Urinary Functional Outcomes Research Articles

MP71-10 PREDICTORS OF PROSTATE CANCER IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA

INTRODUCTION AND OBJECTIVES: The purpose of this study was to assess functional and QoL outcomes associated with various forms of benign prostatic hyperplasia (BPH) surgical treatment using an independent third party survey center. METHODS: An independent third party survey center was employed to send a comprehensive questionnaire to all patients who underwent surgical intervention for BPH at our institution between Jan. 2007 to Jan. 2013. Patients were identified using Current Procedural Terminology codes and our institutional billing records. Overall satisfaction, urinary and sexual functional outcomes were evaluated as part of this survey. After IRB approval, the validated instruments were Sexual Health Inventory for Men (SHIM), the International Prostate Symptoms Score (IPSS) and the International Continence Society e Short Form questionnaires (ICSmaleSF). Overall SHIM, IPSS and ICS scores were analyzed as were the individual domains in each questionnaire, comparing them individually and as a function of specific procedure. RESULTS: There were 906 patients who underwent BPH surgery at our institution during the study interval. Of the 862 alive patients, there were 479 respondents (55.6%). Among responders there were 214 Holmium Laser Enucleation of the Prostate (HoLEP), 210 Transurethral Resection of the Prostate (TURP), 21 Holmium Laser Ablation of the Prostate, 18 Photoselective Vaporization, 9 transurethral Incision of the Prostate and 7 simple prostatectomy. Preoperatively, patient reported continence rates as 55.3%, 58.2%, 71.4%, 57.1%, 66.7% and 80%, respectively (P1⁄4 0.651). Postoperatively, there were no significant differences in SHIM scores. However, total IPSS varied significantly among procedures (p<0.0001). Mean ( SD) IPSS was lowest for simple prostatectomy 4.0 ( 2.6) followed by HoLEP 5.8 ( 5.4). When Individual domains were analyzed, there were significant differences in intermittency (p1⁄40.0004), weak stream (p1⁄40.0029), straining (p< 0.0001) and quality of life QoL (p1⁄40.001). In all domains HoLEP had the lowest scores. Regarding ICSmaleSF, there was a significant difference in favor of TURP in the incontinence domain(p<0.0001) and in favor of HoLEP in the voiding (p1⁄40.0192) and QoL domains (p1⁄40.0344).The majority of the patients were satisfied with their intervention, regret was least in HoLEP 64.1% (p1⁄40.0175). CONCLUSIONS: Patients were generally satisfactied. However, those who underwent a HoLEP tended to have the best functional outcomes and highest QoL scores.

MP71-09 FUNCTIONAL ANALYSIS OF PATIENT OUTCOMES FOLLOWING DIFFERENT SURGICAL INTERVENTIONS FOR BENIGN PROSTATE HYPERPLASIA THROUGH THE ADMINISTRATION OF AN INDEPENDENT SURVEY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Evaluation and Symptoms1 Apr 2015MP71-09 FUNCTIONAL ANALYSIS OF PATIENT OUTCOMES FOLLOWING DIFFERENT SURGICAL INTERVENTIONS FOR BENIGN PROSTATE HYPERPLASIA THROUGH THE ADMINISTRATION OF AN INDEPENDENT SURVEY Haidar Abdul-Muhsin, Mark Tyson, Paul Andrews, Erik Castle, Robert Ferrigni, Wolter Christopher, Swanson Scott, and Mitchell Humphreys Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Mark TysonMark Tyson More articles by this author , Paul AndrewsPaul Andrews More articles by this author , Erik CastleErik Castle More articles by this author , Robert FerrigniRobert Ferrigni More articles by this author , Wolter ChristopherWolter Christopher More articles by this author , Swanson ScottSwanson Scott More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2622AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study was to assess functional and QoL outcomes associated with various forms of benign prostatic hyperplasia (BPH) surgical treatment using an independent third party survey center. METHODS An independent third party survey center was employed to send a comprehensive questionnaire to all patients who underwent surgical intervention for BPH at our institution between Jan. 2007 to Jan. 2013. Patients were identified using Current Procedural Terminology codes and our institutional billing records. Overall satisfaction, urinary and sexual functional outcomes were evaluated as part of this survey. After IRB approval, the validated instruments were Sexual Health Inventory for Men (SHIM), the International Prostate Symptoms Score (IPSS) and the International Continence Society – Short Form questionnaires (ICSmaleSF). Overall SHIM, IPSS and ICS scores were analyzed as were the individual domains in each questionnaire, comparing them individually and as a function of specific procedure. RESULTS There were 906 patients who underwent BPH surgery at our institution during the study interval. Of the 862 alive patients, there were 479 respondents (55.6%). Among responders there were 214 Holmium Laser Enucleation of the Prostate (HoLEP), 210 Transurethral Resection of the Prostate (TURP), 21 Holmium Laser Ablation of the Prostate, 18 Photoselective Vaporization, 9 transurethral Incision of the Prostate and 7 simple prostatectomy. Preoperatively, patient reported continence rates as 55.3%, 58.2%, 71.4%, 57.1%, 66.7% and 80%, respectively (P= 0.651). Postoperatively, there were no significant differences in SHIM scores. However, total IPSS varied significantly among procedures (p<0.0001). Mean (±SD) IPSS was lowest for simple prostatectomy 4.0 (±2.6) followed by HoLEP 5.8 (±5.4). When Individual domains were analyzed, there were significant differences in intermittency (p=0.0004), weak stream (p=0.0029), straining (p< 0.0001) and quality of life QoL (p=0.001). In all domains HoLEP had the lowest scores. Regarding ICSmaleSF, there was a significant difference in favor of TURP in the incontinence domain(p<0.0001) and in favor of HoLEP in the voiding (p=0.0192) and QoL domains (p=0.0344).The majority of the patients were satisfied with their intervention, regret was least in HoLEP 64.1% (p=0.0175). CONCLUSIONS Patients were generally satisfactied. However, those who underwent a HoLEP tended to have the best functional outcomes and highest QoL scores. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e915 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Haidar Abdul-Muhsin More articles by this author Mark Tyson More articles by this author Paul Andrews More articles by this author Erik Castle More articles by this author Robert Ferrigni More articles by this author Wolter Christopher More articles by this author Swanson Scott More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP5-18 A MULTI-INSTITUTIONAL ANALYSIS OF THE IMPACT OF OBESITY ON COMPLICATIONS AFTER ROBOTIC VS. OPEN RADICAL PROSTATECTOMY

