Incidence Of Postoperative Incontinence Research Articles

Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique-A Prospective Randomized Study.

To compare the safety and efficacy of the en bloc technique with the standard 2-lobe technique for holmium laser enucleation of the prostate (HoLEP). This prospective study included patients with benign prostatic hyperplasia (BPH) who underwent HoLEP from September 2020 to March 2022, by en bloc or 2-lobe technique. Patient demographics, prostate volume, enucleation, morcellation and operative time, and incidence of postoperative incontinence were compared between the 2 groups. We included 64 patients (30 en bloc and 34 2-lobe techniques) who underwent HoLEP in this study. The mean age, prostate volume, creatinine, and PSA of patients were comparable in both groups [(68.53 vs. 67.55 years; P=.62), (79.43 vs. 79.88 g, P=.92), (1.08 mg/dL vs. 1.20 mg/dL, P=.35), (3.78 vs. 4.63 ng/mL; P=.376), respectively]. The enucleation time was significantly shorter in the en bloc group than in the 2-lobe group (54.2 vs. 61.67; P=.03). Additionally, the mean operative time was also comparatively shorter in the en bloc group than the 2-lobe group (72.36 vs. 80.50; P=.057). The improvement in the quality-of-life (QoL) score was significantly better with en bloc than the 2-lobe group (3.80 vs. 2.11; P=.01). There was a significant difference in stress urinary incontinence on days 1, 7, and 30 (P .001) with en bloc compared to the two-lobe technique. Although the outcomes of en bloc and 2-lobe endoscopic enucleation of prostate techniques were comparable, the en bloc technique seems to be a better option in most patients undergoing HoLEP due to less enucleation and operative time and lowered stress urinary incontinence incidence.

Effects of continuous nursing care on postoperative urinary incontinence in patients with prostate cancer

Objective To explore the effects of continuous nursing on postoperative urinary incontinence in patients with prostate cancer, so as to provide clinical evidence to improve the quality of postoperative and extended nursing care. Methods A total of 120 patients with prostate cancer underwent radical prostatectomy in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to January 2017, who met the inclusion criteria were recruited in the research. The patients were randomly divided into experimental group and control group by sortition randomization method, with 60 cases in each. The patients in control group were given routine discharge health education, and the experimental group received continuous nursing on the basis of routine discharge nursing. Three months after discharge, the incidence, duration, frequency and quantity of urinary incontinence in the two groups were recorded by the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) . A self-designed prostate cancer postoperative-related knowledge questionnaire, which evaluated the patients understanding prostate cancer care, was completed by the patients of the two groups. A self-designed satisfaction questionnaire was used to evaluate and compare the satisfaction of the two groups of patients to the quality of nursing. Results The incidence rate and the duration of postoperative urinary continence in the experimental group [16.7%, (4.1±2.8) d] were significantly lower than those in the control group (χ2=9.076, t=-2.630; P<0.05) . After 3 months of discharge, the score of related knowledge and the satisfaction of nursing work in the experimental group were both higher than those of the control group, and the differences were statistically significant (P<0.05) . Conclusions Continuous nursing care for discharged patients after prostatectomy can enhance patients' knowledge of disease, effectively reduce the incidence of postoperative incontinence, reduce urinary incontinence duration, and improve patients' satisfaction with nursing quality. Key words: Prostatic neoplasms; Urinary incontinence; Postoperative complications; Health education; Continuous nursing care

En-Bloc Technique With Anteroposterior Dissection Holmium Laser Enucleation of the Prostate Allows a Short Operative Time and Acceptable Outcomes

To simplify anteroposterior dissection holmium laser enucleation of the prostate by combining it with a novel en-bloc enucleation technique that omits median lobe enucleation and removes the adenoma en-bloc in benign prostatic hyperplasia patients. Between September 2013 and May 2014, 65 patients with benign prostatic hyperplasia underwent holmium laser enucleation of the prostate with the en-bloc technique we developed at our institution. Twenty-six patients who underwent surgery performed by the same experienced surgeon were included in our study. We evaluated the surgical parameters, including total operative time, enucleation time, morcellation time, and hemoglobin loss. Peak flow rate and postvoid residual urine volume were assessed 3 months postoperatively, and urinary incontinence was assessed 1 day after catheter removal and at 1 and 3 months postoperatively in all patients. Mean total operating time and mean enucleation time were 56.4 and 26.5 minutes, respectively. Peak flow rate and postvoid residual urine volume significantly improved. The incidence of postoperative incontinence at 3 months was 3%. Our en-bloc enucleation method required a short operating time and may address concerns regarding the complexity of the enucleation procedure. We believe the incidence of postoperative incontinence can be further reduced with additional refinements of this procedure.

Does Neoadjuvant Androgen Deprivation Therapy Before Primary Whole Gland Cryoablation of the Prostate Affect the Outcome?

To evaluate the effect of neoadjuvant androgen deprivation therapy (NADT) on the outcomes for primary whole gland prostate cryoablation (CRYO). NADT before CRYO has sometimes been used for prostate volume reduction, with some theoretical benefit toward improving disease control. NADT has been shown to be beneficial for biochemical disease-free survival (bDFS) with radiotherapy but not in conjunction with radical prostatectomy. We retrospectively compared risk-stratified cohorts according to whether they had received NADT. bDFS was defined using the Phoenix criteria, and postoperative morbidity and complications were compared. A total of 1761 men had undergone NADT before CRYO and 2727 had not. No differences were found in the incidence of postoperative incontinence, pad use, potency, or fistula formation. The rate of urinary retention at 12 months was slightly lower for those who had not undergone NADT (0.8% vs 1.2%, P = .015). No difference was found in bDFS between the NADT and non-NADT men (66.9% vs 66.5% at 5 years). When stratified by risk, however, a statistically significant difference was found between the NADT and non-NADT men only in the intermediate-risk cohort (71.3% vs 65.9%; P < .013). bDFS was statistically similar between the NADT and non-NADT men, except in the intermediate-risk cohort, with slightly improved survival for those undergoing NADT. No significant difference was found in the complication rates. These data do not support the routine use of NADT for men undergoing primary whole gland cryoablation, although its use could be considered for men with larger prostates or men in the intermediate-risk category.

Urinary Incontinence after Prostatectomy in Dogs

Eleven dogs with prostatic disease were treated by total prostatectomy. Urinary incontinence persisted in three of nine dogs, two of which were also incontinent before surgery. The incidence of postoperative incontinence may be reduced by undermining the prostatic capsule to preserve as much prostatic urethra as possible. The risk of postoperative incontinence appeared greater if there was prostatic neoplasia or preoperative urinary incontinence.