Postoperative Urinary Continence Recovery Research Articles

Early recovery of urinary continence after robot-assisted radical prostatectomy is associated with membranous urethra and neurovascular bundle preservation.

We investigated the correlation between surgical outcomes and postoperative urinary continence recovery in robot-assisted radical prostatectomy (RARP). Patients who underwent RARP in our institution (n = 195) were included in this study. Preserved urethral length (PUL) was assessed during the procedure. Other outcomes of the surgical procedure were collected from operative records. Kaplan-Meier analysis with log-rank test was used to compare urinary continence recovery rate with the PUL, sparing of the neurovascular bundle (NVB), and other surgical procedures. Univariate and multivariate analyses were performed using Cox proportional hazards model, and p-values of <0.05 were considered significant. Patients with a PUL ≥26 mm had 10.0%, 24.7%, 36.6%, and 89.0% continence recovery rates at 30, 60, 90, and 365 days after surgery, respectively, while patients with a PUL <26 mm had 0%, 17.8%, 26.1%, and 80.9% recovery rates, respectively. Kaplan-Meier curves showed significantly better postoperative urinary continence recovery at 30 days after RARP in patients with a PUL ≥26 mm than those with a PUL <26 mm (p = 0.0028) and in patients with NVB preservation than those with no NVB preservation (p = 0.014). Urinary continence recovery within 30, 60, and 90 days after surgery was 90.6% for patients with a PUL of ≥26 mm and NVB preservation, while only 82.3% for patients with a PUL of <26 mm or no NVB preservation. Our results suggest that a PUL ≥26 mm and NVB preservation after RARP correlate with a significantly higher postoperative rate of recovery of urinary continence.

Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies.

The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.

Initial experience and short-term outcomes of single-port extraperitoneal transvesical robot-assisted radical prostatectomy: a two-center study.

This study presents the procedure of single-port extraperitoneal transvesical approach to robot-assisted radical prostatectomy (SETvRARP) on the da Vinci Xi platform coupling with a 4-channel single port and evaluated the short-term outcomes in the first 72 prostate cancer (PCa) patients. Seventy-two patients with localized PCa were enrolled. Each operation was conducted by the same single robotic surgery group in two centers using the da Vinci Xi system. The median operation time was 150 min, and the median estimated blood loss was 50 mL. All operations were successfully carried out without open conversion or transfusion. No ≥ Grade II complications were noted. Urethral catheters were routinely removed on postoperative day 7. Sixty-eight (94.4%) patients recovered to immediate urinary continence after surgery, with 72 (100%) patients achieving full continence on postoperative day 14. A positive surgical margin was observed in 15 (20.8%) patients. Postoperative urodynamic studies regarding peak urinary flow, bladder capacity, and residual urine were not statically different from the preoperative results. No biochemical recurrence was noted in all patients within the follow-up period. Postoperative erectile function was not statistically different from the preoperative results (P=0.1697). SETvRARP using the da Vinci Xi system coupling with a 4-channel single port is a valid radical prostatectomy technique in well-selected PCa patients, resulting in superior postoperative recovery of urinary continence. Meanwhile, the outcomes in functional protection and cancer control need to be further investigated with a long-term follow-up duration.

Independent Factors Affecting Postoperative Short-Term Urinary Continence Recovery after Robot-Assisted Radical Prostatectomy.

Background Our team had firstly applied the transvesical approach to robot-assisted radical prostatectomy (RARP) in patients afflicted with localized prostate cancer (PCa). The present study aims to present the postoperative recovery of urinary continence (UC) following the anterior, transvesical, and posterior approaches to RARP for localized PCa and evaluate the independent predictors to early UC recovery after RARP. Methods Patients harboring localized PCa and receiving anterior, transvesical, and posterior approaches to RARP between January 2017 and June 2020 were enrolled in this analysis. Results on UC recovery were compared between these three approaches with the Kaplan–Meier method. All clinical and pathological variables were further analyzed via univariable and multivariable regression analysis to determine the independent factors contributing to short-term UC recovery after RARP. Results A total of 135, 73, and 66 instances were included in the anterior, transvesical, and posterior groups, respectively. Over the postoperative follow-up period, both the transvesical and posterior approaches showed an advantage over the anterior approach in promoting postoperative UC recovery (both p values <0.001). Three months after surgery, 55 (40.7%), 4 (5.5%), and 5 (7.6%) patients failed to UC in the anterior, transvesical, and posterior groups, respectively. Patient age, preoperative PSA, prostate volume, biopsy Gleason score, surgical approach, extended lymph node dissection technique, nerve-sparing technique, and positive lymph node were related to UC status based on univariable analyses (p < 0.05). Multivariable analysis results point patient age, prostate volume, surgical approach, and nerve-sparing technique as independent factors that affect postoperative UC recovery after RARP. Conclusions The application of transvesical approach to RARP for localized PCa could obtain promising outcomes in terms of postoperative UC recovery. In addition, surgical strategies encompassing the nerve-sparing technique and the Retzius-sparing procedures, namely, the transvesical or posterior approach, during RARP could independently enable early achievement of postoperative continence.

