Urinary Recovery Rates Research Articles

The application of full-length urethral preservation without anastomosis in single-port laparoscopic radical prostate cancer

Objective: To preliminarily examine the feasibility and outcome of single-port laparoscopic radical prostatectomy with full-length urethral preservation (FLUP-SPRP). Method: This study was a prospective case series study. A total of 25 patients with prostate cancer who met the enrollment criteria and agreed to this surgical procedure from March 2022 to December 2022 were collected at the Department of Urology, the Second Affiliated Hospital of Nanjing Medical University. The age of the patients was (67.2±7.6) years (range: 61 to 76 years). This novel procedure was performed by an experienced surgeon who performed single hole radical prostatectomy skillfully. Patient urinary control, tumor control, and related surgical complications after surgery were regularly monitored. Postoperative urinary control was evaluated using the daily amount of urine pad, 0 to 1 piece of urine pad was to restore urinary control, and 0 to 1 piece of pad within 24 hours after catheter removal was immediate urinary control. Result: All prodecures were successfully completed without transit to open surgery. The surgical time was (128.4±22.4) minutes (range: 100 to 145 minutes), the intraoperative blood loss was (68.2±13.7) ml (range: 50 to 120 ml). The urethral injury occurred in 4 cases during surgery and was repaired by sutures. The urinary control recovery rates within 24 hours, 1 week, 4 weeks, and 7 weeks after surgery were 80.0%, 84.0%, 92.0% and 100%, respectively. Postoperative large section pathology revealed 1 case with a positive basal margin of the prostate and negative margins of all prostate glands around the urethra. Postoperative complications included urinary tract infection in 3 cases, urodynia in 2 cases, and acute urinary retention in 1 case. MRI follow-up 3 months after surgery showed normal anatomy of the bladder and urethra. The follow-up values of prostate specific antigen at 3 and 6 months after surgery were less than 0.1 μg/L. Conclusions: The preliminary results of this study indicate that the FLUP-SPRP procedure is safe and feasible. The early results of postoperative urinary control and oncology are as expected.

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.

Early and late urinary continence outcomes after unilateral and bilateral nerve-sparing robot-assisted radical prostatectomy: A retrospective multicentre cohort study in Japan (the MSUG94 group).

The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established. We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method. The pad-free rates at 12months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12months of surgery did not significantly differ between the unilateral and bilateral NS groups. NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP.

