Complication Of Radical Prostatectomy Research Articles

Antimicrobial Prophylaxis in Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review.

It remains unclear whether antibiotic prophylaxis (AP) should be recommended or discouraged in robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer (PCa). The development of microbial resistance and side effects are risks of antibiotic use. This systematic review (SR) investigates the evidence base for AP in RALP. A systematic literature search was conducted until 12 January 2023, using Embase, MEDLINE, Cochrane CENTRAL, Cochrane CDSR (via Ovid) and CINAHL for studies reporting the effect of AP on postoperative infectious complications in RALP. Of 436 screened publications, 8 studies comprising 6378 RALP procedures met the inclusion criteria. There was no evidence of a difference in the rate and severity of infective complications within 30 days after RALP surgery between different AP protocols. No studies omitted AP. For patients who received AP, the overall occurrence of postoperative infectious complications varied between 0.6% and 6.6%. The reported urinary tract infection (UTI) rates varied from 0.16% (4/2500) to 8.9% (15/169). Wound infections were reported in 0.46% (4/865) to 1.12% (1/89). Sepsis/bacteraemia and hyperpyrexia were registered in 0.1% (1/1084) and 1.6% (5/317), respectively. Infected lymphoceles (iLC) rates were 0.9% (3 of 317) in a RALP cohort that included 88.6% pelvic lymph node dissections (PLND), and 3% (26 of 865) in a RALP cohort where all patients underwent PLND. Our findings underscore that AP is being administered in RALP procedures without scientifically proven evidence. Prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to ensure the comparability of results and guidance on AP in RALP.

Efficacy of Low-Intensity Extracorporeal Shock Wave Treatment in Erectile Dysfunction Following Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Erectile dysfunction (ED) is a well-known complication of radical prostatectomy (RP). Oral 5-phosphodiesterase inhibitors are currently the most widely used penile rehabilitation treatment for ED following RP, but they are less effective than for those with general ED. Low-intensity extracorporeal shock wave treatment (LI-ESWT), causing a biological change that induces neovascularization, has recently been used as a treatment for ED. Therefore, we conducted a systematic review and meta-analysis to investigate the efficiency of LI-ESWT in ED following RP. PubMed, Embase, and the Cochrane Library were searched up until December 2021. The endpoint was the change in IIEF scores after LI-ESWT. Five papers (460 patients) were included in the final analysis. In IIEF scores performed 3–4 months after LI-ESWT, the group receiving LI-ESWT showed statistically significantly better results than the control (WMD = −2.04; 95% CI, −3.72 to −0.35; p = 0.02). However, there were a total of two studies that measured the results after 9–12 months. There was no statistical difference between the two groups (WMD = −5.37; 95% CI, −12.42 to 1.69; p = 0.14). The results of this analysis indicate that LI-ESWT showed a statistically significant effect on early recovery in penile rehabilitation of ED following RP. However, the level of evidence was low. Therefore, careful interpretation of the results is required.

Inguinal hernia associated with radical prostatectomy.

Inguinal hernias are a long-term complication of radical prostatectomy (RP). We investigated the clinical features and surgical outcomes of patients with inguinal hernias developing after RP. We retrospectively investigated 80 patients (86 hernias) who underwent inguinal hernia repair after RP. We repaired all RP-associated inguinal hernias by the tension-free method with a mesh plug. We also retrospectively investigated 729 adult male patients (779 hernias) who underwent inguinal hernia repair as a control group. A higher proportion of the 80 post-RP patients developed right-sided hernias (53 [66%]) than the controls, which was significant. A higher proportion of the 86 post-RP hernias were indirect (76 [89%]) than the controls, which was also significant. The mean times to hernia development after robot-assisted RP, laparoscopic RP, and radical retropubic prostatectomy were 20.3, 48.9, and 73.2months, respectively. The total complication rates did not differ significantly between the post-RP group and control group. The proportion of post-RP patients with right-sided hernia was significantly higher than controls. Indirect inguinal hernias were predominant among the post-RP hernias. The mesh plug method is safe and effective for inguinal hernia repair after RP. The time from robot-assisted RP to the development of inguinal hernia was shorter than those from laparoscopic RP, and radical retropubic prostatectomy.