with RP outcome and whether expectations regarding functional outcomes were accurate. Multivariable logistic regression models were fit to identify the association between patient expectations, change in functional outcomes, and satisfaction. RESULTS: Overall, 87.9% of men were satisfied with their treatment outcomes following RP, and 81.2% and 52.9% responded that their expectations were moderately to extremely accurate for the urinary and sexual functional outcomes, respectively. The relationship between mean change in functional scores vs. patient satisfaction and expectations of functional outcomes vs. patient satisfaction are shown in Table 1. In a multivariate analysis, both lesser changes in functional scores and accuracy of patient expectations were independent predictors of patient satisfaction (Table 2). CONCLUSIONS: Both changes in functional status and accurate patient expectations are important predictors of long-term satisfaction following open RP. Evidence-based preoperative counseling and expectations management are critical to ensure long-term patient satisfaction following RP.

MP5-17 RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOMES, AND PATIENT SATISFACTION FOLLOWING RADICAL PROSTATECTOMY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I1 Apr 2015MP5-17 RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOMES, AND PATIENT SATISFACTION FOLLOWING RADICAL PROSTATECTOMY Michael Fenstermaker and Herbert Lepor Michael FenstermakerMichael Fenstermaker More articles by this author and Herbert LeporHerbert Lepor More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.244AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been postulated that accurate outcomes expectations are important contributors to patient satisfaction following radical prostatectomy (RP). We explore the relationship between patient expectations, functional outcomes, and patient satisfaction following open RP. METHODS Between January 2000 and March 2009, 1425 men undergoing open RP by a single surgeon enrolled in an IRB-approved prospective longitudinal outcomes study. Baseline and post-treatment functional outcomes were captured prospectively through 2013 using the UCLA Prostate Cancer Index. Differences between baseline function and the most recent reported functional outcome assessment were calculated. A total of 897 (62.9%) of these men responded to a survey in 2013 capturing the level of patient satisfaction with RP outcome and whether expectations regarding functional outcomes were accurate. Multivariable logistic regression models were fit to identify the association between patient expectations, change in functional outcomes, and satisfaction. RESULTS Overall, 87.9% of men were satisfied with their treatment outcomes following RP, and 81.2% and 52.9% responded that their expectations were moderately to extremely accurate for the urinary and sexual functional outcomes, respectively. The relationship between mean change in functional scores vs. patient satisfaction and expectations of functional outcomes vs. patient satisfaction are shown in Table 1. In a multivariate analysis, both lesser changes in functional scores and accuracy of patient expectations were independent predictors of patient satisfaction (Table 2). CONCLUSIONS Both changes in functional status and accurate patient expectations are important predictors of long-term satisfaction following open RP. Evidence-based preoperative counseling and expectations management are critical to ensure long-term patient satisfaction following RP. Satisfaction with Treatment Outcome by Functional Change and Accuracy of Outcome Expectations Total Cohort (n=897) Satisfied with Outcome (n=788) Unsatisfied with Outcome (n=109) p-valuea,b Change in Sexual Function, Median (IQR) -33 (-54.2, -16.7) -33 (-55.2, -12.5) -50 (-62.5, -31.7) <0.0001a Change in Urinary Function, Median (IQR) -11 (-27.7, 0) -11 (-27.7, 0) -27.7 (-61, -11) <0.0001a Expectations accurate for sexual function, n (%) Not at all 185 (20.6) 138 (18.0) 47 (44.3) <0.0001b Slightly 226 (25.2) 200 (26.0) 26 (24.5) Moderately 317 (35.3) 295 (38.4) 22 (20.8) Extremely 146 (16.3) 135 (17.6) 11 (10.3) Expectations accurate for urinary function, n (%) Not at all 50 (5.6) 24 (3.1) 26 (24.3) <0.0001b Slightly 113 (12.5) 88 (11.4) 25 (23.4) Moderately 344 (38.4) 308 (39.8) 34 (31.8) Extremely 375 (41.8) 353 (45.7) 22 (20.6) a: Mann-Whitney U Test, b: Chi-square Test Table 2. Predictors of treatment outcome satisfaction Model 1: Urinary Function Model 2: Sexual Function Change in Function OR (95% CI) OR (95% CI) Above Median 1.00 1.00 Below Median 2.00 (1.10-3.63) 2.32 (1.38-3.93) Expectations Met Not at all 1.00 1.00 Slightly 4.41 (1.86-10.43) 2.69 (1.44-5.04) Moderately 9.91 (4.52-21.73) 3.76 (2.01-7.06) Extremely 15.7 (6.61-37.42) 5.47 (2.26-13.28) Both models control for age, race, marital status, follow-up time, Gleason score, D Amico Risk, subsequent hormonal treatment, and reported importance of functional income © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e51-e52 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Fenstermaker More articles by this author Herbert Lepor More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Functional outcomes of polypropylene midurethral sling resection for treatment of mesh exposure/extrusion: Does it lead to a relapse of incontinence?

