Abstract
BackgroundIn this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP).MethodsRetrospective analysis was applied to patients who underwent RARP between October 2010 and July 2014. The following parameters were assessed in all patients: age, body mass index (BMI), prostate-specific antigen, magnetic resonance imaging and pressure-flow studies findings. The impact of preoperative and intraoperative factors on postoperative urinary incontinence (UI) was assessed using multivariate logistic regression analysis. To evaluate the effects of IPP, the patients were divided into groups according to the IPP length: Group 1, < 5 mm and Group 2, ≥ 5 mm. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, Quality of Life index and the number of pads used were assessed.ResultsA total of 119 patients were eligible for this study. Multivariate analyses showed that IPP (odds ratio (OR) 1.14, 95% confidence interval (CI) 1.02–1.28, p < 0.05) and nerve-sparing (NS) (OR 0.23, 95% CI 0.18–0.61, p < 0.01) were significant factors related to UI in the first month after RARP. Twelve months after RARP, multivariate analyses revealed that only NS is a factor related to postoperative UI (OR 0.23, 95% CI 0.18–0.61, p < 0.01). The comparison of Groups 1 and 2 indicated significant differences in age (p < 0.01), prostate volume (p < 0.01), total IPSS and voiding symptom score (p < 0.05), compliance (p < 0.01), and detrusor pressure at maximum flow (p < 0.01). Group 1 had a higher continence rate (38.0%) than Group 2 (20.8%) in the first month after RARP (p < 0.05), but the difference was no longer significant from the third month after RARP. The total IPSS and voiding symptom scores were significantly different between the two groups before RARP, however, the significant difference disappeared from the first month after RARP.ConclusionsThe data suggest that IPP affects early postoperative UI. Although NS was strongly involved in UI in the early and later stages after RARP, IPP had no effect on UI in the later stages.
Highlights
In this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP)
RARP is less invasive than conventional open radical prostatectomy (ORP) or laparoscopic radical prostatectomy (LRP), there is postoperative urinary incontinence (UI), as with other procedures
The magnetic resonance imaging (MRI) evaluation aebgfdch revealed that the median values of prostate volume (PV), membranous urethra length (MUL), membranous urethra width (MUW), levator thickness (LT) and IPP before RARP were 26.0 (9.6–66.1) mL, 12.1 (8.9– 16.1) mm, 10.6 (9.8–13.5) mm, 11.1 (7.9–15.1) mm, and 3.8 (0.0–16.5) mm, respectively
Summary
We investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP). The robot-assisted laparoscopic radical prostatectomy (RARP) has become a widely performed type of treatment in patients with PCa due to low blood. RARP is less invasive than conventional open radical prostatectomy (ORP) or laparoscopic radical prostatectomy (LRP), there is postoperative urinary incontinence (UI), as with other procedures. Various surgical techniques have been reported to reduce postoperative UI after RARP [3]. Several studies reported that RARP provides earlier urinary continence compared to ORP and LRP [1]. It has been reported that 17.3% of patients undergoing RARP had urinary continence immediately after catheter removal. The 12-month urinary recovery after RARP ranged from 84 to 97% better than after ORP, where urinary recovery ranged from 60 to 93% and after LRP ranged from 66 to 95% [1, 4]
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