Laparoscopic Radical Prostatectomy Patients Research Articles

A Randomized Controlled Study of Robot-Assisted versus 3D Laparoscopic Radical Prostatectomy in Patients with Carcinoma Prostate.

A prospective randomized comparative study was performed from 1st January 2020 to 30th June 2021. All patients included were diagnosed with localized/locally advanced ca prostate. 60 patients fulfilling the inclusion and exclusion criteria were randomized into 2 groups. Groups A and B included patients who underwent robot-assisted radical prostatectomy and 3D laparoscopic transperitoneal radical prostatectomy, respectively. Various demographic, intraoperative, postoperative, and follow-up parameters were collected. Outcomes were evaluated in the form of the trifecta (continence, potency, and BCR-free status) and pentafecta rates (trifecta with no perioperative complications and negative surgical margins) in between the two groups. The mean operative time in Group A was 137.83 mins ± 17.27 compared to 148.20 mins ± 26.16 in Group B. Trifecta rates in Group A and Group B were 43.3%, 63.3%, and 76.6% and 40%, 53.3%, and 70% at 1, 3, and 6 months. Pentafecta rates in Group A and Group B were 36.6%, 53.3%, and 70% and 33.3%, 40%, and 53.3% at 1, 3, and 6 months. Complication rates were 10% in Group A and 13.3% in Group B, respectively. Only one patient in our study (Group B) had a positive surgical margin. We conclude from our comparative study, that both robot-assisted and 3D laparoscopic transperitoneal radical prostatectomy are feasible and efficacious treatment modalities for achieving acceptable trifecta and pentafecta rates in managing ca prostate with earlier continence and shorter urethrovesical anastomosis time in the robotic arm.

The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy.

This study aimed to develop a nomogram to predict the recovery of immediate urinary continence in laparoscopic radical prostatectomy (LRP) patients. A prediction model was developed based on a dataset of 154 LRP patients. Immediate urinary continence was defined as free from using pads within 7 days after the removal of the urinary catheter. The least absolute shrinkage and selection operator regression (LASSO) model was applied to screen the features. Multivariate logistic regression analysis was used to establish prediction model integrating the features selected from the LASSO regression analysis. Receiver operating curve (ROC), calibration and decision curve analysis (DCA) were used to assess the model's discrimination, calibration and clinical utility. The identified features of the prediction model included age, body mass index (BMI) and three pelvic anatomic parameters measured by MRI: membranous urethral length (MUL), intravesical prostatic protrusion length (IPPL) and puborectalis muscle width (PMW). The nomogram showed good discrimination with an are under the curve(AUC) of 0.914 (95% CI, 0.865-0.959, p < 0.001). Moreover, good calibration was showed in the model. Lastly, DCA showed that the nomogram was clinically useful. The developed novel nomogram that can predict the possibility for post-prostatectomy patients to recover immediate urinary continence could be used as a counseling tool to explain urinary incontinence to patients after LRP.

A study on clinicopathological correlations after laparoscopic radical prostatectomy patients for high risk prostate carcinoma

A study on clinicopathological correlations after laparoscopic radical prostatectomy patients for high risk prostate carcinoma

PJY03 - Post-operative outcomes following robotic assisted laparoscopic radical prostatectomy in patients between the ages of 65 and 69 and between the ages of 70 and 75 years

PJY03 - Post-operative outcomes following robotic assisted laparoscopic radical prostatectomy in patients between the ages of 65 and 69 and between the ages of 70 and 75 years

Inspired by the Research Process: Lessons Learned in the Participation of a Mixed Method Randomized Comparative Clinical Trial