The Burch colposuspension, which was regarded as the gold standard treatment for stress urinary incontinence for several years, has been replaced by minimally invasive sling devices. Although these procedures are simple and minimally invasive, they are associated with complications such as infection, mesh erosion, chronic pain, and de novo detrusor overactivity, which may necessitate surgical resection or tape removal. The aim of the study was to assess urinary function outcomes including continence, after partial resection of suburethral tapes. Patients were admitted for resection of tape due to extrusion/exposure, between 2011 and 2014. Patients were evaluated with physical examination, transvaginal ultrasound, cough stress test, 24-hour bladder diary, Incontinence Impact Questionnairre-7 form and Urogenital Distress Inventory-6 form. Minimum follow-up time was 2 months after treatment of the tape complication (mean 20, range 2 to 38). Recurrence of incontinence after partial tape resection was observed in 9% (3/32) cases. In two patients due to stress urinary incontinence recurrence repeat anti-incontinence surgery was necessary. Although one patient had suffered from incontinence after resection of tape, she did not desire operation. The results of this study indicated that preservation of the anti-incontinence effects of slings might not be dependent on the intactness of the sling. Recurrence of incontinence after partial tape resection is uncommon and in the majority of cases this stress incontinence is minimally and does not require repeat operation.

Lower urinary tract dysfunction after nerve-sparing radical hysterectomy.

The aim of this review is to provide a comprehensive overview of the current role of nerve-sparing radical hysterectomy (NSRH) in reducing the incidence of postoperative lower urinary tract dysfunction (LUTD) and in improving quality of life. A detailed online search was performed using the following keywords: nerve sparing, radical hysterectomy, cervical cancer, and all these terms in combination with urinary dysfunction or bladder dysfunction in order to analyze the effect of NSRH on urinary functional outcomes. Articles retrieved were analyzed and assigned a level of evidence (LE) according to the criteria of the Centre for Evidence-Based Medicine in Oxford, UK. Our review highlights the heterogeneity of conducting and reporting studies in the literature. Autonomic pelvic nerve injuries during the procedure are thought to be the major cause of LUTD. The amount of LUTD depends upon the extent and type of nerve injury. Anatomically based surgical techniques are developed to avoid nerve injury without compromising oncological control. All studies comparing NSRH to standard RH yielded promising results with respect to postoperative LUTD. A recent meta-analysis showed similar cancer control rates between the two techniques. However, controversies remain about the ideal surgical approach for nerve sparing and there is no consensus as to the level and landmarks of dissection to preserve the maximal amount of nerves without compromising oncological outcomes. Available evidence suggests that NSRH is safe and associated with lower incidence of LUTD. However, there is no standardized technique for NSRH and controversies remain about its oncological safety. Long-term oncological data from multicenter surgical trials are needed as well as a universally accepted standard to report studies on NSRH.

