Urinary Function Scores Research Articles

Effect of kegel pelvic floor muscle exercise on improving urinary disorder in rectum cancer patients after rectal surgery: a randomized clinical trial.

Postoperative urinary dysfunction poses a significant challenge for rectal cancer patients. While pelvic floor muscle training (PFMT) has shown promise in other contexts, its efficacy following rectal cancer surgery remains uncertain. A clinical trial involving 79 rectal cancer patients found that initiating Kegel exercises post-surgery led to significant improvements in urinary symptoms compared to standard care. Adherence to exercises correlated with symptom reduction, with no reported adverse events. We have defined the main outcome of our study as the improvement in urinary function scores post-surgery. Effectiveness is considered as any statistically significant improvement in these scores. Early initiation of Kegel exercises shows promise in alleviating postoperative urinary dysfunction in rectal cancer patients. Further research is needed to optimize postoperative care protocols and enhance patient outcomes.

Individualized center-based analysis of urinary and sexual functional outcome after radical prostatectomy based on the prostate cancer outcome study: a post hoc pathway to patient outcome measurement analysis for quality improvement.

We evaluate differences of patient-reported outcome measurements (PROM) based urinary continence and sexual function 12 months after radical prostatectomy (RPE) based on perioperative, surgical, and patient-specific characteristics in a large European academic urology center. All men enrolled in the Prostate Cancer Outcome Study (PCO) study who were treated with RPE between 2017 and 2021 completed EPIC-26 information surveys before and 12 months after RPE. Survey data were linked to clinical data of our institution. Logistic regression analyses were performed to examine the correlation between individual surgeons, patient characteristics, patient clinical data, and their urinary continence and sexual function. In total, data of 429 men were analyzed: unstratified mean (SD) EPIC-26 domain score for urinary function decreased from 93.3 (0.7) to 60.4 (1.5) one year after RPE, respectively for sexual function from 64.95 (1.6) to 23.24 (1.1). Patients with preoperative adequate urinary function (EPIC-26 score > 80) reported significantly different mean urinary function scores between 53.35 (28.88) and 66.25 (25.15), p= 0.001, stratified by surgeons experience. On binary logistic regression analyses, only nerve sparing techniques (OR: 1,83, 95% CI: 1.01;3.21; p = 0.045) and low body mass index (OR: 0.91, CI: 0.85;0.99, p= 0.032) predicted adequate postoperative urinary function. The results show how using provider-specific data from a larger cohort study enables to develop institution-specific analysis for functional outcomes after RPE. These models can be used for internal quality improvement as well as enhanced and provider-specific patient communication and shared decision making.

Military service and health-related quality of life among gay and bisexual prostate cancer survivors: Results from the Restore-2 study

IntroductionThere are notable disparities in health-related quality of life (HRQOL) between gay and bisexual men (GBM) and heterosexual patients with prostate cancer (PCa); however, the role of past military service...

Long-Term Urinary Toxicity Follow-Up of Combined External Beam Radiation and Cs-131 LDR Brachytherapy Boost for Prostate Cancer