Early and late postoperative complications of radical prostatectomy with extended pelvic lymphadenectomy

Early and late postoperative complications of radical prostatectomy with extended pelvic lymphadenectomy

The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy

IntroductionArousal incontinence (AI) is a lesser known complication of radical prostatectomy (RP), and few data are available on its impact on self-esteem and sexual relationships. AimThe goal of this study was to assess the impact of AI on patient self-esteem, confidence, and sexual relationships. MethodsThis was a retrospective study. The validated Self-Esteem and Relationship (SEAR) questionnaire, as well as questions regarding AI, stress urinary incontinence (SUI), climacturia, International Prostate Symptom Score, and the International Index of Erectile Function erectile function domain, were sent to men who had undergone an RP within the past 24 months at a single institution. The data were de-identified and analyzed using descriptive statistics. OutcomesThe outcomes of this study include prevalence of AI, SEAR domain scores, patient and partner bother, management strategies employed by the patients, and the presence of concurrent climacturia or SUI. ResultsFifty-three percent of men experienced post-operative AI; of these, 41% were currently experiencing AI, and 12% reported having prior AI that had resolved. Bother of any severity was reported by 87% of men, and perceived partner bother was reported by 64% of men. Forty-one percent of men with current AI avoided sexual activity due to the presence of AI, and 14% of men with prior AI still avoided intercourse. There was no difference in total SEAR score or in the subdomains of self-esteem, sexual relationship, or confidence between men with current AI compared to those with no AI. Clinical ImplicationsAI leads to patient bother and avoidance of sexual situations. Strengths & LimitationsThis is the largest study specifically evaluating AI and the only study assessing its impact on self-esteem, sexual relationships, and self-confidence. Limitations include lack of a validated AI questionnaire, poor survey response rate, being a single-center study, and the potential for recall bias. ConclusionAlthough AI is a common occurrence post-RP and is associated with patient bother in the majority of men, it does not impact overall self-esteem, confidence, or sexual relationships compared to post-RP men who have not experienced AI.Salter CA, Bach PV, Katz D, et al. The Relationship and Psychosocial Impact of Arousal Incontinence After Radical Prostatectomy. J Sex Med 2020;17:94–98.

Surgical correction of urinary incontinence associated with orgasm (climacturia) using a compression graft (clinical cases)

Climacturia is a rarely discussed functional complication of radical prostatectomy. Various methods of medical and surgical treatment of climacturia have been described. In this article we present two clinical cases of successful surgical treatment of climacturia which involved three-piece penile prosthesis implantation and placement of compression graft made of porcine dermal collagen on urethra.

SINGLE STEP IMPLANTATION OF AN ARTIFICIAL SPHINCTER OF THE BLADDER AND PENILE PROSTHESIS AS A METHOD OF CORRECTING OF ERECTILE DYSFUNCTION AND URINARY INCONTINENCE