MP5-09 COMPARISON OF URINARY OUTCOMES IN SUTURE-LINE VERSUS NEO-ORIFICE ANASTOMOTIC TYPES IN THE STUDER NEOBLADDER

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-09 COMPARISON OF URINARY OUTCOMES IN SUTURE-LINE VERSUS NEO-ORIFICE ANASTOMOTIC TYPES IN THE STUDER NEOBLADDER Kathryn Cunningham, Yasmin I. Bootwala, Graciela Nogueras-Gonzalez, Huong Truong, Clay Pendleton, and O. Lenaine Westney Kathryn CunninghamKathryn Cunningham More articles by this author , Yasmin I. BootwalaYasmin I. Bootwala More articles by this author , Graciela Nogueras-GonzalezGraciela Nogueras-Gonzalez More articles by this author , Huong TruongHuong Truong More articles by this author , Clay PendletonClay Pendleton More articles by this author , and O. Lenaine WestneyO. Lenaine Westney More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.392AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studer and other investigators have postulated the negative effect of the “funnel-shaped” outlet resulting from utilizing the inferior aspect of the anterior neobladder wall closure for the urethral anastomosis. This technique has been linked to dysfunctional voiding. We aimed to compare the functional results of the two anastomotic types, the “funnel-shaped” or suture line and the neo-orifice technique. METHODS We reviewed the records of patients who underwent a Studer ileal neobladder reconstruction from 1/1/2000 to 5/30/2012 at our institution. In addition to demographic information, the charts were evaluated for anastomotic leak on post-operative cystogram, urinary incontinence (day and/or night), urinary retention and subsequent procedures to correct incontinence or outlet obstruction. Incontinence was defined as any leakage between regularly scheduled voids. RESULTS 363 of 465 patients met the inclusion criteria of follow-up greater than 6 months. The majority were male, 90.6% (n=329), with a mean age at cystectomy of 59.7 years. Mean follow up was 49 months (range, 6.1 - 138.7). Urethral anastomotic technique was divided between suture line and neo-orifice, 47% and 53%, respectively. Any urinary incontinence was identified in 41.8% of patients at last follow up, with 20.3% reporting daytime incontinence and 39.2% complaining of nighttime incontinence. Surgical intervention for urinary incontinence was performed on 23 patients (6.4%) including artificial urethral sphincter (15), male sling (4), ileal conduit/catheterizable diversion (3), and transurethral injection (1). There was no significant difference in regards to urinary incontinence, day or night, with respect to anastomotic type (p=.241) [RR= 1.158 , 95% CI .908 - 1.476]. Urinary retention occurred in 16% of patients, with surgical intervention required in 3.3%. No significant difference was seen in this outcome in regard to type of anastomosis (p=0.247) [RR=1.36, 95%CI .845 - 2.195]. Suture line anastomoses were more likely to have a leak identified on cystogram (24.1 vs. 15.2%, p=0.033, RR=1.59, 95% CI: 1.036 - 2.430). CONCLUSIONS Our data showed no significant difference in urinary functional outcomes – incontinence and retention - when comparing these two anastomotic types. However, the suture-line technique was shown to have a higher risk of anastomotic leak. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e85 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Kathryn Cunningham More articles by this author Yasmin I. Bootwala More articles by this author Graciela Nogueras-Gonzalez More articles by this author Huong Truong More articles by this author Clay Pendleton More articles by this author O. Lenaine Westney More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Robot-assisted radical cystectomy with intracorporeal neobladder diversion: The Karolinska experience.

Introduction:The aim of this report is to describe our surgical technique of totally intracorporeal robotic assisted radical cystectomy (RARC) with neobladder formation.Materials and Methods:Between December 2003 and March 2013, a total of 147 patients (118 male, 29 female) underwent totally intracorporeal RARC for urinary bladder cancer. We also performed a systematic search of Medline, Embase and PubMed databases using the terms RARC, robotic cystectomy, robot-assisted, totally intracorporeal RARC, intracorporeal neobladder, intracorporeal urinary diversion, oncological outcomes, functional outcomes, and complication rates.Results:The mean age of our patients was 64 years (range 37-87). On surgical pathology 47% had pT1 or less disease, 27% had pT2, 16% had pT3 and 10% had pT4. The mean number of lymph nodes removed was 21 (range 0-60). 24% of patients had lymph node positive dAQ1isease. Positive surgical margins occurred in 6 cases (4%). Mean follow-up was 31 months (range 4-115 months). Two patients (1.4%) died within 90 days of their operation. Using Kaplan-Meier analysis, overall survival and cancer specific survival at 60 months was 68% and 69.6%, respectively. 80 patients (54%) received a continent diversion with totally intracorporeal neobladder formation. In the neobladder subgroup median total operating time was 420 minutes (range 265-760). Daytime continence and satisfactory sexual function or potency at 12 months ranged between 70-90% in both men and women.Conclusions:Our experience with totally intracorporeal RARC demonstrates acceptable oncological and functional outcomes that suggest this is a viable alternative to open radical cystectomy.