Longer preserved urethral length in robot-assisted radical prostatectomy significantly contributes to post-operative urinary continence recovery.

ObjectivesTo assess the relationship between the surgical procedure of robot‐assisted radical prostatectomy (RARP) and urinary continence recovery by reviewing the video database.MethodsVideo and data about men diagnosed with prostate cancer and underwent RARP were extracted and reviewed. Preserved urethral length (PUL) was semi‐quantitatively measured using the lateral width of a 16‐Fr urethral balloon catheter while cutting the urethra on a video screen. In addition, by reviewing intraoperative RARP video database, other surgical skill outcomes were also collected. Kaplan–Meier analysis with log‐rank test was used to compare the urinary continence recovery rate, stratified by the PUL. Univariate and multivariate analyses were performed using the Cox proportional hazards model, and p‐values of <0.05 were considered significant.ResultsThe number of patients included in this study was 213. In univariate analysis, a PUL of ≥16 mm, a body mass index of <23.1 kg/m2 and a resected prostate volume of <44.3 g were statistically significant factors that influenced urinary continence recovery [hazard ratio (HR) 1.58, p = 0.036; HR 0.67, p = 0.021; and HR 0.58, p = 0.005, respectively]. Those factors also remained statistically significant in the multivariate analysis (HR 1.87, p = 0.022; HR 0.54, p = 0.001; and HR 0.57, p = 0.005, respectively). One year post‐operatively, the recovery rate from urinary continence was 79.0% for patients with a PUL of ≥16 mm and 66.5% for patients with a PUL of <16 mm.ConclusionThese results suggest that patients with longer PUL in RARP have a significantly higher rate of post‐operative urinary continence recovery.

V12-11 THE EFFECT OF VESICOPEXY ON URINARY CONTINENCE RECOVERY FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: TECHNIQUE AND OUTCOMES

You have accessJournal of UrologyProstate Oncology I (Prostatectomy) (V12)1 Sep 2021V12-11 THE EFFECT OF VESICOPEXY ON URINARY CONTINENCE RECOVERY FOLLOWING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY: TECHNIQUE AND OUTCOMES Alireza Ghoreifi, Wesley Yip, Kian Asanad, Marissa Maas, Guadalupe Gonzalez, Jamal Nabhani, and Hooman Djaladat Alireza GhoreifiAlireza Ghoreifi More articles by this author , Wesley YipWesley Yip More articles by this author , Kian AsanadKian Asanad More articles by this author , Marissa MaasMarissa Maas More articles by this author , Guadalupe GonzalezGuadalupe Gonzalez More articles by this author , Jamal NabhaniJamal Nabhani More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002093.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) is a challenging issue in patients undergoing robotic-assisted radical prostatectomy (RARP). Multiple techniques that aim to restore normal lower urinary tract anatomy have been proposed to improve postoperative continence. The aim of this video is to present a new technique of vesicopexy and its effect on early postoperative urinary continence recovery in patients undergoing RARP with an anterior approach. METHODS: In this technique, following the completion of the urethrovesical anastomosis, the bladder is fixed to the anterior abdominal wall using a 2-0 V-Loc™ barbed suture. Pelvic floor exercises using Kegel technique were recommended to all patients following catheter removal. Urinary continence was assessed using a pictorial pad usage questionnaire at 1 and 3 months postoperatively. Continence was defined as no or only safety pad usage. The illustrative case in the video is a 68-year-old male with prostate cancer, who underwent RARP with vesicopexy using the Da Vinci Xi robot platform. We also report the feasibility and outcomes of this technique in 60 consecutive patients who underwent RARP and vesicopexy between March 2019 and December 2020. RESULTS: A total of 60 patients were included in the pilot study. The median age was 65 years, and median body mass index was 28. The median preoperative International Prostate Symptom Score was 10. 12 (20%) patients underwent a bladder neck reconstruction, and nerve sparing was performed unilaterally in 24 (40%) and bilaterally in 24 (40%) patients. Salvage surgery was performed in one patient following failed cryotherapy. The remainder of the baseline and clinical features of the patients are shown in Table 1. At 1- and 3-month follow-ups, continence rates were 52% and 85%, respectively. Postoperative complications were seen in 5 (8.3%) patients (3 urine leak, 1 pelvic abscess, and 1 urinary retention) that were managed medically/conservatively. CONCLUSIONS: Vesicopexy is a safe, feasible and simple technique that may lead to a satisfactory recovery of early continence in patients undergoing RARP with an anterior approach. The next step is to evaluate this technique through a randomized controlled trial. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1027-e1027 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author Wesley Yip More articles by this author Kian Asanad More articles by this author Marissa Maas More articles by this author Guadalupe Gonzalez More articles by this author Jamal Nabhani More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement Loading ...