To evaluate and update our institutional data on chronic patient-reported urinary symptoms in patients with prostate cancer treated with combined external beam radiation therapy (EBRT) and Cesium-131 (Cs-131) LDR brachytherapy boost. Patients treated from September 2006-July 2022 and with at least 6 months of follow-up were analyzed. Patients filled out the Expanded Prostate Cancer Index Composite (EPIC) questionnaire pre-treatment and at each scheduled follow-up. Mean EPIC urinary scores were calculated for urinary summary, urinary function, urinary bother, urinary incontinence, and urinary irritative/obstructive domains. Changes of 7-points or more in mean domain scores were deemed clinically significant. The prevalence of urinary bleeding was calculated and bleeding occurring more than "about once a week" ("more than once a week", "about once a day", and "more than once a day") was deemed clinically significant. Outcomes were analyzed at each follow-up timepoint using paired t-test. A total of 341 patients with prostate cancer were included in the analysis of which 183 were intermediate-risk and 158 high-risk. 174 patients were treated with tri-modality therapy, and SpaceOAR was used in 108 patients. Long-term statistically significant decreases in mean EPIC QOL scores were seen in urinary summary, urinary function, urinary bother, urinary incontinence, and urinary irritative/obstructive domains at 6 months, with clinically and statistically significant decreases in urinary function and urinary incontinence at 6 months (86±17.4, 83.4±22.2 respectively) and up to 18 months post-treatment (84.8±17.4, 83.6±20.7 respectively) compared with pre-treatment scores (93.1±10.7, 90.8±14.8 respectively), with both domains returning to clinical baseline at 24 months. Urinary irritative/obstructive mean scores clinically and significantly decreased at 9 months (77±17.4) compared to pre-treatment (84.7±13.5), returning to clinical baseline at 12 months. The prevalence of clinically significant urinary bleeding at 6, 12, 24, 36, 48, and 60 months was 1.3%, 2.6%, 3.7%, 0.7%, 0.9%, and 2.3% respectively. At the median follow-up of 42 months (IQR 54, 18-72), mean EPIC scores were clinically improved (≥7-point increase) from pre-treatment baseline in 15-30% of patients across the analyzed urinary domains. Long-term patient-reported clinically significant decreases in urinary function and urinary incontinence mean EPIC scores occurred up to 18 months following combined external beam radiation and Cs-131 prostate brachytherapy and returned to baseline at 24 months, while clinically significant decrease in urinary irritability/obstructive mean scores occurred at 9 months and returned to baseline at 12 months. At 42 months follow-up, mean urinary domain scores improved from pre-treatment baseline in 15-30% of patients.

Phase I/II randomized clinical trial of in-clinic acupuncture prior to BCG in patients with high-risk non-muscle invasive bladder cancer.

4590 Background: Acupuncture can reduce pain and urinary urgency and frequency. Treatment-related dose-limiting dysuria and irritative bladder symptoms are common in patients receiving intravesical Bacillus Calmette-Guerin (BCG) for the treatment of non muscle-invasive bladder cancer (NMIBC). We evaluated the feasibility, safety, and tolerability of weekly in-clinic pre-procedure acupuncture among patients receiving induction BCG. Methods: Patients with high-risk NMIBC undergoing induction BCG were randomized 2:1 to a standardized acupuncture protocol (Acu) or an attention waitlist control. Acu patients received acupuncture prior to each of 6 weekly BCG instillations. Feasibility was assessed via recruitment, retention, and intervention adherence. Acupuncture safety and tolerability were assessed via physician-reported CTCAE v5.0 and adverse events (AEs). Secondary endpoints included BCG treatment adherence, patient-reported BCG-related toxicity, and bladder cancer-specific and generic quality of life (QOL), assessed with the EORTC-QLQ-NMIBC-24 and -C30 surveys. Subjective assessments of acupuncture acceptability were assessed through patient exit surveys. Results: Between 1/21 and 7/22, 43 patients were randomized to Acu (n=28) vs. Control (n=15). Median age was 70.3 years and 76% were male. Week 7 follow-up surveys were completed by 93% of patients; 6 patients withdrew early due to disease progression, refractory gross hematuria, or for patient preference. Acupuncture was successfully delivered prior to each BCG treatment in Acu patients with no acupuncture-related AEs or interruptions to induction BCG. BCG-attributed AEs were reported by 91% Acu and 100% Control patients, including pain (28% vs. 43%, respectively, p=0.34) and urinary symptoms (62% vs. 79%, respectively, p=0.31). Comparing Acu with Controls, change in QOL over the study period demonstrated greater improvements in median urinary symptoms (9.5, IQR 0.0-19.0 vs. 0.0, IQR -14.3-7.1, p=0.02) and a trend towards improvement in median pain scores (16.7, IQR 0.0-16.7 vs. 8.3, IQR 0.0-33.3 p=0.68) among patients in the Acu arm. 96% of Acu patients reported that acupuncture was “very/extremely helpful” and 91% would recommend acupuncture to other patients. Conclusions: Acupuncture prior to induction BCG treatments is feasible and safe. In this Phase I/II trial, we observed reductions in pain and a trend towards improved urinary function scores over successive treatments among patients undergoing in-clinic pre-BCG instillation acupuncture. Patients receiving acupuncture reported high degrees of satisfaction with treatments. Future larger randomized controlled trials are needed to further characterize the efficacy of acupuncture with respect to pain, urinary symptoms and impact on QOL, and continuation of maintenance therapy during BCG treatment. Clinical trial information: NCT04496219 .