Urinary functional outcomes in female neobladder patients

The ratio between orthotopic and non-orthotopic diversions in women is far lower than in male patients. Data on urinary function in female patients with neobladders are therefore sparse. We investigated the urinary function of female neobladder patients utilizing the Bladder Cancer Index, a validated and reliable health-related quality-of-life (HRQOL) questionnaire. Furthermore, we tried to identify preoperative factors that may influence functional results. All living female patients with an orthotopic neobladder (N = 82) from the University of Southern California Bladder Cancer Database were sent a questionnaire including the University of Michigan Bladder Cancer Index. Univariate analyses were performed using the Kruskal-Wallis test followed by a multivariate stepwise regression model. Fifty-six patients (68.3%) responded and were included in the analysis. Thirty-five (62.5%) of these patients had to catheterize their neobladder to a certain amount, while 25 patients (44.6%) depend on catheterization to empty their neobladder. Univariate analyses showed that patient age (>65 years) was the only variable associated with a statistically significant lower rate of neobladder catheterization. Better urinary bother scores were associated with organ-confined disease (p = 0.038) and education level (p = 0.01). However, these variables were not significant in a multivariate stepwise linear regression model. Considerably more women require urinary catheterization to void than previously reported. In this study, representing the largest investigated cohort in this topic, we were unable to identify any predictors of this outcome or any other urinary HRQOL in this cohort.

Urinary Outcomes Are Significantly Affected by Nerve Sparing Quality During Radical Prostatectomy

To assess the effect of nerve sparing (NS) quality on self-reported patient urinary outcomes after radical prostatectomy. A total of 102 preoperatively potent men underwent laparoscopic or robotic radical prostatectomy; NS was prospectively graded at surgery using a 0-4 scale/neurovascular bundle. Urinary functional outcomes were measured by validated Expanded Prostate Cancer Index Composite questionnaire at baseline and follow-up time points (1, 3, 6, 9, and 12 months) in 99 men who underwent various degrees of NS. Mixed linear regression was used to analyze the effect of NS quality and other clinical factors on urinary outcomes. Patients with at least 1 neurovascular bundle spared completely, along with its supportive tissues (NS grade 4/4), noted significantly improved Expanded Prostate Cancer Index Composite urinary functional and continence outcomes as early as 1 month postoperatively and up to 12 months. Significantly less urinary bother was also noted in these men by 9-12 months postoperatively. Multivariate analysis revealed that bilateral or unilateral excellent NS (at least 1 bundle graded 4/4), increasing time from surgery, young patient age, and lower body mass index positively and significantly affected urinary functional outcomes, including pad use. Men who received excellent unilateral NS recovered urinary function about as well as men who had both neurovascular bundles spared in similar fashion. The quality of NS significantly influences patient-defined urinary functional convalescence. Completely sparing at least 1 neurovascular bundle along with its supportive tissues has a dramatic effect on the recovery of urinary continence and quality of life in preoperatively potent men.

Short-term Functional Outcomes and Complications Associated With Transperineal Template Prostate Mapping Biopsy

To assess the complications and erectile and urinary functional outcomes of transperineal template mapping biopsy (TTMB) of the prostate. We retrospectively reviewed the records of 84 patients undergoing TTMB at our institution and recorded complications and functional outcomes. Erectile and urinary functions were measured at baseline, 2 weeks, and 6 ± 2 weeks after TTMB using the International Index of Erectile Function short version (IIEF-5) and International Prostate Symptom Score questionnaires. Erectile and urinary function parameters were compared between baseline and 2 and 6 weeks after TTMB in a paired fashion. A subanalysis of erectile function was performed in preoperatively potent men (IIEF-5 >17). Sixteen patients (19%) experienced complications. The most common events were transient urinary retention (6%), prostatitis (4%) and local events, including perineal hematoma, bruising, or perineal pain (5%). One patient with hematuria required intervention. IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 20 (interquartile range [IQR], 16-23), 18 (IQR, 12-22), and 18 (IQR, 12-22), respectively (P= .096 and P= .034). Among preoperatively potent men, IIEF-5 scores at baseline, 2 weeks, and 6 weeks were 22 (IQR, 20-24), 21 (IQR, 18-24), and 22 (IQR, 18-24), respectively(P= .011 and P= .018). International Prostate Symptom Scores were 6 (IQR, 3.5-11) at baseline, rose to 10 (IQR, 4.8-15) at 2 weeks (P= .012), and returned to 7 (IQR, 3.5-13) at 6 weeks (P= .628). TTMB has a favorable morbidity profile, with mostly mild and transient complications. Urinary retention occurred in 6%, and only 1 patient required intervention with bladder irrigation. Despite a statistically significant decline in erectile function from baseline, the median change in IIEF-5 score was 1 point. Urinary symptoms worsened initially but returned to baseline within 6weeks.

352 HOW DOES PATIENT AGE REALLY EFFECT QUALITY OF LIFE OUTCOMES AFTER RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER?