MP80-20 FUNCTIONAL OUTCOMES OF LAPAROSCOPIC VS ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP80-20 FUNCTIONAL OUTCOMES OF LAPAROSCOPIC VS ROBOT-ASSISTED RADICAL PROSTATECTOMY Marco Paciotti, Luigi Nocera, Carlo Andrea Bravi, Cesare Saitta, Adele Piro, Luca Sarchi, Roberto Contieri, Mottaran Angelo, Maria Peraire Lores, Eleonora Balestrazzi, Federico Piramide, Ruben De Groote, Geert De Naeyer, Paolo Casale, Rozzano, Giovanni Lughezzani, Alexandre Mottrie, and Nicolò Maria Buffi Marco PaciottiMarco Paciotti More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Cesare SaittaCesare Saitta More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Mottaran AngeloMottaran Angelo More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Paolo CasalePaolo Casale More articles by this author , Rozzano Rozzano More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and Nicolò Maria BuffiNicolò Maria Buffi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We entered the third decade of the robotic era in prostate cancer (PCa) surgery, and robotic platforms are increasingly spreading worldwide. Robotic surgery is usually believed to facilitate critical steps of the prostatectomy, increasing the precision of the surgical act and optimizing the probability of favorable outcomes. However, strong evidence supporting superiority of robotic vs laparoscopic prostatectomy (LRP) in terms of functional results are still missing. We performed a systematic review (SR) and meta-analysis (MA) to assess the functional outcomes of LRP vs robot-assisted radical prostatectomy (RARP). METHODS: We searched for all the studies comparing LRP and RARP in Medline, Embase, the Cochrane Central Register of Controlled Trials, and abstracts from the AUA and EAU meetings up to October 2022. Results were independently reviewed by two authors following the PRISMA guidelines. A SR+MA were performed. We followed a predefined PICOS approach: (P) patients affected by PCa (I) LRP (C) RARP (O) continence and potency recovery and (S) randomized controlled trials (RCTs). Continence was defined as using no pads or one safety pad per day. Potency was defined either as IIEF-5 score >17 or capability of intercourse. Effect measures for the outcomes were relative risk (RR) and 95% CI. Random-effect models were utilized to report RR. The RoB 2 was used to assess the risk of bias. RESULTS: Three RCTs were included in this SR. A total of 966 patients undergoing RARP for localized PCa were included in the three studies. The number of patients undergoing LRP vs RARP was 60 vs 60, and 586 vs 196, and 64 vs 64 in the #1, #2 and #3 RCT, respectively. Continence recovery and erectile function (EF) at 3 months were the most reported outcomes. Across the three studies, the pooled RR for 3 months continence was 1.15 (1.06-1.24), while the pooled RR for 3 months EF was 1.55 (1.23-1.95), both in favor of robotic surgery (Table 1). Therefore, we found a significant Risk of bias was assessed for all the three studies and determined as follows: “unclear risk of bias”. CONCLUSIONS: This MA found a higher EF and urinary continence recovery rate in patients who underwent RARP vs LRP for localized PCa. Therefore, evidence from RCTs demonstrated that robotic surgery offers a significant advantage in terms of functional outcomes in these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1161 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marco Paciotti More articles by this author Luigi Nocera More articles by this author Carlo Andrea Bravi More articles by this author Cesare Saitta More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Roberto Contieri More articles by this author Mottaran Angelo More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Paolo Casale More articles by this author Rozzano More articles by this author Giovanni Lughezzani More articles by this author Alexandre Mottrie More articles by this author Nicolò Maria Buffi More articles by this author Expand All Advertisement PDF downloadLoading ...

Эффективность трехмерной системы визуализации при выполнении лапароскопической радикальной простатэктомии.

Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р&lt;0,05); 2) the IBLV was reduced by 47–51% (р&lt;0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р&lt;0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.

Postoperative functional and cancer control evaluation of conventional and Retzius-sparing robot-assisted radical prostatectomy: Comparison of selected cases by propensity score matching.

Although many reports have shown that Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is effective for postoperative urinary continence, the postoperative voiding status and sexual function associated with this technique have not yet been adequately compared with those associated with conventional RARP (C-RARP). In this study, the lower urinary tract function, erectile function, and cancer control after C-RARP and RS-RARP were compared chronologically. We selected 50 cases of C-RARP and RS-RARP each by propensity score matching and evaluated them over time using various questionnaires. Urinary continence recovery rates and biochemical recurrence (BCR)-free survival rates were calculated using the Kaplan-Meier method and compared between the two groups using the log-rank test. When urinary continence was defined as 0 pads per day, 0 pads per day + 1 security linear, or ≤1 pad per day, the postoperative improvement in urinary continence was better with RS-RARP over the course of up to 1 year for all definitions. The International Consultation on Incontinence Questionnaire-Short Form total scores and the Overactive Bladder Symptom Scores were better in the postoperative RS-RARP group. There were no significant differences in the International Prostate Symptom Score total score, QOL score, and erectile hardness score between the two groups during the observation period. The BCR-free survival did not differ significantly between the two groups CONCLUSIONS: Postoperative urinary continence was better in the RS-RARP group than in the C-RARP group; however, the voiding function, erectile function, and cancer control did not differ significantly.

Retzius-sparing vs. standard robot-assisted radical prostatectomy for clinically localised prostate cancer: a comparative study.