This article provides a clinical example of the simultaneous implantation of an artificial sphincter of the bladder and a triple-component prosthesis of the penis, which allows almost completely to rehabilitate a patient with total incontinence and erectile dysfunction after laparoscopic radical prostatectom y for prostate cancer. The urgency of writing this article was a high incidence of prostate cancer, which has no tendency to decrease.It should be noted that when choosing the optimal method for treating prostate cancer, it is necessary to take into account the stage of the disease development, the patient’s age, concomitant diseases, possible complications, test results, and the wishes of the patient. In the stages of prostate cancer T1T2, radical prostatectomy in any of its embodiments, openly laparoscopically or with the help of a robot is a routine operation, at stage T3, in order to achieve an acceptable result, it is necessary not only sufficient surgical technique, but the correct preoperative preparation (the use of hormone therapy).One of the frequent complications of radical prostatectomy at stage T3 is urinary incontinence and erectile dysfunction, which is caused by the need for more “aggressive” techniques, the frequency of which reaches, in the opinion of different authors, 30 to 90%. With incontinence after a radical prostatectomy of moderate and severe degree, the implantation of an artificial urethral sphincter remains the preferred method of treatment. Artificial sphincter allows you to fully control the process of retention of urine and urination. Note that the restoration of potency after surgery is a very difficult problem. After the operation, one of the methods of preserving the erectile function is the early administration of 5fosofodiesterase inhibitors, but their reception does not always allow to maintain the erectile function, in this case, patients can be rehabilitated by penile implantation. The installation of a three-component phalloprosthesis or artificial sphincter separately is already a routine operation, but simultaneous treatment of two com plications and sim ultaneous im plantation of two prostheses is a rarity.

Assessment of Physical Therapy Strategies for Recovery of Urinary Continence after Prostatectomy

Introduction:Urinary incontinence is a complication of radical prostatectomy. Pelvic floor exercises can facilitate recovery of continence after surgery; however, there is not sufficient evidence that physical therapy with biofeedback training is effective, particularly with respect to providing a faster recovery.Objective:To analyze the application of physical therapy techniques in the recovery of urinary incontinence after prostatectomy.Methodology:A randomized clinical trial was conducted from April to October 2015 with patients undergoing radical prostatectomy up to three months after surgery at the Santa Casa de Misericordia in Northeastern Brazil. The physical therapy intervention consisted of up to eight individual sessions. Patients were randomized into the intervention group, which performed exercises and received biofeedback training, and the control group, which performed exercises alone. Participants were assessed before, during and after treatment. The initial assessment included a structured instrument addressing sociodemographic and urological data. Frequencies were calculated for all variables and comparisons were checked by the Mann-Whitney test and for correlation significance.Results:The study included 13 patients aged 54-74 years, the majority undergoing retropubic surgery with mild urinary incontinence [11 (84.6%)]. There was a significant difference in the outcome of the pad test before (p=0.070) and after (p=0.015) treatment between the groups, but the reduction of urinary loss and the time to recovery of continence were equivalent for both groups.Conclusion:Both interventions provided improvement in the degree of incontinence within two months of treatment.

New model of urethral catheter in treatment of patients after radical prostatectomy: efficiency and possibilities of implementation into clinical practice

Vesicourethral anastomosis (VUA) stricture applies to late postoperative complications of radical prostatectomy significantly reduces the quality of life of patients. Factors significantly affecting the rate of stricture formation VUA are not well understood, exactly how is not fully understood the mechanism of its development. Common approach to the treatment of these patients does not exist. The most common and less traumatic treatment methods include bougienage, internal optical urethrotomy and transurethral resection VUA. Given the high rate of relapse after such endoscopic surgery by many authors to optimize surgical care to patients with VUA stricture it has been proposed, however the prevention of its development measures still exists. Developed at the Urology Department of A.I. Evdokimov Moscow State University of Medicine and Dentistry new model of urinary catheter can take place in certain methods of prevention and treatment of strictures VUA.

Complications of radical prostatectomy relate to risk stratification of prostate cancer patients

Complications of radical prostatectomy relate to risk stratification of prostate cancer patients

The Devastated Bladder Outlet in Cancer Survivors After Local Therapy for Prostate Cancer

Prostate cancer is common; this combined with the long life expectancy after treatment has sparked a growing emphasis on prostate cancer survivorship care. An important goal of such care is preserving quality of life through ameliorating the side effects of therapy. Posterior urethral stenosis (PUS) can occur as a complication of radical prostatectomy (RP) and radiation therapy (RT). Evaluation includes a history, physical exam, uroflowmetry, lab tests, cystoscopy, and radiological studies. PUS is initially managed with endoscopic techniques such as dilation or internal urethrotomy. Patients who fail such therapies can be offered surgical reconstruction. Continence is an important factor in the management of PUS. In some cases, particularly after radiotherapy, the outlet may not be salvageable, and a permanent indwelling catheter or urinary diversion may be the only options. We review the evaluation of patients with the devastated bladder outlet: those undergoing repeat endoscopic treatments, surgical reconstruction, or urinary diversion.