Effect of routine duloxetine administration in the early postoperative period on postprostatectomy stress incontinence in patients undergoing laparoscopic radical prostatectomy

Post-prostatectomy stress incontinence (PPI) is an important health problem for patients with radical prostatectomy history. Duloxetine is a common drug, used in PPI with the out of indications in most countries. In this study, we aimed to evaluate the prophylactic effect of duloxetine administration in PPI during the early postoperative period in patients undergoing laparoscopic radical prostatectomy (LRP). The retrospective study included 209 patients who underwent LRP. Patients were divided into two groups: Group I (n=96) was initiated on pelvic floor exercises (PFE) + duloxetine in the early postoperative period and continued this regimen for a total of 12 weeks and Group II (n=113) only performed PFE for 12 weeks after surgery. Exclusion criteria were as follows: a history of neuromuscular dysfunction of bladder, post-prostatectomy urge incontinence, receiving adjuvant radiotherapy during the 12- week period, prior anti-incontinence surgery, and post-voiding urine&gt;100 ml. The prevalence rates of urinary incontinence measured at the time of urinary catheter removal (baseline) and at weeks 3, 6, and 12 after surgery and the number of wet pads per day were compared. The study included 209 patients with a mean age of 60.68 ± 7.16 years. Baseline urinary continence rates were similar in Group I and Group II (29.2% vs. 35.4%, p=0.338). At 12 weeks, although PPI rates have decreased in both groups, there was no difference between Group I and Group II (15.6% vs. 24.8%, p=0.103). Administration of prophylactic duloxetine in the early postoperative period, which started without regard to the positivity of PPI, is not significantly effective to early postoperative urinary continence recovery.

PT038 - Fascial anastomosis suspension technique (FAST) during open retropubic radical prostatectomy: A novel method to improve early postoperative recovery of urinary continence

PT038 - Fascial anastomosis suspension technique (FAST) during open retropubic radical prostatectomy: A novel method to improve early postoperative recovery of urinary continence

Short-term therapeutic outcomes of robotic-assisted laparoscopic radical prostatectomy for oligometastatic prostate cancer: a propensity score matching study.

BackgroundThe role of local treatment in oligometastatic prostate cancer (PCa) is gaining interest with the oligometastases hypothesis proposed and the improvement of various surgical methods and techniques. This study aimed to compare the short-term therapeutic outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP) for oligometastatic prostate cancer (OPC) vs. localized PCa using propensity score matching.MethodsTotally 508 consecutive patients underwent RALP as a first-line treatment. The patients were divided into two groups according to oligometastatic state: the OPC group (n = 41) or the localized PCa group (n = 467). Oligometastatic disease was defined as the presence of two or fewer suspicious lesions. The association between the oligometastatic state and therapeutic outcomes of RALP was evaluated, including biochemical recurrence (BCR) and overall survival (OS). A Cox proportional hazards model was used to assess the possible risk factors for BCR.ResultsTotally 41 pairs of patients were matched. The median operative time, the median blood loss, the overall positive surgical margin rate, the median post-operative hospital stays, and the post-operative urinary continence recovery rate between the two groups showed no statistical significance. The 4-year BCR survival rates of the OPC group and localized PCa group were 56.7% and 60.8%, respectively, without a significant difference (P = 0.804). The 5-year OS rates were 96.3% and 100%, respectively (P = 0.326). Additionally, the results of Cox regression showed that oligometastatic state was not an independent risk factor for BCR (P = 0.682).ConclusionsOur findings supported the safety and effectiveness of RALP in OPC. Additionally, oligometastatic state and sites did not have an adverse effect on BCR independently.

The efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis

Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Methods From August 2016 to November 2018, 31 patients with prostate cancer underwent laparoscopic radical prostatectomy. The patients were 62-85 years old(mean 74.8 years), and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml). The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml. All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Surgical procedure: After resection of the prostate in laparoscopic radical prostatectomy, the bladder neck was sutured at 6 o'clock position to narrow the bladder neck ( tennis racquet reconstruction). The interval was 1 cm, and 2-3 needles were sutured, the distance between the neck of the bladder and the ureter was extended. The bladder neck mucosa and urethral mucosa eversion were performed. The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline. After the knot was tightened, the posterior wall of the bladder was folded and bladder neck was elevated. The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra. Finally, the bladder and urethra were anastomosed. The postoperative urinary continence recovery and the clinical effect were recorded. Results The operation time of 31 patients ranged from 80 to 210, with an average of 139.7 minutes. Intraoperative bleeding was 50-330 ml, with an average of 144.2 ml. None of the patients switched to open surgery during the operation, and there was no injury to large vessels and rectum, and no anastomotic leakage. Postoperative pathology showed 21 cases of pT2 stage, 10 cases of pT3 stage, 2 cases of positive margin, including 1 case of basal part and 1 case of apex part, both of which received medical castration therapy postoperatively.The surgical margin was positive in 2 cases (6.45%). 31 patients removed the urinary catheter in ten days after surgery. 17 cases (54.8%) recovered instantly urinary continence; 7 cases (22.6%) urinary continence in 1 month after operation; 4 cases (12.9%) urinary continence in 3 months after operation; and 3 cases (9.7%) urinary control in 6 months after operation. One case had urinary retention after removing the urinary catheter, and cathetered for 2 more weeks. After pulling out again, the urinary continence was good. Conclusions Laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis may be helpful for early recovery of urinary continence. Key words: Prostatectomy; Bladder neck extension; Mucosal eversion; Urinary continence

Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.

To present the functional and oncological outcomes after ≥1 year of follow-up, following an experience of >1000 robot-assisted radical prostatectomies (RARPs) with our standardised total anatomical reconstruction (TAR) technique. To evaluate which factors influence postoperative continence recovery in order to obtain a nomogram to predict the risk of postoperative urinary incontinence (UI). The enrolment phase began in June 2013 and ended in May 2017. Patients were prospectively included in the study with the following inclusion criteria: (i) localised prostate cancer (clinical stages cT1-3, cN0, cM0); (ii) indication for RP; and (iii) preoperative multiparametric prostate magnetic resonance imaging. All patients underwent RARP with the TAR technique done at the end of the demolitive phase. The continence rates were assessed at 24h, and 1, 4, 12, 24 and 48weeks after catheter removal. Patients were defined as continent if they answered 'zero pad' or 'one safety pad' per day. A logistic regression model was used to evaluate the potential impact of some pre- and intraoperative factors on postoperative urinary continence recovery. Model discrimination was assessed using an area under (AUC) the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of postoperative UI after RARP with the TAR technique was generated based on the logistic model. In all, 1008 patients were enrolled in our study. At 24h, and 1, 4, 12, 24 and 48weeks after catheter removal, 621 (61.61%), 594 (58.93%), 803 (79.66%), 912 (90.48%), 950 (94.25%) and 956 (94.84%) patients were continent, respectively. In the logistic regression model, the variables analysed had a higher impact on continence recovery at 4 and 12weeks. At 4weeks, the postoperative odds of urinary continence recovery increased with the absence of diabetes [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.41-5.41] and D'Amico low vs high risk (OR 2.01, 95% CI 1.01-3.99). At 12weeks, urinary continence increased with the absence of diabetes (OR 3.01, 95% CI 1.23-7.35), D'Amico low vs high risk (OR 4.04, 95% CI1.56-10.47), and D'Amico intermediate vs high risk (OR3.33, 95% CI 1.66-6.70). ROC curves were drawn andan AUC value of 61.9% (95% CI 57.49-66.36) at 4weeks and 63.8% (95% CI 58.03-69.65) at 12weeks werecomputed. Based on these parameters, two nomograms (at 4 and 12weeks postoperatively) were generated. The TAR technique conferred excellent results in the early recovery of urinary continence. Two nomograms were created, to predict preoperatively the postoperative odds of urinary continence recovery at 4 and 12weeks after RARP by integrating the presence of diabetes and D'Amico risk classification.