Retzius-sparing robot-assisted radical prostatectomy (RARP) is not yet universally accepted due to still limited functional data and some concerns on oncological safety compared to the standard one. We assessed perioperative, pathological and early functional outcomes in patients with clinically localised prostate cancer treated with Retzius-sparing versus standard RARP. A single-surgeon cohort of 207 consecutive patients undergoing RARP was analysed. A later study group of 102 patients receiving the Retzius-sparing approach was compared with an earlier control group of 105 patients receiving the standard one. Urinary continence recovery 1 week after catheter removal was the primary study outcome. Urinary continence recovery 1, 2, 3 and 6 months after catheter removal, potency recovery 6 months postoperatively, rate of perioperative complications and positive surgical margins were secondary study outcomes. Patients in the study group reported significantly higher urinary continence recovery rates 1 week (91.2% vs. 54.3%, p < 0.001), 1 month (92.2% vs. 66.7%, p < 0.001), 2 months (95.1% vs. 74.3%, p < 0.001), 3 months (96.1% vs. 83.8%, p = 0.01), but not 6 months (97% vs 90.5%, p = 0.09) after catheter removal compared to controls. Potency recovery rates 6 months after catheter removal were significantly higher in the study than the control group (68.2% vs 51.6%, p = 0.03). On multivariable analyses, the Retzius-sparing approach was an independent predictor of 1-week urinary continence recovery, but not of 6-month potency recovery. There were significant differences neither in perioperative complication rate (9.8% in the study vs. 14.3% in the control group, p = 0.28) nor in positive surgical margin rate (9.8% in the study vs. 8.6% in the control group, p = 0.75). In a comparative study, we observed a significant improvement in immediate urinary continence, but not in early potency recovery, using the Retzius-sparing compared to the standard approach for RARP, with no increase in perioperative complication and positive surgical margin rate.

Significance of postoperative membranous urethral length and position of vesicourethral anastomosis for short-term continence recovery following robot-assisted laparoscopic radical prostatectomy

BackgroundWe assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA).MethodsClinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation.ResultsContinence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (< 25 kg/m2) (p = 0.040), longer preoperative MUL (≥ 9.5 mm) (p = 0.013), longer postoperative MUL (≥ 9 mm) (p < 0.001), higher PVUA (< 14.5 mm) (p = 0.019) and shorter operating time (< 170 min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90–7.40, p < 0.001) and higher PVUA (OR 2.02, 95% CI 1.07–3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into 3 groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% versus 68.2% versus 85.0% (p < 0.001) at 3 months.ConclusionsPVUA and postoperative MUL were significant factors for short-term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.

Novel cystography parameter to predict early recovery from urinary continence after radical prostatectomy for prostate cancer: a retrospective study.

The purpose of this study was to investigate whether postoperative cystography findings can predict early and long-term recovery from incontinence after radical prostatectomy (RP), compared with the other cystography parameters. I retrospectively reviewed 118 patients who underwent robot-assisted RP (RARP) for localized prostate cancer at single institution between January 2016 and April 2021. One hundred and seven patients were included in the study. Postoperative cystography was routinely performed 7 days after surgery. The bladder neck to pubic symphysis ratio, vesicourethral angle, and bladder neck anteroposterior length (BNAP) ratio (the bladder neck-posterior margin distances divided by the anteroposterior lengths) were evaluated. Continence was defined as cessation of pad use. The association between these variables and urinary incontinence was also analyzed. The urinary incontinence recovery rates 1, 3, 6, and 12 months after RARP were 43.92%, 66.35%, 87.85%, and 97.19%, respectively. Multivariate logistic regression analysis demonstrated that a lower BNAP ratio and wider vesicourethral angle were significantly associated with continence restoration at 1, 3, and 6 months after surgery. In addition, in terms of days of pad usage, lower BNAP ratio, wider vesicourethral angle, and bladder neck preservation were significantly associated with recovery from urinary incontinence within 12 months as assessed by Cox proportional hazard analysis. This study demonstrated that vesicourethral angle and BNAP ratio were independent predictors of early recovery from post-prostatectomy incontinence. I suggest that both the sagittal and coronal views of postoperative cystography help anticipate early continence restoration after RARP.

Pharmacokinetics and Safety of Doripenem in Healthy Chinese Subjects and Monte Carlo Dosing Simulations.