Partial-gland Cryoablation Outcomes for Localized Prostate Cancer in Patients with Magnetic Resonance Imaging (MRI)-visible and MRI-invisible Lesions

BackgroundExpert consensus recommends treatment of magnetic resonance imaging (MRI)-visible prostate cancer (PCa). Outcomes of partial-gland ablation (PGA) for MRI-invisible PCa remain unknown. ObjectiveTo compare recurrence-free survival, adverse events, and health-related quality of life (HRQoL) outcomes following cryoablation of MRI-visible vs invisible PCa. Design, setting, and participantsWe analyzed data for 75 men who underwent cryoablation therapy between January 2017 and January 2022. PCa identified on MRI-targeted and/or adjacent systematic biopsy cores was defined as MRI-visible, whereas PCa identified on systematic biopsy beyond the targeted zone was defined as MRI-invisible. Outcome measurements and statistical analysisThe primary outcome was recurrence at 12 mo after PGA, defined as the presence of clinically significant PCa (grade group [GG] ≥2) on surveillance biopsy. Adverse events were captured using the Clavien-Dindo classification and HRQoL was captured using the Expanded Prostate Cancer Index-Clinical Practice (EPIC-CP) tool. Results and limitationsOf the 58 men treated for MRI-visible and 17 treated for MRI-invisible lesions, 51 (88%) and 16 (94%), respectively, had at least one surveillance biopsy performed. There were no statistically significant differences in age, race, body mass index, biopsy GG, prostate-specific antigen, prostate volume, or treatment extent between the MRI-visible and MRI-invisible groups. Median follow-up was 44 mo (interquartile range 17–54) and did not significantly differ between the groups. The recurrence rate at 12 mo did not significantly differ between the groups (MRI-visible 39%, MRI-invisible 19%; p = 0.2), and log-rank survival analysis demonstrated no significant difference in recurrence-free survival (p = 0.15). Adverse event rates did not significantly differ (MRI-visible 29%, MRI-invisible 53%; p = 0.092); no man in the MRI-visible group had a Clavien-Dindo grade ≥III complication, while one subject in the MRI-invisible group had a Clavien-Dindo grade III complication. Median EPIC-CP urinary and sexual function scores were similar for the two groups at baseline and at 12 mo after PGA. Study limitations include the retrospective design and small sample size. ConclusionsWe observed similar cancer control, adverse event, and HRQoL outcomes for MRI-visible versus MRI-invisible PCa in the first comparison of partial-gland cryoablation. Longer follow-up and external validation of our findings are needed to inform patient selection for PGA for MRI-invisible PCa. Patient summaryPatients with prostate cancer lesions that are not visible on magnetic resonance imaging (MRI) scans who undergo partial gland ablation may have similar treatment outcomes compared to patients with cancer lesions that are visible on MRI.