Estimated Minimal Residual Membranous Urethral Length on Preoperative Magnetic Resonance Imaging Can Be a New Predictor for Continence After Radical Prostatectomy

To identify a parameter predicting postoperative recovery of urinary continence after radical prostatectomy, associations between parameters on preoperative magnetic resonance imaging (MRI) and postoperative continence status were investigated. This prospective study enrolled 113 patients with localized prostate cancer who underwent MRI before radical prostatectomy. Continence was evaluated using the Expanded Prostate Index Composite instrument before surgery and at 1, 3, 6, 12, 18, 24, and 36 months postoperatively. We developed a novel parameter, minimal residual membranous urethral length (mRUL), defined as the distance between the lower margins of the puboperinealis and bulbospongiosus muscles in a direction parallel with the urethra on preoperative MRI, which is supposed to represent the minimal intact residual part of the membranous urethra during RP. Thicknesses of the levator ani and periurethral sphincter complex were also estimated on MRI. Continence recovery was significantly faster in patients with longer mRUL (≥6.4 mm) than in patients with shorter mRUL (<6.4 mm; log-rank test, P = .003). Interestingly, incontinence rate before radical prostatectomy was significantly lower in patients with longer mRUL (2.0%) than in those with shorter mRUL (17.5%; P = .008). Multivariate analysis showed that longer mRUL was significantly related to superior continence recovery (hazard ratio, 0.78; P = .005). Thicknesses of the levator ani and periurethral sphincter complex were not associated with continence recovery. Preoperative mRUL offers an independent predictor of continence recovery after radical prostatectomy and is also associated with preoperative (baseline) continence status.

A Pragmatic Randomized Controlled Trial Examining the Impact of the Retzius-sparing Approach on Early Urinary Continence Recovery After Robot-assisted Radical Prostatectomy

BackgroundRetzius-sparing (posterior) robot-assisted radical prostatectomy (RARP) may expedite postoperative urinary continence recovery. ObjectiveTo compare the short-term (≤3 mo) urinary continence (UC), urinary function (UF), and UF-related bother outcomes of posterior RARP compared with standard anterior approach RARP. Design, setting, and participantsA total of 120 patients aged 40–75 yr with low–intermediate-risk prostate cancer (per the National Comprehensive Cancer Network guidelines) underwent primary RARP at a tertiary care institution. InterventionEligible men were randomized to receive either posterior (n=60) or anterior (n=60) RARP. Outcome measurements and statistical analysesPrimary outcome was UC (defined as 0 pads/one security liner per day) 1 week after catheter removal. Secondary outcomes were short-term (≤3 mo) UC recovery, and UF and UF-related bother scores (measured by the International Prostate Symptom Score [IPSS] and IPSS quality-of-life scores, respectively) assessed at 1 and 2 wk, and 1 and 3 mo following catheter removal. Continence outcomes were objectively verified using 24-hr pad weights. UC recovery was analyzed using Kaplan–Meier method and Cox proportional hazards regression; UF and UF-related bother outcomes were compared using linear generalized estimating equations (GEEs). Perioperative complications, positive surgical margin, and biochemical recurrence-free survival (BCRFS) represent secondary outcomes reported in the study. Results and limitationsCompared with 48% in the anterior arm, 71% men undergoing posterior RARP were continent 1 wk after catheter removal (p=0.01); corresponding median 24-h pad weights were 25 and 5g (p=0.001). Median time to continence in posterior versus anterior RARP was 2 and 8 d postcatheter removal, respectively (log-rank p=0.02); results were confirmed on multivariable regression analyses. GEE analyses showed that UF-related bother (but not UF) scores were significantly lower in the posterior versus anterior RARP group at 1 wk, 2 wk, and 1 mo on GEE analyses. Incidence of postoperative complications (12% anterior vs 18% posterior) and probability of BCRFS (0.91 vs 0.91) were comparable in the two arms. ConclusionsIn this single-center randomized study, the Retzius-sparing approach of RARP resulted in earlier recovery of UC and lower UF-related bother compared with standard RARP. These results require long-term validation and reproduction by other centers, as well as studies on men with high-risk localized disease. Patient summaryIn our hands, men with low–intermediate-risk prostate cancer undergoing Retzius-sparing robot-assisted radical prostatectomy (RARP) had earlier recovery of urinary continence and lower urinary function-related bother than those undergoing standard RARP.

