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Wang CJ, Chen CX, Liu Y, Wen Z, Li HY, Huang HT, Yang XS. Comparative analysis of perioperative outcomes in obese patients undergoing robot-assisted radical prostatectomy (RARP) versus open radical prostatectomy (ORP): a systematic review and meta-analysis. J Robot Surg 2024; 18:248. [PMID: 38856862 DOI: 10.1007/s11701-024-02010-9] [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: 05/07/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
The purpose of this study was to conduct a comparative analysis of the perioperative outcomes associated with robot-assisted laparoscopic prostatectomy (RARP) versus open radical prostatectomy (ORP) in the obese population diagnosed with prostate cancer. We performed a comprehensive search in key databases such as PubMed, Embase, Web of Science, and the Cochrane Library, encompassing studies of all languages, with a final search date of April 2024. We also omitted articles that consisted of conference abstracts and content that was not pertinent to our study. The aggregated outcomes were evaluated utilizing the metrics of weighted mean differences (WMDs) and odds ratios (ORs). A sensitivity analysis was also integrated into our assessment. The meta-analysis was facilitated by employing Stata/MP version 18 software. Additionally, the study was duly registered with PROSPERO under the identifier: CRD 42024540216. This meta-analysis, which included five trials, shows that compared to ORP, RARP is associated with a reduced estimated blood loss (EBL) (WMD -445.77, 95%CI -866.08, -25.45; p = 0.038), a decreased transfusion rate (OR 0.17, 95%CI 0.13, 0.21; p < 0.001), and a diminished overall complication rate (OR 0.71, 95%CI 0.58, 0.86; p = 0.001). No statistically significant differences were found in operative time (OT) (WMD 1.88, 95%CI -46.53, 50.28; p = 0.939) or length of stay (LOS) (WMD -0.41, 95%CI -1.07, 0.25; p = 0.221). Among patients with obesity and prostate cancer, RARP demonstrates advantages over ORP by reducing estimated blood loss, transfusion requirements, and the incidence of complications. Notably, there were no significant differences in operative duration and hospital stay between the two surgical approaches. These findings suggest that RARP could be a preferable surgical option for obese individuals with prostate cancer.
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Affiliation(s)
- Chong-Jian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cai-Xia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hong-Yuan Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hao-Tian Huang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xue-Song Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
- Health Management Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Wu X, Wong CHM, Gandaglia G, Chiu PKF. Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy. Curr Opin Urol 2023; 33:482-487. [PMID: 37646515 DOI: 10.1097/mou.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Urinary incontinence is common postoperative complication following robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (PCa). Despite the increasing adoption of RARP in the treatment of high-risk PCa (HRPC), concerns persist regarding the adequacy of reported continence outcomes in this subgroup. This review aims to illuminate the state of continence recovery in HRPC patients post-RARP. RECENT FINDINGS Urinary continence (UC) recovery rates in HRPC was reported to be lower than the intermediate/low-risk counterparts from 6 to 24 months post-RARP. Predictive models showed that age, obesity, race, disease status, and surgical approaches represent predictors of continence recovery. Special techniques like NeuroSAFE technique and Retzius-Sparing approach also play a role in reducing incontinence also in the high-risk scenario. SUMMARY RARP for HRPC appears to be associated with worse continence compared with other risk groups. A multimodality approach for prediction and prevention of incontinence after RARP is vital. Further research into this area is necessary to enhance continence recovery outcomes in HRPC patients undergoing RARP.
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Affiliation(s)
- Xiaobo Wu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chris Ho-Ming Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Carbin Joseph DD, Dranova S, Harrison H, Papanikolou D, Uribe S, Broe M, Adamou C, Whiting D, Frajkoulis G, Moschonas D, Patil K, Kusuma VRM, Hicks J, Abou Chedid W, Perry MJA. Functional and oncological outcomes of robot-assisted radical prostatectomy in obese men: a matched-pair analysis. J Robot Surg 2023; 17:2027-2033. [PMID: 37131055 DOI: 10.1007/s11701-023-01607-w] [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: 02/20/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
Robot-assisted radical prostatectomy (RARP) in men with body mass index (BMI) ≥ 35 kg/m2 is considered technically challenging. We conducted a retrospective matched-pair analysis to compare the oncological and functional outcomes of RARP in men with BMI ≥ 35 kg/m2. We interrogated our prospectively maintained RARP database and identified 1273 men who underwent RARP from January 2018 till June 2021. Among them, 43 had BMI ≥ 35 kg/m2, and 1230 had BMI < 35 kg/m2. A 1:1 genetic matching was performed between these two groups for PSA, Gleason grades, clinical stage, D'Amico risk stratification, and nerve-spare extent. Continence rates and biochemical rates on 1-year follow-up were analysed. We performed statistical analysis using SPSS, and Paired tests were done using Wilcoxon sign rank-sum test. p < 0.05 was considered statistically significant. The two groups were comparable in almost all parameters except for age. Console time (p = 0.20) and estimated blood loss (p > 0.90) were not significantly different. There was no blood transfusion, open conversion or (Clavien-Dindo grade ≥ 3) intra/postoperative complication in either of the two groups. The two groups did not have any difference in biochemical recurrence rates (BCR) on 1-year follow-up (p > 0.90). Men with BMI ≥ 35 achieved continence rates equivalent to men with BMI < 35 within 1 year. On logistic regression analysis, age (p < 0.001) and extent of nerve sparing (p = 0.026) emerged as significant factors influencing continence recovery. RARP is safe in men with BMI ≥ 35 kg/m2. The 1-year continence and oncological outcomes are similar to matched men with BMI < 35 kg/m2 undergoing RARP.
