated with better UB, SF and SB (all: p <or= 0.05); conversely, HT was associated with worse UF, SF and SB (all: p <or= 0.05).More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT) demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time. CONCLUSION Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders), subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother appear to have divergent trajectories.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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Song LJ, Lu HK, Wang JP, Xu YM. Cadaveric study of nerves supplying the membranous urethra. Neurourol Urodyn 2009; 29:592-5. [DOI: 10.1002/nau.20768] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Stolzenburg JU, Nicholas M, Minh D, Dietel A, Hicks J. Does a nerve-sparing technique for potency affect continence after open radical retropubic prostatectomy? BJU Int 2009; 103:1292; author reply 1192-3. [PMID: 19402827 DOI: 10.1111/j.1464-410x.2009.08582_1.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Quality of life outcomes following treatment for localized prostate cancer: is there a clear winner? Curr Opin Urol 2009; 19:303-8. [DOI: 10.1097/mou.0b013e328329eb00] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lawrentschuk N, Lindner U, Fleshner N. CURRENT TEXTBOOKS AND ANATOMY OF THE PROSTATE - A CASE FOR AN UPDATE. BJU Int 2009; 103:1319-22. [DOI: 10.1111/j.1464-410x.2009.08426.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Survival in prostate cancer patients ≥70 years after radical prostatectomy and comparison to younger patients. World J Urol 2009; 27:637-42. [DOI: 10.1007/s00345-009-0414-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 04/08/2009] [Indexed: 01/21/2023] Open
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