The aim of this study was to investigate the pharmacokinetics (PK) of doripenem in healthy Chinese subjects and evaluate the optimal dosage regimens of doripenem. A randomized, single-dose, three-period, self-crossover controlled extended-infusion clinical trial was conducted with 12 healthy Chinese subjects. Plasma and urine samples were collected to determine doripenem concentrations. Non-compartmental and population PK analysis were performed to characterize the PK of doripenem. The Monte Carlo simulation was employed to optimize dosing regimens based on the probability of target attainment of doripenem against pathogens with different minimum inhibitory concentrations (MIC). All 12 healthy Chinese subjects completed the study, and the doripenem was well tolerated. The study showed linearity relationships in the peak plasma concentration and the area under the concentration-time curve after intravenous infusion of doripenem from 0.25 g to 1.0 g. The cumulative urinary recovery rate of doripenem was 68.1–72.0% within 24 h. PPK modeling showed a two-compartmental model, with first-order elimination presenting the best fit for doripenem PK. Monte Carlo simulation results showed that 1.0 g q12h or 0.5 g q8h was an optimal regimen for pathogens susceptible to doripenem (MIC ≤ 1 mg/L); while high dose and extended infusion (1 g, q8h, 4 h infusion) was proposed for unsusceptible pathogens (2 ≤ MIC ≤ 8 mg/L). In the dose range of 0.25 to 1.0 g, doripenem showed linear pharmacokinetics. Doripenem at 1.0 g with a prolonged infusion time of 4 h was predicted to be effective against pathogens with MICs as high as 8 mg/L.

Feasibility of robot-assisted radical prostatectomy in men at senior age ≥75 years: perioperative, functional, and oncological outcomes of a high-volume center

Objectives The aim of this study was to assess whether age ≥75 years impairs surgical, functional, and oncological outcomes after robot-assisted radical prostatectomy (RARP). Materials and methods Patients with prostate cancer (PCa) were stratified in ≥75(n = 669) vs. <70 years(n = 8,268). Multivariable cox regression analyses (MVA) tested for effect of senior age on erectile function-, urinary continence-recovery, biochemical recurrence (BCR), and metastatic progression (MP). Results RARP duration, blood loss, and 30d complication rates were similar between groups. For patients ≥75 vs. <70 years, rates of erectile function after 36 and urinary continence after 12 months were 27 vs. 56% (p < 0.001) and 85 vs. 86% (p = 0.99), respectively. Mean quality of life (QoL) score after 12 months improved in both groups (p = 0.9). At 48 months, BCR- and MP-free rates were 77 vs. 85% (p < 0.001) and 97 vs. 98% (p = 0.3), respectively. MVA confirmed the negative effect of senior age on erectile function but no significant effect on urinary continence, BCR or MP, before and after propensity score matching. Conclusion Apart from erectile function, senior age has no significant effect on urinary continence recovery, BCR- or MP-free rates after RARP. Post-RARP QoL improved even in senior patients. Modern therapy of senior PCa patients should be based on individual counseling than just age.

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.

An evidence-based analysis comparing two approaches of robot-assisted laparoscopic radical prostatectomy: the standard technique and Retzius-sparing technique

Objective: To compare the postoperative outcomes and urinary continence recovery time between standard robotic-assisted laparoscopic radical prostatectomy (RARP) and Retzius-sparing robotic-assisted laparoscopic radical prostatectomy (RsRARP). Methods: A total of 92 patients with low to intermediate-risk prostate cancer who underwent RARP (n=52) and RsRARP (n=40) in Sir Run Run Shaw Hospital from October, 2016 to January, 2018 were retrospectively reviewed. Perioperative data (operative time, estimated blood loss, complications, postoperative staging, postoperative Gleason score) and surgical outcomes (rate of margin positive, urinary continence recovery time) of RARP and RsRARP group were comparatively analyzed. Results: All 92 cases were successfully performed with robot. RARP group had a significantly shorter mean operative time when compared with that in RsRARP group ((103±23) min vs (130±26) min, P<0.05). The two groups had comparable estimated blood loss ((100±54) ml vs (103±64) ml, P>0.05), rate of postoperative infection (5.8% (3/52) vs 5.0% (2/40), P>0.05) and rate of postoperative urine leakage (3.8%(2/52) vs 2.5%(1/40), P>0.05). The two groups had a comparable rate of margin positive (7.7%(4/52) vs 12.5%(5/40), P>0.05). Compared with RsRARP group, the RARP group had a lower rate of urinary continence recovery immediately after the catheter removing at 1 week, 1 month and 3 months after the operation (all P>0.05). The two group had a comparable rate of urinary continence recovery at 6 months after the operation (P>0.05). Conclusion: The RsRARP technique has a good tumor control and obvious advantage of early urinary continence recovery compared with the standard RARP technique. RsRARP technique is safe and effective for the treatment of localized prostate cancer.