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History (II)1 Apr 2013352 HOW DOES PATIENT AGE REALLY EFFECT QUALITY OF LIFE OUTCOMES AFTER RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER? Sanoj Punnen, Allison Glass, Janet Cowan, Matthew Cooperberg, and Peter Carroll Sanoj PunnenSanoj Punnen San Francisco, CA More articles by this author , Allison GlassAllison Glass San Francisco, CA More articles by this author , Janet CowanJanet Cowan San Francisco, CA More articles by this author , Matthew CooperbergMatthew Cooperberg San Francisco, CA More articles by this author , and Peter CarrollPeter Carroll San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have suggested that younger men do better with respect to sexual and urinary quality of life after surgery for prostate cancer. The objective of this study was to review urinary and sexual function and bother outcomes 2 years after radical prostatectomy and to see how these results differed by patient age at treatment. METHODS Men within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database were selected for this analysis if they had radical prostatectomy for localized prostate cancer and had quality of life data at baseline and 2 years post treatment. UCLA Prostate Cancer Index was used to provide a validated assessment of urinary and sexual function and bother at baseline and follow up. Repeated measures mixed model regression was used to assess the effect of age (characterized into <55, 56-65, and > 65 years) on urinary and sexual function and bother scores after surgery. Logistic regression was used to assess the effect of age on the likelihood of a significant decline in urinary and sexual function and bother scores, defined as a half standard deviation decline from baseline. RESULTS 2018 men made up the final analytic cohort. Age did not appear to have a significant effect on urinary function and bother scores over time. Figure 1 shows mean sexual function scores after adjustment for common demographic and clinical variables. Younger patients had higher scores after treatment, however they also had larger declines in sexual function scores after treatment compared to older patients. Sexual bother did not appear to differ significantly by age after surgery. Logistic regression showed that patients who were 56-65 years were less likely to undergo a significant decline in sexual function at 2 years after surgery compared to younger (<55 years) patients (OR 0.71, 95% CI 0.5-0.97, p=0.03) but there was no difference between patients who were <55 years and those who were >65 years (p=0.14). CONCLUSIONS Although younger patients have higher sexual function scores after surgery they have more to lose and may undergo larger declines then older patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e142-e143 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanoj Punnen San Francisco, CA More articles by this author Allison Glass San Francisco, CA More articles by this author Janet Cowan San Francisco, CA More articles by this author Matthew Cooperberg San Francisco, CA More articles by this author Peter Carroll San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary functional outcomes and toxicity five years after proton therapy for low- and intermediate-risk prostate cancer: Results of two prospective trials

Background. To assess genitourinary (GU) function and toxicity in patients treated with image-guided proton therapy (PT) for early- and intermediate-risk prostate cancer and to analyze the impact of pretreatment urinary obstructive symptoms on urinary function after PT. Material and methods. Two prospective trials accrued 171 prostate cancer patients from August 2006 to September 2007. Low-risk patients received 78 cobalt gray equivalent (CGE) in 39 fractions and intermediate-risk patients received 78–82 CGE. Median follow-up was five years. The International Prostate Symptom Score (IPSS) and GU toxicities (per CTCAE v3.0 and v4.0) were documented prospectively. Results. Five transient GU events were scored Gr 3 per CTCAE v4.0, for a cumulative late GU toxicity rate of 2.9% at five years. There were no Gr 4 or 5 events. On multivariate analysis (MVA), the only factor predictive of Gr 2 + GU toxicity was pretreatment GU symptom management (p = 0.0058). Patients with pretreatment IPSS of 15–25 had a decline (clinical improvement) in median IPSS from 18 before treatment to 10 at their 60-month follow-up. At last follow-up, 18 (54.5%) patients had a > 5-point decline, 14 (42.5%) remained stable, and two patients (3%) had a > 5-point rise (deterioration) in IPSS. Patients with IPSS < 15 had a stable median IPSS of 6 before treatment and at 60 months. Conclusion. Urologic toxicity at five years with image-guided PT has been uncommon and transient. Patients with pretreatment IPSS of < 15 had stable urinary function five years after PT, but patients with 15–25 showed substantial improvement (decline) in median IPSS, a finding not explained by initiation or dose adjustment of alpha blockers. This suggests that PT provides a minimally toxic and effective treatment for low and intermediate prostate cancer patients, including those with significant pretreatment GU dysfunction (IPSS 15–25).