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Affiliation(s)
| | - Sabina Dranova
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Holly Harrison
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Santiago Uribe
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Mark Broe
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Danielle Whiting
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | | | - Krishna Patil
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - James Hicks
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
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Geng E, Yin S, Yang Y, Ke C, Fang K, Liu J, Wang D. The effect of perioperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy: a meta-analysis. Int Braz J Urol 2023; 49:441-451. [PMID: 37267610 PMCID: PMC10482454 DOI: 10.1590/s1677-5538.ibju.2023.0053] [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: 02/15/2023] [Accepted: 05/09/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Pelvic floor muscle exercise (PFME) is the most common conservative management for urinary incontinence (UI) after radical prostatectomy (RP). We performed this meta-analysis to investigate whether PFME during the entire perioperative period, including before and after RP, can significantly improve the recovery of postoperative UI. METHODS We systematically reviewed randomized controlled trials (RCT) from PubMed, Medline, web of science, Cochrane library, and clinicalitrials.com prior to October 2022. Efficacy data were pooled and analyzed using Review Manager Version 5.3. Pooled analyses of urinary incontinence rates 1, 3, 6, and 12 months postoperatively were conducted, using odds ratio (OR) and 95% confidence intervals (CIs). RESULTS We included a total of 15 RCT studies involving 2178 patients received RP. Postoperative UI could be improved after 1 month, 3 months and 6 months, and the OR were 0.26 (95%CI:0.15-0.46) 0.30 (95%CI: 0.11-0.80) 0.20 (95%CI: 0.07- 0.56) in postoperative PFME group compared to no PFME group. However, there was no significant difference between the two groups in 12 months after surgery, and the OR was 0.85(95%CI: 0.48,1.51). There were similar results in perioperative PFME group compared to no PFME group with the OR of 0.35 (95%CI: 0.12, 0.98) and 0.40 (95%CI: 0.21, 0.75) in 1 and 3 months after surgery. Our results indicated no significant difference between perioperative PFME group and postoperative PFME group. The OR was 0.58 (95%CI: 0.20-1.71) 0.58 (95%CI:0.20-0.71) and 0.66 (95%CI: 0.32-1.38) in 1, 3 and 6 months after surgery. CONCLUSION Application of PFME after RP significantly reduced the incidence of early postoperative UI, and additional preoperative PFME had no significant improvement on the recovery of UI.
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Affiliation(s)
- Erkang Geng
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Sifan Yin
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Yulin Yang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Changxing Ke
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Kewei Fang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Jianhe Liu
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
| | - Daoqi Wang
- Second Affiliated Hospital of Kunming Medical UniversityDepartment of UrologyKunmingChinaDepartment of Urology, the Second Affiliated Hospital of Kunming Medical University Kunming, China
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Hakozaki K, Takeda T, Yasumizu Y, Tanaka N, Matsumoto K, Morita S, Kosaka T, Mizuno R, Asanuma H, Oya M. Predictors of urinary function recovery after laparoscopic and robot-assisted radical prostatectomy. Int Braz J Urol 2022; 49:50-60. [PMID: 36512455 PMCID: PMC9881801 DOI: 10.1590/s1677-5538.ibju.2022.0362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Even in the era of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP), we sometimes encounter patients with severe urinary incontinence after surgery. The aim of the present study was to identify predictors of urinary continence recovery among patients with urinary incontinence immediately after surgery (UIIAS). MATERIALS AND METHODS We identified 274 patients with clinically localized prostate cancer who underwent LRP and RALP between 2011 and 2018. UIIAS was defined as a urine loss ratio > 0.15 on the first day of urethral catheter removal. Urinary continence recovery was defined as using ≤ 1 pad/day one year after surgery. In the present study, we evaluated factors affecting urinary function recovery one year after surgery among patients with urinary incontinence immediately after LRP and RALP. RESULTS UIIAS was observed in 191 out of 274 patients (69.7%). A multivariate analysis identified age (<65 years, p = 0.015) as an independent predictor affecting immediate urinary continence. Among 191 incontinent patients, urinary continence one year after surgery improved in 153 (80.1%). A multivariate analysis identified age (<65 years, p = 0.003) and estimated blood loss (≥ 100 mL, p = 0.044) as independent predictors affecting urinary continence recovery one year after surgery. CONCLUSION The present results suggest that younger patients and patients with higher intraoperative blood loss recover urinary continence one year after surgery even if they are incontinent immediately after surgery.
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Affiliation(s)
- Kyohei Hakozaki
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Toshikazu Takeda
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan,Correspondence address: Toshikazu Takeda, MD, PhD Department of Urology, Keio University School of Medicine 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan Fax: +81-3-3225-1985 E-mail:
| | - Yota Yasumizu
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Nobuyuki Tanaka
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Shinya Morita
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Ryuichi Mizuno
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Asanuma
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Mototsugu Oya
- Keio University School of MedicineDepartment of UrologyTokyoJapanDepartment of Urology, Keio University School of Medicine, Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Azal W, Capibaribe DM, Col LSBD, Andrade DL, Moretti TBC, Reis LO. Incontinence after laparoscopic radical prostatectomy: a reverse systematic review. Int Braz J Urol 2022; 48:389-396. [PMID: 35168312 PMCID: PMC9060170 DOI: 10.1590/s1677-5538.ibju.2021.0632] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria. MATERIALS AND METHODS In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP. RESULTS We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported. CONCLUSION RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.
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Affiliation(s)
- Wilmar Azal
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Diego M. Capibaribe
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Luciana S. B. Dal Col
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas, PUC-Campinas - Campinas, SP, Brasil
| | - Danilo L. Andrade
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Tomas B. C. Moretti
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas, PUC-Campinas - Campinas, SP, Brasil
| | - Leonardo O. Reis
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas, PUC-Campinas - Campinas, SP, Brasil
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