<h3>Background Information</h3> Post Anesthesia Care Unit (PACU) nurses met with the clinical nurse specialist to participate in a music-based intervention research study whose purpose was to reduce anxiety and pain in laparoscopic radical prostatectomy patients. One co-investigator was a nursing student whose expertise was in music. The research team chose to frame their study using a mixed method, randomized comparative design between two complementary music interventions: (1) patient-selected music preferences using Spotify; (2) pre-recorded guided breathing relaxation narrative underscored with minimal, hypnotic music. <h3>Objectives of Project</h3> To participate as co-investigators in a mixed method randomized comparative study to determine the effectiveness of music listening interventions in reducing anxiety and pain scores in the PACU; learn about patient experiences through qualitative inquiry. <h3>Process of Implementation</h3> 1.Co-investigators took CITI protection for human subjects 2.Submitted study protocol; approved by IRB 3.IT Department programed music interventions on devices 4.Invitation PreOp phone call night prior 5.Night prior, team collates brown envelope; headset/fully charged i-Pods in plastic bag w/coded randomized group; I-Pods checked fully charged/tested 6.PI/Co-investigators consented patients in waiting room 7.Drew music G-cleft by patient's ID 8.Patient escorted to Prep; listened to music 9.Once awake – patient offered assigned music until discharge 10.Blinded RN records "Post" STAI scores; completes PACU data form 11.RN documents patient's own words to qualitative inquiry 12.RN returns plastic bag/data sheet to LCN desk. All equipment sanitized; placed in locked drawer for recharging; ready for next patient 13.Nurses shared results of their study with nursing leaders and surgeons <h3>Statement of Successful Practice</h3> The PACU nurses successfully completed the research study, authored a music listening manuscript, submitted manuscript for publication, and disseminated results of the study through local and national poster presentations. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Participating in the conduct of research inspires bedside PACU nurses to continue their scientific inquiry by creating new knowledge to improve perianesthesia nursing practice and patient care. Future research should focus on the benefits of PACU nurses participating in research and contributing to nursing theory.

Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Mixed Method Randomized Comparative Clinical Trial

<h3>Introduction/Background</h3> Laparoscopic radical prostatectomy surgery patients have reported severe pain post operatively and experienced psychological distress for potential urinary incontinence and sexual dysfunction. Over this past year, PACU nurses identified anxiety and pain management as the primary cause of these patients' increased length of stay in PACU. <h3>Identification of the problem</h3> Patients undergoing major cancer surgery frequently express increased anxiety about how severe their pain will be as well as their oncology surgical outcomes. Mid-Atlantic academic teaching hospital's postanesthesia care unit (PACU) Standards of Care Committee met to discuss investigating complementary music listening methods to enhance pharmacologic pain management to address concerns in this surgical population. <h3>Purpose of the Study</h3> To compare two methods of music listening interventions on anxiety, pain, heart rate, blood pressure, and oxygen saturation among post anesthesia care unit (PACU) patients who are recovering from laparoscopic radical prostatectomy surgeries: a) patient-preferred music listening via Spotify selections; and b) relaxation breathing narrative over minimalistic hypnotic music. <h3>Methodology</h3> Randomization of participants by computer-generated table of random numbers for effective balance between the two groups. A power analysis was calculated to have 77 male participants: Group I (n=37) and Group II (n=40). Inclusion criteria/exclusion criteria established. Nurses blinded to study interventions. The study started in December 2019 and concluded in December 2020. Data collection began in PreOP and continued through discharge. <h3>Results</h3> Both Groups I and II had reduced pain scores at discharge as compared to PACU admission; both groups had significant reduction (p=0.046 Group I, and Group II (p=0.002), but changes for comparative groups (I and II) were not significant between the two groups (p=0.53). <h3>Discussion</h3> Both interventions reduced State Trait Anxiety Inventory scores and pain scores to a similar degree; this reduction was clinically and statistically significant. Pain medication use did not differ between the two groups. Notably, three study participants did not require any pain medication throughout their entire PACU stay. Qualitative inquiry question on discharge revealed significant relaxation, distraction, pain relief, and comfort when listening to music. <h3>Conclusion</h3> Study revealed both relaxation/breathing track and personally selected music can meaningfully improve patients' anxiety and PACU pain scores. <h3>Implications for perianesthesia nurses and future research</h3> Future multicenter studies of music listening methods should be studied in other surgical/procedural patients recovering in PACU.

An EBP Project: What Is the Best Music Listening Intervention for Patients Recovering in the Post Anesthesia Care Unit (PACU)