The transrectal single-port laparoscopic radical prostatectomy in a cadaver model.

Radical prostatectomy is the most commonly used and most effective treatment for localized prostate cancer; however, this treatment modality is not without disadvantages. After describing the first technique of radical perineal prostatectomy, several techniques, including open, laparoscopic, and robotic retropubic radical prostatectomy were developed and preferred in the treatment of patients. The desire for reproducible, minimally invasive surgery, which reduces complication rates and maximizes cosmetic outcomes, is met by natural orifice transluminal endoscopic surgery (NOTES).[1] Akca et al.[2] revealed that radical prostatectomy may be performed using a transrectal NOTES route. The authors state that transrectal radical prostatectomy is technically feasible in the cadaver model and the transrectal NOTES route provides good exposure and easy access to the posterior surface of the prostate. Anatomy dissection studies using human cadavers are valuable to show surgeons exactly what is intended for them to see without the risk of disrupting the integrity of the cadaver.[3] We would like to congratulate the authors for an ethical cadaver study of a new treatment modality and for finding a cost-effective model to explore the feasibility of the technique. Rectal injury or rectal perforation is one of the most important complications in radical prostatectomy, and the frequency of this complication varies from 0% to 11% in the literature.[4] Additionally, a recent study showed that rectal perforation is an important cause of litigation in cases of radical prostatectomy in the United States of America, and this complication represents 40 % of all cases of negligence in the performance of radical prostatectomy surgery.[5] Even though the authors state that a meticulous repair of rectal mucosa makes this procedure less morbid than an inadvertent unrecognized rectal injury, a living human study may show that prolonged retraction on the rectal wall in the single port procedures can damage the viability of rectal tissue. Opening the gastrointestinal system can cause several complications, including sepsis and even death. Thus, concerning the motto ‘primum nil nocere’, an innovative technique should be experienced by using fundamental anatomical principles. Humphreys et al.[6] introduced another innovative surgical technique called NOTES radical prostatectomy for localized prostate cancer via a transurethral approach. This technique has the same advantages as transrectal NOTES radical prostatectomy, such as minimal invasiviness and improved cosmetic outcomes, with the lack of potential risks seen rectal injury. Nevertheless, the study by Akca et al.[2] is noteworthy, important, and will guide researchers in finding the best type of approach for radical prostatectomy surgery.

AB032. Penile rehabilitation using Vacuum Erection Device for erectile dysfunction after radical prostatectomy

ObjectiveErectile dysfunction (ED) is one of the most common complications of radical prostatectomy (RP), and seriously affecting the quality of life for patients after RP. At present, more and more doctors and patients increasingly accept and use penile rehabilitation therapies to treat ED post-RP. Among them, the vacuum erectile device (VED), a non-invasive means, can improve hypoxia within the penis and inhibit smooth muscle cell apoptosis and cavernous fibrosis. We summarize the efficacy of VED for treatment of ED after RP, and investigate patient compliance and satisfaction.MethodsOne group of 259 patients undergoing RP, including 143 cases of open RP, 116 cases of laparoscopic RP. All patients used VED (Osbon, Timm Medical, Inc.) for rehabilitation within 3 months after RP. Another group undergoing RP but not using VED was control. IIEF-5 scores, length and circumference of penis and SEP3 percentage were compared between these groups before and after RP. The compliance of VED and satisfaction for rehabilitation were also compared.ResultsThe IIEF-5 score after 6 months rehabilitation was significantly higher in the patients using VED than that in the controls (P<0.05).The shortening of penile length and circumference after VED were also significantly lower than that of the control group (P<0.05). The average length using VED was 10 months (1-18 months), and IIEF-5 score and penile length and circumference were higher in those using VED more than 1 year than those using less than six months (P<0.05). The SEP3 and satisfaction rate were significantly higher in 172 cases undergoing neurovascular-bundle-sparing RP than controls (P<0.05).ConclusionsThe early use of VED rehabilitation can improve erectile function for RP patients, help to preserve the length and reduce the shrinkage of penis. Long-term use of VED can have better results.