Estimation of absolute oral bioavailability without performing an intravenous clinical study

The absolute oral bioavailability (BA) of drugs are yet to be determined, and intravenous pharmacokinetic studies are currently considered indispensable for determining the BA values of oral drugs. The aim of this study was to develop and validate a novel approach to estimating BA values without intravenous pharmacokinetic data. Based on the drug inclusion criteria, such as exhibiting a urinary recovery rate of (Ru) of ≥20% in a clinical study, 13 drugs were included in the present study, and pharmacokinetic data for them were collected from the literature. The fraction excreted unchanged into urine (fe) was calculated for healthy subjects by dividing the Ru value by the total recovery rate. The contribution of renal excretion to total clearance from the systemic circulation (Rren) was estimated by subjecting oral clearance and creatinine clearance to regression in subjects with normal and impaired renal function. BA was estimated as fe/Rren and compared with the observed BA (BAobs). The predicted BA values for 9 drugs fell within ±20% of their BAobs. The examined approach makes it possible to estimate BA values for drugs with mean renal excretion values in healthy subjects and oral clearance in subjects with various renal function, without intravenous pharmacokinetic data.

Diffusion tensor-based fiber tracking of the male urethral sphincter complex in patients undergoing radical prostatectomy: a feasibility study

ObjectivesTo study the diffusion tensor-based fiber tracking feasibility to access the male urethral sphincter complex of patients with prostate cancer undergoing Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP).MethodsTwenty-eight patients (median age of 64.5 years old) underwent 3 T multiparametric-MRI of the prostate, including an additional echo-planar diffusion tensor imaging (DTI) sequence, using 15 diffusion-encoding directions and a b value = 600 s/mm2. Acquisition parameters, together with patient motion and eddy currents corrections, were evaluated. The proximal and distal sphincters, and membranous urethra were reconstructed using the deterministic fiber assignment by continuous tracking (FACT) algorithm, optimizing fiber tracking parameters. Tract length and density, fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were computed. Regional differences between structures were accessed by ANOVA, or nonparametric Kruskal–Wallis test, and post-hoc tests were employed, respectively, TukeyHSD or Dunn’s.ResultsThe structures of the male urethral sphincter complex were clearly depicted by fiber tractography using optimized acquisition and fiber tracking parameters. The use of eddy currents and subject motion corrections did not yield statistically significant differences on the reported DTI metrics. Regional differences were found between all structures studied among patients, suggesting a quantitative differentiation on the structures based on DTI metrics.ConclusionsThe current study demonstrates the technical feasibility of the proposed methodology, to study in a preoperative setting the male urethral sphincter complex of prostate cancer patients candidates for surgical treatment. These findings may play a role on a more accurate prediction of the RS-RARP post-surgical urinary continence recovery rate.

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.

Recovery of pad-free continence in elderly men does not differ from younger men undergoing robot-assisted radical prostatectomy for aggressive prostate cancer

To analyze urinary continence outcome following robot-assisted radical prostatectomy (RARP) for aggressive prostate cancer in men aged ≥ 70 and < 70years. Retrospective analyses of prospectively collected long-term data from a monocentric cohort of 350 men with D'Amico high-risk prostate cancer undergone robot-assisted radical prostatectomy at a single institution between 2005 and 2016. The association between time since operation and zero-pad urinary continence recovery was comparatively analyzed by separate pre-operative and post-operative Cox proportional-hazard regression models. Median age in the age group ≥ 70years was 73years compared with 62years in the < 70year age group. Distribution of men receiving adjuvant and salvage radiotherapy/hormonal therapy was similar in both age groups. Urinary continence recovery rate at 12, 24, and 36months after surgery of men aged ≥ 70years was 66, 79 and 83%, respectively, and statistically similar to that of men < 70years: 71, 81, and 85% (log-rank test p = 0.24). Multivariable analyses demonstrated no significant difference in return to continence between the two age groups (p = 0.28 and p = 0.17). In addition, clinical stage and type of nerve sparing (unilateral, bilateral or non-nerve sparing) were found to be independently predictive of pad-free continence recovery. Regardless of age, return to continence in men with aggressive prostate cancer undergoing RARP continues to improve way beyond the first 12months after surgery. Considering the dire effects of post-operative radiotherapy on continence in this aggressive cancer cohort, advanced age alone should not discourage recommending multimodal therapy involving RARP.