<h3>Introduction</h3> In the Weinberg PACU, Patients who were having laparoscopic radical prostatectomies experience severe pain which caused them to have an increase length of stay. Additionally, these patients who suffered from prostate cancer also have high levels of anxiety that required them to have large doses of opioids administered for their pain management. The Perianesthesia nurses questioned what complementary evidence could support a non-pharmacologic approach to reducing this patient population's post-operative pain. <h3>Identification of the problem</h3> What is the best music listening intervention for patients recovering in the post anesthesia care unit? <h3>EBP Question/Purpose</h3> <b>PICO question. Databases utilized</b>. P - Post Anesthesia patients recovering in the PACU I - Best method of music listening C - Preferred music listening compared to relaxation breathing narrative O - Listening to best method will reduce anxiety and PACU pain score <h3>Methods/Evidence</h3> Literature search yielded 1006 articles and only 20 were appropriate articles that met our PICO criteria. The evidence search strategy range from year 2012-2020. The data base searches were PUBMED, CINAHL, ERIC, Jonna Briggs Institute, and Cochrane Review data bases were searched. The key mesh terms used were: music, music listening, music therapy, intervention, surgery, PACU, post- operative, randomized controlled trials, anxiety, pain and pain management. <h3>Synthesis /Recommendations</h3> Appraisal results were six level 1A's, three level 2A's, three level 1B's, two level 2B's, one level 4A's, one level 5A's and one level 5B's. Synthesis recommended two evidence-based music listening interventions: Preferred music listening method and relaxation breathing over minimalistic music for therapeutic interventions to reduce anxiety and pain. <h3>Future Perianesthesia Research</h3> Translation of EBP project to practice implemented the "Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Randomized Comparative Clinical Trial. The results of this study revealed that both preferred selected music listening method and guided relaxation breathing over a minimalistic hypnotic track can meaningfully reduced patient's anxiety and PACU pain scores.

Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Randomized Comparative Clinical Trial

PurposeRandomized comparative mixed method approach with qualitative inquiry study's aim sought to determine if there was a difference in pre/post-intervention State-Trait Anxiety Inventory (STAI) scores and postanesthesia pain scores between two music listening groups of laparoscopic radical prostatectomy patients. DesignProspective randomized comparative mixed method approach with a qualitative inquiry. MethodsSample size of 77 male participants assigned by a table of random numbers to Spotify patient-preferred music selection Group I (n = 37) or minimalist hypnotic music with guided relaxation breathing (MHMGRB) instructional narrative Group II (n = 40). Outcome measures used patients’ STAI questionnaire and reported PACU admission and discharge pain scores. ResultsBoth Groups I and II had reduced pain scores at discharge as compared to admission; both groups had a significant reduction (P = .046 Group I, and Group II (P = .002), but changes for comparative groups (I and II) were not significant between the two groups (P = .53). ConclusionsStudy revealed that both patient-preferred selected music and MHMGRB can meaningfully reduce patients’ anxiety and PACU pain scores.

Construction of pelvic floor muscle rehabilitation training program for patients undergoing laparoscopic radical prostatectomy.

BackgroundLaparoscopic radical prostatectomy (LRP) is the standard treatment for early localized PCa, of which urinary incontinence is the most common postoperative complication. Pelvic floor muscle rehabilitation training is recognized as the first line of intervention measures, but the existing rehabilitation training programs are not clear in the formulation process, the content is not unified, and the clinical operability is not strong. In order to better guide clinical pelvic floor muscle rehabilitation training after LRP and prevent and control urinary incontinence, this study constructed a pelvic floor muscle rehabilitation training program for LRP patients.MethodsLiterature analysis, qualitative interview, and an expert group meeting method were used to form the draft of pelvic floor muscle rehabilitation training program for LRP patients. On this basis, after 2 rounds of Delphi expert consultation, the research team modified and improved the program.ResultsThe consultation experts involved in the 2 rounds were the same, 15 questionnaires were sent out, and 15 were recovered with an effective recovery of 100%. The expert authority coefficient was 0.87. In the second round of consultation, Kendall’s harmony coefficient was 0.14 (P<0.001), the mean coefficient of variation of expert opinion was 0.07 (P<0.001), and the mean value of importance assigned to each item was 4.53–5.00 points. Finally, the pelvic floor muscle rehabilitation training program for LRR patients was formed. Including rehabilitation training evaluation, rehabilitation training advanced time and content, rehabilitation training form of three first-level indicators, 12 second-level indicators, 53 third-level indicators.ConclusionsThe pelvic floor muscle rehabilitation training program for LRP patients developed in this study is scientific, reliable, safe and feasible, which can provide reference for clinical pelvic floor muscle rehabilitation training after LRP and prevention and control of urinary incontinence.