The Complications of Radical Prostatectomy in the Atlas Shepherd Dog: Clinical and Echographic Follow Up

The aim of this study is to raising the possible difficulties and the complications met in intra and post-operatively during a radical prostatectomy (RP). Four (n=4) healthy Atlas Shepherd Dog, of 2 years old underwent a RP on the level of the canine clinical pathology of Tiaret veterinary science Institute (Algeria). A clinical and echographic follow-up post-operative revealed the presence of a light urinary incontinence, solved in the short run for two dogs. Whereas it is persistent and complicated in cystitis and a leakage of the urine at the anastomosis site in the two other dogs. A treatment containing antibiotics systemically and locally associated with a disinfection of the wounds was set up. Following a hospitalization two dogs were restored completely, whereas the two others had inevitable complications been dependant on the urinary system. For a good management of the complications related to total prostatectomy, a rigorous clinical follow-up, associated with an ultrasonographic examination prove to be essential.

Robotic Repair of Rectovesical Fistula: Combined Anterior and Posterior Approach with Omental Flap Interposition

Abstract Introduction and Objectives: Rectovesical fistulas are a rare but devastating complication of radical prostatectomy. Management can be challenging due to deep location in the pelvis and recent surgery. We present a case of a patient whose prostatectomy was complicated by unrecognized rectal injury and pelvic abscess. After diverting colostomy, he was referred for management of the resulting rectovesical fistula. The patient failed primary closure with a sliding rectal advancement flap. Methods: In this video, we demonstrate robotic repair of a rectovesical fistula. The fistula tract was first dissected posterior to the bladder. Due to the location of the fistula, a transvesical approach was also required to identify the distal end of the fistula. Once the fistula was completely separated from the bladder, it was primarily closed. An omental flap was then mobilized and secured over the fistula site. Results: The patient underwent successful repair using minimally invasive techniques, preventing th...

PE64: Postoperative complications of radical prostatectomy approached by robot-assisted, conventional laparoscopic, perineal and retropubic method in patients with prostate cancer: A prospective and non-randomized comparison study

PE64: Postoperative complications of radical prostatectomy approached by robot-assisted, conventional laparoscopic, perineal and retropubic method in patients with prostate cancer: A prospective and non-randomized comparison study

Pedicled rectus abdominis muscle and fascia flap sling the bulbar urethra for treatment for male-acquired urinary incontinence: report of ten cases

Male urinary incontinence is relatively common complication of radical prostatectomy and of posterior urethroplasty following traumatic pelvic fracture. Here, we investigate the use of pedicled rectus abdominis muscle and fascia flap sling of the bulbar urethra for treatment for male-acquired urinary incontinence. Ten patients with acquired urinary incontinence were included in the study. Urinary incontinence was secondary to TURP in three patients and was secondary to posterior urethroplasty performed following traumatic pelvic fracture in seven patients. Pedicled rectus abdominalis muscle and fascial flaps, approximately 2.5 cm wide and 15 cm long, were isolated. The flaps were inserted into a perineal incision through a subcutaneous tunnel. The free end of the flap was sectioned to form two muscle strips, each 3 cm in length, and inserted into the space between bulbar urethra and corpus cavernosa. After adequate sling tension had been achieved, the two strips of muscle were anastomosed around the bulbar urethra using a 2-zero polyglactin suture. The patients were followed up for between 12 and 82 months (mean 42.8 months). Complete continence was achieved with good voiding in seven of the 10 patients. In other three patients achieved good voiding following catheter removal, but incontinence was only moderately improved. A pedicled rectus muscle fascial sling of the bulbar urethra is an effective and safe treatment for male patients with mild to moderate acquired urinary incontinence, but it may not be suitable for severe incontinence or for patients with weak rectus abdominalis muscles.