PD18-01 RANDOMIZED STUDY EVALUATING SHORT-TERM FUNCTIONAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN LOW-RISK PROSTATE CANCER PATIENTS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III1 Apr 2017PD18-01 RANDOMIZED STUDY EVALUATING SHORT-TERM FUNCTIONAL OUTCOMES OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN LOW-RISK PROSTATE CANCER PATIENTS Alexander Govorov, Dmitry Pushkar, Konstantin Kolontarev, Pavel Rasner, and Vladimir Dyakov Alexander GovorovAlexander Govorov More articles by this author , Dmitry PushkarDmitry Pushkar More articles by this author , Konstantin KolontarevKonstantin Kolontarev More articles by this author , Pavel RasnerPavel Rasner More articles by this author , and Vladimir DyakovVladimir Dyakov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Many techniques have been described to optimize functional outcomes of robot-assisted radical prostatectomy (RARP). Our objective was to test the impact of surgical technique on post-operative urinary continence recovery (UCR), urinary bother symptoms and erectile function (EF) recovery in a randomized study in high-volume center. METHODS From July to December 2015 89 low-risk PCa patients signed the IC and were randomized in Group 1 (n=45, RARP with full bilateral nerve sparing (NS) and lateral prostatic fascia preservation with amniotic membrane allograft nerve wrap) and Group 2 (n=44, conventional RARP with bilateral NS). Posterior rhabdosphincter reconstruction (PRR) was performed in all cases. Patients started tadalafil 5 mg OAD from Day of catheter removal. Groups were comparable for clinical and pathological variables. We evaluated: 1) UCR rate, defined as the use of 0 pad/day; 2) post-op urinary bother symptoms measured using the QoL question in the IPSS questionnaire (no bother, score 0-2; bother, score 3 and more); 3) EF recovery rate, defined as IIEF-5>17. RESULTS Patients with full NS, preservation of lateral prostatic fascia and amniotic membrane use had significantly higher rates of UCR at 1 week, 1 and 3 months and EF recovery rates at 3 and 6 months. Urinary bother scores were lower in these men at 1, 3 and 6 months post-RARP (table 1). There was no difference in positive surgical margins and intra- /post-RARP complication rate. Results were confirmed on multivariable analyses (odds ratio for Group 1 vs. Group 2 - 2.2 for UCR [p=0.006], 1.8 for EF recovery [p=0.004] and 3.6 for urinary bother [p=0.01]). CONCLUSIONS Lateral prostatic fascia preservation with amniotic membrane allograft nerve wrap significantly improved the rate of post-RARP urinary continence, urinary bother and EF recovery in a group of low-risk PCa patients with bilateral NS and PRR in a randomized study. This in turn can translate into a higher post-operative QoL and/or patient satisfaction. The definition of surgical Pentafecta describing intraoperative technical manoeuvers optimizing functional outcomes may include 1) bilateral nerve sparing, 2) preservation of lateral prostatic fascia, 3) PRR, 4) amniotic membrane allograft use and 5) watertight anastomosis. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e359 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Alexander Govorov More articles by this author Dmitry Pushkar More articles by this author Konstantin Kolontarev More articles by this author Pavel Rasner More articles by this author Vladimir Dyakov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Comparison of the postoperative recovery of urinary continence after 3D and 2D laparoscopic radical prostatectomy

Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy. Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015 , including 38 cases underwent 3D laparoscopic radical prostatectomy, 3D group's mean age was (64.2±6.0)years, mean of preoperative PSA was (14.5±7.6)ng/ml, Gleason score (13 cases≤6, 17 cases=7, 8 cases ≥8), the mean prostate volume (41.4±9.1) ml, the classification of clinical stage in 3D group included 2 cases in cT1, 26 cases in cT2, 9 cases in cT3a, 1 cases in cT3b, mean body mass index was (22.8±2.2) kg/m2, mean of MUL(membranous urethral length) was (15.6±2.6) mm; 34 cases in the 2D group, 3D group's mean age was (61.9±6.6)years, mean of preoperative PSA was (16.7±6.8) ng/ml, Gleason score (10 cases≤6, 18 cases=7, 6 cases ≥8), the mean prostate volume (42.1±10.6) ml, the classification of clinical stage in 3D group included 1 cases in cT1, 28 cases in cT2, 5 cases in cT3a, mean body mass index was (21.7±1.9) kg/m2, mean of MUL(membranous urethral length) was (15.5±2.5) mm. All patients got a good function of micturition and urinary continence before the surgery. We compared surgical time, bladder neck-urethral anastomosis time and blood loss in two groups.Membranous urethral length(MUL) were measured on preoperative and postoperative magnetic resonance imaging (MRI). Postoperative continence rate was analyzed at 2 weeks, 4 weeks, 8 weeks, 12 weeks, 24 weeks and 36 weeks after the remove of the catheter. Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery. The age, PSA value, Gleason score, prostate volume, TNM stage, BMI (body mass index) and other relevant aspects of the clinical data showed no significant difference (P>0.05). The time of bladder neck - urethral anastomosis is less than the 2D group [(12.9±1.7) min and (15.7±2.6) min, P=0.021], MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [(0.5±0.1) ml vs. (0.6±0.2) ml, P=0.044], the two groups in operative time [(162.7±17.1) min vs. (175.7±15.7) min, P=0.802], intraoperative blood loss[(191.1±31.6) ml vs. (211.8±43.2) ml, P=0.021], intraoperative blood transfusion rate[5.2% (2/38) vs. 8.8% (3/34), P=0.662], postoperative incidence of urine leakage [7.9% (3/38) vs. 14.7% (5/34), P=0.463], postoperative the MUL [(15.1±2.6) mm vs. (15.0±2.6) mm, P=0.767), there was no statistically significant differen. All patients were followed up for urinary function at least 36 months. The continence rate between two groups at 8 weeks (60.5% vs. 35.3%), 12 weeks (73.7% vs. 47.1%) got significantly difference. Conclusions Compared with 2D laparoscopic, 3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy. Key words: 3D laparoscopy; Radical prostatectomy; Urinary continence; Recovery

Men with Low Preoperative Sexual Function May Benefit from Nerve Sparing Radical Prostatectomy

We determined the effect of nerve sparing radical prostatectomy on sexual and urinary function in men at various levels of pretreatment sexual function. Men in the CaPSURE™ (Cancer of the Prostate Strategic Urologic Research Endeavor) database who underwent radical prostatectomy and had baseline and 2-year posttreatment UCLA-PCI sexual function and urinary function scores were selected. Nerve sparing was categorized as bilateral, unilateral or none and the level of pretreatment sexual function was divided into quartiles. The cohort was divided into subgroups of nerve sparing technique and pretreatment sexual function. Differences between sexual function and urinary function among subgroups were determined. A test of interaction was performed between preoperative sexual function and degree of nerve sparing on postoperative sexual function and urinary function scores. A total of 1,322 patients met the study inclusion criteria. Median patient age was 61 years (range 41 to 79). Bilateral, unilateral and no nerve sparing procedures were performed in 899, 200 and 223 men, respectively. The effects of nerve sparing on sexual function differed among the quartiles of preoperative sexual function (p <0.01). Nerve sparing did not have an effect on the sexual function of men in the lowest quartile of preoperative sexual function score (p = 0.15) but did have a significant beneficial effect on sexual function in the higher 3 quartiles (p = 0.04, p <0.01 and p <0.01, respectively). Alternatively, nerve sparing improved urinary function in men in the lowest quartile of baseline sexual function. Nerve sparing radical prostatectomy results in better sexual function outcomes than no nerve sparing in most men except those with little baseline function. Urinary function was positively impacted in all men. Men who are suitable candidates for nerve preservation may benefit from nerve sparing surgery. Poorer baseline sexual function should not exclude these men from such surgery.