Prostatectomía radical abierta y laparoscópica: comparación de resultados oncológicos y funcionales

Abstract Objective: To compare oncological and functional results of open and laparoscopic radical prostatectomy in patients with prostate cancer. Materials and methods: A retrospective cohort analytical study was carried out, where a total of 70 patients with a clinical diagnosis of localized prostate cancer were evaluated, during the period June 2010 to June 2015. The patients were grouped according to the technique used: open surgery (n = 40) and laparoscopic surgery (n = 30). Preoperative variables were analyzed (age, prostate-specific antigen, biopsy histology, functional status and comorbidities), perioperative (surgical time, intraoperative bleeding, hospital stay and complications), postoperative: oncological (stage, histological findings of the surgical specimen and TNM) and postoperative functional (urinary continence and potency or sexual performance). Results: No significant differences were found in oncological results; but if in intraoperative bleeding (1177 vs 440 cc; p <0.001), hospital stay (5.8 vs 4.6 days; p = 0.003), complications (35 vs 10%; p = 0.016) and continence (65 vs 93%; p = 0.018), in favor of the laparoscopic technique. When evaluating the surgical time, it was found that it was shorter with the open technique (242 vs 295 minutes; p <0.001). Conclusions: At 60 months of follow-up, there was no significant difference in oncological results or sexual potency between the two groups. With the laparoscopic technique, less intraoperative bleeding, fewer intraoperative and postoperative complications, shorter hospital stay and better recovery from urinary continence were found.

Comparison of functional and oncological outcomes of innovative \u201cthree-port\u201d and traditional \u201cfour-port\u201d laparoscopic radical prostatectomy in patients with prostate cancer

BackgroundTo compare the functional and oncological outcomes between innovative “three-port” and traditional “four-port” laparoscopic radical prostatectomy (LRP) in patients with prostate cancer (PCa).MethodsWe retrospectively collected the data of PCa patients treated at our institutions from June 2012 to May 2016. According to the inclusion criteria, a total of 234 patients were included in the study, including 112 in group A (four-port) and 122 in group B (three-port). The perioperatively surgical characteristics, functional and oncological outcomes were compared between groups.ResultsThere were no statistical differences in the baseline parameters between these two groups. Compared with group A, the operative time (OT) and estimated blood loss (EBL) were significantly less in group B. On follow-up, the rate of positive surgical margin (PSM), prostate specific antigen (PSA) biochemical recurrence and continence after LRP did not show any statistically significant difference between the groups. An identical conclusion was also received in comparison of overall survival (OS) and biochemical recurrence-free survival (BRFS) between both groups.ConclusionsInnovative “three-port” LRP can significantly shorten the OT and reduce the EBL compared with the traditional “four-port” LRP. Meanwhile, it does not increase the rate of PSM and PSA biochemical recurrence. “Three-port” LRP could be popularized in the future in view of its superior surgical technique, considerably better functional outcomes and remarkable oncological control.

Ambulatory robot-assisted laparoscopic radical prostatectomy with extended recovery by total extraperitoneal approach.

To evaluate the feasibility of performing robot-assisted laparoscopic radical prostatectomy in an ambulatory with extended recovery setting by using a total extraperitoneal approach. Patients with low- to intermediate-risk, prostate cancer were prospectively recruited in the ambulatory robot-assisted laparoscopic radical prostatectomy with extended recovery by total extraperitoneal approach group (n=30), and a matched-pair inpatient surgery control group by total extraperitoneal approach (n=20). Objective discharge criteria were based on the postanesthesia discharge scoring system. All patients underwent preoperative counseling on preoperative preparation and postoperative care. There were no statistically significant differences between the ambulatory with extended recovery-total extraperitoneal approach and inpatient-total extraperitoneal approach groups in patient factors (age, body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index), disease factors (prostate-specific antigen, clinical Tstage, biopsy Gleason score, prostate volume) and peri-operative parameters (operative time, blood loss, Trendelenburg angle). All total extraperitoneal robot-assisted laparoscopic radical prostatectomy patients (ambulatory with extended recovery and inpatient surgery groups) met the postanesthesia discharge scoring system discharge criteria ≤23h from admission. The mean hospital stays for ambulatory with extended recovery-total extraperitoneal and inpatient-total extraperitoneal groups were 20.3 and 52.4h, respectively (P<0.001). A total of 29 of 30 patients (97%) in the ambulatory with extended recovery-total extraperitoneal group were discharged ≤23h of admission. This is the first prospective evaluation of robot-assisted laparoscopic radical prostatectomy by the total extraperitoneal approach, showing that the short-stay ambulatory with extended recovery approach is safe, feasible and with a high success rate. Total extraperitoneal surgical approach is a critical factor for the success of the ambulatory with extended recovery protocol.