Early Postoperative Radiotherapy is Associated with Worse Functional Outcomes in Patients with Prostate Cancer

The effect of time between radical prostatectomy and radiation therapy on postoperative functional outcomes is still unclear in patients with surgically managed prostate cancer. We hypothesized that a shorter time between radical prostatectomy and radiotherapy might be associated with worse functional recovery rates after radical prostatectomy. We retrospectively evaluated 2,190 patients treated with radical prostatectomy and stratified according to radiotherapy schedule (adjuvant radiotherapy, salvage radiotherapy, no radiotherapy). We examined recovery rates for erectile function and urinary function according to adjuvant radiotherapy, salvage radiotherapy and no radiotherapy, and according to time from surgery to radiotherapy. Cox regression analyses were used to evaluate the impact of these predictors on functional outcomes. Median followup was 48 months. The 3-year erectile function recovery rates were 35.0%, 29.0% and 11.6% in patients who received no radiotherapy, salvage radiotherapy and adjuvant radiotherapy, respectively (p <0.001), and differed significantly according to time to radiotherapy (11.7% vs 34.7% for less than 1 year vs 1 year or more, respectively, p <0.001). The 3-year urinary continence recovery rates were 70.7%, 59.0% and 42.2% in patients who received no radiotherapy, salvage radiotherapy and adjuvant radiotherapy, respectively (p <0.001), and differed according to time to radiotherapy (43.5% vs 62.7% for less than 1 year vs 1 year or more, respectively, p <0.001). Cox regression analyses confirmed the negative impact of early radiotherapy on recovery rates for erectile function and urinary continence. Time from radical prostatectomy to radiotherapy has an important role in the recovery of erectile function and urinary continence. Delayed radiotherapy is preferred to improve functional outcomes after surgery.

Urinary Continence Outcomes after Puboprostatic Ligament Preserving Open Retropubic Radical Prostatectomy at a Sub-Saharan Hospital.

Background. Open retropubic radical prostatectomy is a commonly performed procedure for clinically localized prostate cancer. The demand for high level functional outcomes after therapy is increasing especially for young age patients; in this regard refinements in the surgical technique have been made. There is limited data to show the success of some of these refinements in resource limited settings. Methods. A retrospective clinical study was performed over a 2-year period at Mengo Hospital, Urology Unit. Men with clinically localized prostate cancer and who consented to the procedure were eligible and were recruited. Consequently excluded were those that turned out to have advanced disease and those with severe comorbidities. Patients were followed up for 3 months after surgery. Data was entered using SPSS version 17 and analyzed. Results. A total of 24 men with clinically localized prostate cancer underwent open retropubic puboprostatic ligament preserving radical prostatectomy technique. Mean age was 66, range 54–75 years. Outcome. Two patients had stress incontinence and three were incontinent at 3 months. The urinary continence recovery rate was 19/24 (79%) at 3 months. Conclusion. Preservation of the puboprostatic ligament in open retropubic radical prostatectomy was associated with rapid and a high rate of return to urinary continence among men with clinically localized disease.

Radical prostatectomy: a focus on urinary continence

Radical prostatectomy is the most commonly recommended treatment for patients diagnosed with localized prostate cancer and a sufficiently long life expectancy. Radical prostatectomy has three major aims: cancer control, urinary continence and erectile function preservation. Some a priori patient characteristics, such as age, prostate volume and tumor extension, cannot be modified, with a potential negative impact on urinary continence recovery. However, physicians must make every effort to promote the best possible urinary continence recovery rates and quality by modifying and improving all editable elements, such as conservative surgical techniques (i.e. nerve-sparing techniques, urethral length preservation), pelvic floor exercises and drug therapies.