Nerve‐sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery

Nerve‐sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery

Nerve‐sparing approach during radical prostatectomy is strongly associated with the rate of postoperative urinary continence recovery

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Urinary incontinence and erectile dysfunction are the most bothersome sequelae affecting health-related quality of life in patients treated with radical prostatectomy for prostate cancer. While it has been widely reported that a nerve-sparing approach significantly improves postoperative erectile function, the impact of neurovascular bundle preservation on urinary continence recovery is still a matter of controversy. Our study clearly demonstrates that patients treated with nerve-sparing radical prostatectomy have higher chances of recovering full continence after surgery. The results indicate that, when technically and oncologically feasible, an attempt at a nerve-sparing approach should be planned in order to increase the probability of achieving full continence after radical prostatectomy. To demonstrate that nerve-sparing radical prostatectomy (NSRP) is associated with higher rates of urinary continence (UC) recovery compared with non-nerve-sparing procedures in patients with surgically treated organ-confined prostate cancer. The study included 1249 patients treated with radical prostatectomy between 2003 and 2010. Patients were divided into three preoperative risk groups: low (PSA < 10 ng/mL, cT1, biopsy Gleason sum ≤ 6), high (cT3 or biopsy Gleason 8-10 or PSA > 20 ng/mL) and intermediate (all the remaining). Postoperative UC recovery was defined as the absence of any protection device. The association between nerve-sparing status and UC recovery was assessed in univariable and multivariable Cox regression analyses after accounting for age at surgery, Charlson Comorbidity Index and preoperative risk group. At a mean follow-up of 42.2 months (range 1-78), 993 patients (79.5%) recovered UC. Overall, UC recovery rate at 1 and 2 years was 76% and 79%, respectively. On univariable Cox regression analysis, age at surgery, preoperative risk group, medical comorbidities and nerve-sparing status were significantly associated with UC recovery (all P ≤ 0.001). On multivariable analysis, age, risk group and nerve-sparing status were also independently associated with UC recovery (all P < 0.003). Patients treated with bilateral NSRP had a 1.8-fold higher chance of full UC recovery. Patients treated with bilateral NSRP have significantly higher chances of recovering full continence. Therefore, when oncologically and technically feasible, a nerve-sparing procedure should be attempted.

Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy

Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy

Preoperative Erectile Function Represents a Significant Predictor of Postoperative Urinary Continence Recovery in Patients Treated With Bilateral Nerve Sparing Radical Prostatectomy

The association between baseline functional status and urinary continence recovery after radical prostatectomy remains controversial. We tested the hypothesis that baseline erectile and urinary function predicts urinary continence recovery after bilateral nerve sparing radical prostatectomy. The study included 752 patients with prostate cancer treated with bilateral nerve sparing radical prostatectomy between 2003 and 2009. All patients had preoperative functional and oncological data available, including age at surgery, body mass index, prostate specific antigen, and erectile and urinary function. Preoperatively erectile and urinary function was assessed by the erectile function domain of the International Index of Erectile Function and the International Prostatic Symptoms Score. Urinary continence was defined as wearing no pads. Univariate and multivariate Cox regression models were used to test the association between predictors and urinary continence recovery after surgery. At a mean postoperative followup of 30.7 months (median 29, range 1 to 80) 611 patients (81.3%) had recovered urinary continence. Overall the urinary continence recovery rate at 1 and 3 years was 73.9% and 82.2%, respectively. On univariate Cox regression analysis patient age and the preoperative score on the erectile function domain of the International Index of Erectile Function were significantly associated with urinary continence recovery (each p ≤ 0.04). On multivariate analysis age at surgery and the preoperative erectile function domain of the International Index of Erectile Function were the only independent predictors of urinary continence recovery after bilateral nerve sparing radical prostatectomy (each p ≤ 0.04). Age and preoperative erectile function should be considered for urinary continence predictions after bilateral nerve sparing radical prostatectomy and for accurate patient counseling before surgery. Preoperative erectile function might be a marker of pelvic vascular disease, which may affect the status of the external urinary sphincter.