Robot Destekli Laparoskopik Radikal Prostatektomi Hastalarında Üç Farklı Genel Anestezi Yönteminin Postoperatif Böbrek ve Hepatik Fonksiyonlar Üzerine Etkileri

Robot Destekli Laparoskopik Radikal Prostatektomi Hastalarında Üç Farklı Genel Anestezi Yönteminin Postoperatif Böbrek ve Hepatik Fonksiyonlar Üzerine Etkileri

Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer.

To compare the oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP). We compared patients who underwent the RARP (n=778) and LRP (n=48) techniques for prostate cancer between January 2008 and July 2017 in our clinic. Patient demographics, preoperative and postoperative data, pathologic evaluation, continence, and potency rates were collected and analyzed retrospectively. The preoperative and demographic data of the patients we included in our study were similar. The mean operation time estimated blood loss, length of hospitalization, and catheterization time were significantly shorter in the RARP group. The statistical analysis was in favor of robotic prostatectomy in the terms of the mean length of hospitalization, catheterization time, and early (<30 days) and intermediate (31-90 days) complications. Positive surgical margins and biochemical recurrence rates, and recovery of continence and erectile function, were similar in both groups. RARP and LRP in organ-confined prostate cancer are safe and effective methods. Robotic prostatectomy has a shorter operative time, length of hospitalization, catheterization time, and lower early and late complication rates.

Impact and Predictive Value of Prostate Weight on the Outcomes of Nerve Sparing Laparoscopic Radical Prostatectomy in Patients with Low Risk Prostate Cancer.

To investigate the impact of prostate weight on outcomes of nerve sparing laparoscopic radical prosta-tectomy (LRP) and assess its predictive value on postoperative continence and potency recovery. We conducted a retrospective study on the clinical data of 165 patients with low risk prostate cancer (PCa) who underwent nerve sparing LRP. All the patients included had normal preoperative uri-nary and sexual function. The association of prostate weight with perioperative data was assessed using Spearman correlation coefficient. Univariate and multivariate Cox regression analyses were employed to identify prognostic predictors for continence and potency recovery. Increased prostate weight was significantly associated with older age, higher prostate-specific antigen (PSA), lower biopsy and pathological T stage and Gleason score, longer operative time, and higher estimated blood loss (P < .05). The continence rates at the 3rd, 6th, and 12th month after surgery were 63.6% (105/165), 87.9% (145/165), and 95.8% (158/165); and the potency rates were 44.8% (74/165), 62.4% (103/165) and 77.6% (128/165), respectively. Furthermore, multivariate Cox analysis showed that patient age (HR = 0.52, 95% CI: 0.35- 0.76) and prostate weight (HR = 0.54, 95% CI: 0.34-0.86) were independent predictors for continence recovery, while only patient age (HR = 0.66, 95% CI: 0.45-0.96) could independently predict potency recovery. Larger prostate size was correlated with older age, higher PSA, lower tumor stage and grade, longer operative time, and more intraoperative blood loss in low risk PCa patients. Increased prostate weight may inde-pendently predict poor continence recovery after nerve sparing LRP.

A Meta-analysis of Robot Assisted Laparoscopic Radical Prostatectomy Versus Laparoscopic Radical Prostatectomy.

ObjectiveTo evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.MethodsMeta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.ResultsThis meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P<0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).ConclusionAs an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.

Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer

Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer

Live Surgery for Laparoscopic Radical Prostatectomy—Does it Worsen the Outcomes? A Single-center Experience