Urinary Functional Outcome Following Radical Cystoprostatectomy and Ileal Neobladder Reconstruction in Male Patients

Orthotopic neobladder reconstruction is the preferred method of urinary diversion after radical cystoprostatectomy. We evaluated urinary functional outcomes in male patients after orthotopic neobladder using a patient questionnaire. Between 2002 and 2009 patients with bladder cancer were enrolled in a clinical trial, randomly assigned to undergo T pouch or Studer pouch diversion after radical cystoprostatectomy. Male patients were mailed a questionnaire 12 or more months after surgery including items on urinary function, intermittent catheterization, number/size/wetness of pads and mucus leakage. The questionnaire response rate was 68%. Mean followup was 4.5 years (range 1 to 8). Only 22.3% of patients did not use pads. In the daytime 47% of patients used at least 1 pad, 32.2% used small/mini pads and 22.6% used diapers. At night 72% used pads, 14.7% used small/mini pads and 38.9% used diapers. During the day and night 47% said their pads were dry/barely wet. Overall 62.5% of patients reported mucus leakage. Only 9.5% of patients performed clean intermittent self-catheterization, of whom 70.6% started clean intermittent self-catheterization within the first year after surgery. Increasing age and diabetes mellitus were predictors of urinary function (p = 0.005 and 0.03, respectively) but did not affect pad use. Ileal orthotopic neobladder offers good functional results but most patients wear at least 1 pad and many require diapers at night. Increasing age and diabetes mellitus predict worse urinary function but are not associated with pad use. Emptying failure is uncommon and occurs early in the postoperative period. Pad size/wetness and mucus leakage should be considered when evaluating urinary incontinence.

Comparison of outcomes between pure laparoscopic vs robot‐assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes

To compare perioperative, oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP) with emphasis on health-related quality of life (HRQOL) data as few studies exist. Patients underwent RALP or LRP by a single, fellowship trained surgeon with a standard clinical care pathway. HRQOL data using the Expanded Prostate Cancer Index Composite (EPIC) were collected at 0, 3, 6 and 12 months after 175 consecutive LRP and 174 RALP procedures. Urinary and sexual function outcomes were compared using two methods: (1) EPIC summary/subscale analyses described as percent return to baseline function and (2) traditional single-question analysis. The two groups were statistically similar with respect to demographics, clinical stage, perioperative outcomes, stage-specific surgical margin rates, and baseline urinary and sexual function scores. There was no statistical difference in postoperative urinary function between RALP and LRP using EPIC or single-question analyses at 3, 6 and 12 months. EPIC questionnaire data showed a greater return to baseline sexual function over time (mixed model analysis) in RALP than in LRP patients who had a bilateral nerve sparing procedure (Sexual Summary Score, P= 0.005; Sexual Function and Bother Subscales, P= 0.007). Using EPIC, RALP patients receiving a bilateral nerve sparing procedure showed improved percent return to baseline potency at 3 and 6 months (P < 0.025) compared with LRP patients, but had similar outcomes at 12 months (73.7% vs 66.2%, P= 0.3). Single-question analysis suggested improved potency after RALP compared with LRP, with a greater percentage of RALP patients reporting successful sexual intercourse in the past 4 weeks (87.5% vs 66.7% at 12 months, P= 0.06). When comparing surgical techniques, RALP and LRP groups showed statistically similar postoperative urinary function outcomes. RALP patients had an earlier return of sexual function when compared with LRP patients after a bilateral nerve sparing procedure.

Urethrovesical Anastomosis Using Barbed Suture During Robot-Assisted Radical Prostatectomy

Introduction and Objectives: Barbed polyglyconate suture (V-Loc®; Covidien, Mansfield, Massachusetts) was first used for the urethrovesical anastomosis (UVA) during robot-assisted radical prostatectomy (RARP) beginning January 2010. Safety and feasibility were previously demonstrated in 51 patients.1 In this video, we demonstrate the technique of urethrovesical anastomosis with barbed suture and the results of a randomized, controlled trial assessing perioperative and functional outcomes after urethrovesical anastomosis with barbed polyglyconate versus monofilament poliglecaprone in RARP. Methods: After institutional review board approval, 64 patients meeting all inclusion criteria participated in this multi-surgeon prospective, randomized, controlled trial between May and September 2010. Posterior repair and urethrovesical anastomosis during RARP were performed with barbed polyglyconate (n = 33) or monofilament poliglecaprone (n = 31) suture. Primary outcomes were anastomotic (UVA) and posterior reconstruction time. Secondary outcomes included cystogram leak, bladder neck reconstruction rate, and 6-week functional outcomes assessed by patient-administered questionnaire. Results: Posterior reconstruction was performed in 3.3 minutes versus 4.3 minutes (a 23.3% reduction), and UVA was performed in 10.1 minutes versus 13.8 minutes (a 26.8% reduction). The absolute time difference for the two-layer anastomosis was 4.7 minutes. All other perioperative outcomes were equivalent between groups. Patient urinary functional outcomes, including pad usage and leakage rates, were equivalent at 6 weeks. Conclusions: Anastomosis during RARP with barbed polyglyconate suture can be performed safely and more efficiently than with standard monofilament suture. We demonstrated a 25% decrease in anastomotic time with no increase in adverse events, no instances of urinary retention, and equivalent functional outcomes measured by the patient-administered questionnaire. No competing financial interests exist. Runtime of video: 8 mins 22 secs