Post Prostatectomy Incontinence

Post prostatectomy incontinence is a bothersome complication of radical prostatectomy. While most men recover from initial post prostatectomy incontinence, some do not. It is important to understand the natural history of post prostatectomy incontinence as well as different measures to correct the incontinence. This manuscript will review current understanding of post prostatectomy incontinence with an emphasis on the evaluation and current management of post prostatectomy incontinence.

Early and late complications of radical prostatectomy

The analysis of radical prostatek-tomiya (RPE) results at 128 patients taking place of treatment in the clinic of urology of SPbGMU named after academician I. P. Pavlov since 2005 till 2012 is carried out. Age of patients was from 52 to 81 year (averagely — 66.0 years). The intraoperative mortality was absent. The intraoperative complications included the injury of rectum at four patients (2.3%) and damage of the ureter at one patient (0.7%). The late complications included a stricture of vesicourethral anastomosis — at five patients (3.9%), an urine incontinence later than 12 months after the operation — at five patients (3.9%). The carried-out statistical analysis didn't reveal any factors which are statistically influenced to the anastomosis stricture development. It is noted that the level of intraoperative hemorrhage and the operation’s duration authentically correlated with the duration of urinary retention recovery after radical prostatektomy

Causes of primary refractoriness to the treatment of erectile dysfunction with phosphodiesterase type 5 inhibitors and means to overcome it

Aim: to elucidate causes of primary refractoriness to phosphodiesterase type 5 inhibitors. Materials and methods: 28 men aged from 38 to 59 (mean 46) years suffering from erectile dysfunction and primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors were interviewed using the International Index of Erectile Function (IIEF-5) questionnaire. In addition, they were examined by ultrasound dopplerography of penile vessels, subjected to neurologic testing and measurement of blood testosterone, TSH, prolactin, and glucose levels. Results and discussion: The primary refractoriness to the treatment with phosphodiesterase type 5 inhibitors was attributable to hypothyroidism in 3.5% of the cases, to diabetic neuropathy in 3.5%, to complications of radical prostatectomy in 3.5%, to hyperprolactinemia in 7%, to atherosclerosis of cavernous arteries in 7%, to venogenic erectile dysfunction in 7%, to hypogonadism in 11%, to combination of hypogonadism, diabetic neuropathy and angiopathy in 57%. Hypothyroidism, hyperprolactinemia, hypogonadism, and type 2 diabetes mellitus (12.5% of the cases) were detected for the first time in the examined patients. Pathogenetic therapy resulted in the elimination of erectile dysfunction in the patients presenting with hypothyroidism, hyperprolactinemia, and isolated hypogonadism. Combined treatment of erectile dysfunction with Nebido and Levitra proved efficacious in 14 of the 16 patients with combined hypogonadism, diabetic neuropathy, and angiopathy. Conclusion: The main causes of primary refractoriness to phosphodiesterase type 5 inhibitors appear to be endocrinopathies and diabetic neuro/angiopathy. Combined examination of the patients in these conditions makes it possible to reveal dangerous disorders. Self-treatment with phosphodiesterase type 5 inhibitors is undesirable. Medicamental therapy (including combined application of testosterone preparations and phosphodiesterase type 5 inhibitors) permits to cope with erectile dysfunction in 75% of the patients.