ObjectiveTo compare outcomes of laparoscopic radical prostatectomy (LRP) performed in live surgery versus daily routine LRP. MethodsFrom January 2014 to June 2017, data from LRP performed at our Institution in live broadcasting by 3 experienced laparoscopic surgeons during educational events were collected. A 1:2 matching (according to BMI, comorbidities, NCCN risk groups, and operating surgeon) was performed with the routine LRP patients collected in our prospectively-maintained database. Chosen procedures were performed within the same time span by the same surgeons. Data of interest were compared. ResultsTwenty-three live surgery LRPs were analyzed (Group A). Forty-six matched patients were the controls (Group B). Groups were comparable at baseline. No differences were found in perioperative data (operative time, blood loss, and intraoperative complications, 4.3% in both Groups) and postoperative complications. Particularly, 10 (43.5%) and 22 patients (47.8%) did not report complications (Group A vs B, respectively, P = .54). The majority of complications were Clavien 1-2, with 2 patients per Group requiring blood transfusion. Overall positive surgical margins rate was 26.1%. It was significantly higher in Group A (43.5% vs 17.4%; P = .02), but no differences were found in the number of patients who relapsed, who needed radiotherapy or androgen deprivation therapy within a median follow-up of 25 months in both Groups. No differences were found regarding functional data. Limitations include a low sample size and limited follow-up. ConclusionLRP has similar perioperative outcomes when performed in either live surgery or daily routine setting. We underline the higher positive surgical margins rate after live surgeries that should increase the awareness before embarking on it.

Laparoscopic Radical Prostatectomy in Patients with High-Risk Prostate Cancer: Feasibility and Safety. Results of a Multicentric Study.

In Western countries about 25% of prostate cancer (PCa) are high-risk tumors at presentation and its treatment is still a matter of debate among urologists. When a surgical approach is preferred the use of a mininvasive tecnique is still difficult due to the lack of data supporting it in literature. The aim of this study is to evaluate feasibility and safety of laparoscopic radical prostatectomy (LRP) for high-risk PCa. The study included 1114 patients with high-risk PCa submitted to LRP between 1998 and 2014. High-risk patients were defined according to D'Amico classification. We collected functional and oncological long-term outcomes and evaluated with univariate and multivariate analyses the role of predictive factors for survival and biochemical recurrence (BR). Mean age at treatment was 62 ± 8 years; mean follow-up was 74 ± 50 months. We obtained an overall survival (OS) of 96.6% at a mean follow-up of 74 months (1076 patients) and a disease-free survival of 66.2% (737 patients). Age (p = 0.0006), pT (p < 0.0001), pN (p = 0.0018), and surgical margins (p = 0.0076) resulted as independent predictors for BR in multivariate analysis. pN (p = 0.0025) and Gs (p = 0.0003) are independent predictors for OS and cancer-specific survival in a univariate analysis; just the Gs results significant in the multivariate model. According to our encouraging data about oncological and functional outcomes we believe that radical prostatectomy represents an effective treatment for patients with high-risk PCa and that laparoscopy is a safe approach offering a mini-invasive alternative to open surgery.

Urodynamic changes in patients with prostate cancer undergoing robotic-assisted radical prostatectomy: A comparison with laparoscopic radical prostatectomy

ObjectiveThis study investigated the urinary incontinence status and urodynamic changes of localized prostate cancer patients after laparoscopic radical prostatectomy (LRP) and robotic-assisted radical prostatectomy (RaRP). Materials and methodsWe enrolled 36 and 30 patients who underwent LRP and RaRP, respectively. The urinary incontinence status and videourodynamic studies (VUDS) of the LRP and RaRP groups during the first year after the surgery were compared. ResultsThe RaRP group was younger and had a smaller prostate volume, shorter operation time, less blood loss, and higher proportion of patients who received postoperative radiotherapy than the LRP group. Twenty RaRP and 26 LRP patients completed VUDS during the 1-year follow-up. Overall, reduced detrusor voiding pressure (Pdet), increased maximal urinary flow rate (Qmax), and reduced bladder outlet obstruction index (BOOI) were detected at 3, 6, and 12 months postoperatively. At 12 months, both the LRP and RaRP groups had similar significant reductions of Pdet. However, only the RaRP group had a significant increase of Qmax and significant reduction of BOOI. Overall, 56.5% of patients (26 of 46) had detrusor overactivity (DO) before the surgery. The de novo DO rate and DO remission rate were 15.2% and 19.6%, respectively, without significant difference between the LRP and RaRP groups. At 6 months, the RaRP group had a significantly lower rate of stress urinary incontinence (SUI) than the LRP group (4.5% versus 47.2%, p = 0.003). In the RaRP group, the greater degree of recovery of both stress and urgency urinary continence developed during the first 6 months postoperatively. ConclusionThe changes of VUDS at 12 months postoperatively for radical prostatectomy included reduced Pdet and BOOI, and increased Qmax. At 6 months, the RaRP group had a lower SUI rate then the LRP group. The key phase of urinary continence recovery was the first 6 months after the surgery.