Anastomosis During Robot-assisted Radical Prostatectomy: Randomized Controlled Trial Comparing Barbed and Standard Monofilament Suture

To compare perioperative and functional outcomes after urethrovesical anastomosis (UVA) with barbed polyglyconate and monofilament poliglecaprone in robot-assisted radical prostatectomy (RARP). Barbed polyglyconate suture was first used for the UVA during RARP beginning in January 2010; safety and feasibility were previously demonstrated in 51 patients. From May to September 2010, 64 patients meeting all the inclusion criteria participated in the present multisurgeon prospective, randomized, controlled trial and underwent posterior repair and UVA during RARP with either barbed polyglyconate (n=33) or monofilament poliglecaprone (n=31) suture. The primary outcomes were the anastomotic (UVA) and posterior reconstruction times. Secondary outcomes included cystogram leak, bladder neck reconstruction rate, and 6-week functional outcomes assessed by a self-administered validated patient questionnaire. Posterior reconstruction was performed within 3.3 minutes with the barbed suture versus 4.3 minutes with the monofilament poliglecaprone suture (23.3% reduction) and UVA within 10.1 versus 13.8 minutes, respectively (26.8% reduction). The absolute time difference for the 2-layer anastomosis was 4.7 minutes (a 26.0% reduction in the total anastomosis time). All other perioperative outcomes were equivalent between the 2 groups. Urinary functional outcomes, including the pad use and leakage rates, were equivalent at 6 weeks. Anastomosis during RARP with the V-Loc barbed suture can be performed safely and more efficiently than with standard monofilament suture. We demonstrated a 26% decrease in the anastomotic time with no increase in the adverse events, no instances of urinary retention and equivalent functional outcomes were measured with the self-administered patient questionnaire.

Qualitay of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer

Purpose: Health related quality of life concerns factor prominently in prostate cancer management. We describe health related quality of life impact and recovery profiles of 4 commonly used operative treatments for localized prostate cancer. Materials and Methods: Beginning in February 2000 all patients treated with open radical prostatectomy, robot assisted laparoscopic prostatectomy, brachytherapy or cryotherapy were asked to complete the UCLA-PCI questionnaire before treatment, and at 3, 6, 12, 18, 24, 30 and 36 months after treatment. Outcomes were compared across treatment types with statistical analysis using univariate and multivariate models. Results: A total of 785 patients treated between February 2000 and December 2008 were included in the analysis with a mean followup of 24 months. All health related quality of life domains were adversely affected by all treatments and recovery profiles varied significantly by treatment type. Overall urinary function and bother outcomes scored significantly higher after brachytherapy and cryotherapy compared to open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. Brachytherapy and cryotherapy had a 3-fold higher rate of return to baseline urinary function compared to open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. Sexual function and bother scores were highest after brachytherapy, with a 5-fold higher rate of return to baseline function compared to cryotherapy, open radical prostatectomy and robotic assisted laparoscopic radical prostatectomy. All 4 treatments were associated with relatively transient and less pronounced impact on bowel function and bother. Conclusions: In a study of sequential health related quality of life assessments brachytherapy and cryotherapy were associated with higher urinary function and bother scores compared to open radical prostatectomy and da Vinci® prostatectomy. Brachytherapy was associated with higher sexual function and bother scores compared to open radical prostatectomy, robotic assisted laparoscopic radical prostatectomy and cryotherapy.

Oncological and Functional Outcomes of Radical Cystectomy and Orthotopic Bladder Replacement in Women

To report oncological and functional results in women undergoing radical cystectomy and orthotopic bladder replacement. The charts of all women undergoing bladder replacement after radical cystectomy at UCSF through April 2008 were reviewed. Pathologic characteristics, survival (overall and disease-specific), and urinary functional outcomes are reported. Survival was estimated using Kaplan-Meier methods, and Cox proportional hazards regression analyses were performed to determine factors associated with incontinence, retention, and mortality. Fifty-six women with a mean follow-up of 35 months were analyzed. The cancer recurrence rate was 32%. Kaplan-Meier estimated 5-year recurrence-free, cancer-specific, and overall survival were 54%, 57%, and 47%, respectively. Pathologic lymph node status (HR 14.2, P <.001) and age at diagnosis (HR 1.7, P = .04) were the only clinical or pathologic characteristics significantly associated with survival. The overall continence rate (no pads) was 57%. Hypercontinence occurred in 24% of patients. With careful patient selection and usage of urethral frozen section, rates of local recurrence are low. Overall rates of incontinence (43%) and hypercontinence (24%) are similar to those previously reported. When pathologically organ-confined, women have an excellent disease-specific survival. Orthotopic bladder replacement is a safe and effective form of urinary diversion after radical cystectomy in women.

Contemporary radical prostatectomy.

Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP) has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.