MP54-10 IMPACT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY ON WORK STATUS, QUALITY OF LIFE AND TIME TO SURGICAL TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP54-10 IMPACT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY ON WORK STATUS, QUALITY OF LIFE AND TIME TO SURGICAL TREATMENT Avery Braun, Samuel Washington, Janet Cowan, Matthew Cooperberg, Lindsay Hampson, and Peter Carroll Avery BraunAvery Braun More articles by this author , Samuel WashingtonSamuel Washington More articles by this author , Janet CowanJanet Cowan More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Lindsay HampsonLindsay Hampson More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stress urinary incontinence (SUI) after radical prostatectomy (RP) can impact quality of life, work status and need for additional surgery. We aim to characterize the cumulative incidence of SUI procedures and report changes in urinary function (UF) and bother (UB), physical function (PF) and work status 1 year after RP. METHODS: Men with prostate cancer (PCa) treated by primary RP (1998-2016) were selected from CaPSURE. SUI was defined as use of any urinary pads per day (ppd) 1 year after RP. SUI procedure was tracked by CPT codes for urinary sling and artificial sphincter. Patients reported work status (full-time paid, part-time paid, unpaid), UF and UB scores (0-100) using UCLA PCa Index and PF using SF36 Index. Associations of incontinence with changes in UF, UB and PF and work status were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression were used to evaluate risk of undergoing a SUI procedure. RESULTS: Of 2,989 men treated with RP, 664 (22%) reported SUI at 1 year. Mean age was 61 years. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve sparing surgery (all p<0.01). Cumulative incidence of SUI procedures was 1.4% at 10 years after RP (0 ppd: 0,3%; 3+ ppd: 12.9%) with median time to intervention of 48 months (IQR 27, 84). SUI procedures comprised of 53% AUS, 24% slings, 9% both and 15% unspecified. Older age (HR 2.68 per 10 years, 95% CI 1.41-5.08, p<0.01) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50, p<0.01) were associated with higher risk of undergoing SUI procedure. UF scores declined significantly from 94 at baseline to 77 at 1 year after RP, while UB and PF remained stable. After RP, UF, UB and PF were inversely associated with increasing number of ppd from 0 to 3+ (all p<0.01). (Figure 1a) Incontinence status (SUI 15% vs no SUI 14%) was not associated with change from paid (FT or PT) to unpaid work at 1 year. QOL scores were not associated with work status. (Figure 1b). CONCLUSIONS: SUI at 1 year after RP may occur in up to 22% of patients; however, 10-year rate of SUI procedure was low at 1.4% with median time to intervention of 48 months. Incontinence affected urinary QOL but did not significantly impact work status. This information suggests that men with SUI after RP may continue to work and go under-treated despite impact on quality of life. Source of Funding: UCSF Goldberg-Benioff Program in Translational Cancer Biology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e757 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Avery Braun More articles by this author Samuel Washington More articles by this author Janet Cowan More articles by this author Matthew Cooperberg More articles by this author Lindsay Hampson More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of Concentrated Long-Chain Omega-3 Polyunsaturated Fatty Acid Supplementation on Quality of Life after Radical Prostatectomy: A Phase II Randomized Placebo-Controlled Trial (RCT-EPA)

Prostate cancer (PCa) and associated treatments incur symptoms that may impact patients' quality of life. Studies have shown beneficial relationships between diet, especially omega-3 fatty acids, and these symptoms. Unfortunately, only few data describing the relationship between long-chain omega-3 fatty acids (LCn3) and PCa-related symptoms in patients are available. The purpose of this study was to evaluate the effects of LCn3 supplementation on PCa-specific quality of life in 130 men treated by radical prostatectomy. Men were randomized to receive a daily dose of either 3.75 g of fish oil or a placebo starting 7 weeks before surgery and for up to one-year post-surgery. Quality of life was assessed using the validated EPIC-26 and IPSS questionnaires at randomization, at surgery, and every 3 months following surgery. Between-group differences were assessed using linear mixed models. Intention-to-treat analyses showed no significant difference between the two groups. However, at 12-month follow-up, per-protocol analyses showed a significantly greater increase in the urinary irritation function score (better urinary function) (MD = 5.5, p = 0.03) for the LCn3 group compared to placebo. These results suggest that LCn3 supplementation may improve the urinary irritation function in men with PCa treated by radical prostatectomy and support to conduct of larger-scale studies.

Discrimination of Sexual and Gender Minority Patients in Prostate Cancer Treatment: Results from the Restore-1 Study.

This study is the first to quantify experiences of discrimination in treatment undertaken by sexual and gender minority prostate cancer patients. Participants were 192 gay and bisexual and one transgender prostate cancer patients living in the US recruited from North America's largest online cancer support group. In this online survey, discrimination in treatment was measured using the Everyday Discrimination Scale (EDS), adapted for medical settings. Almost half (46%) endorsed at least one item, including 43% that the provider did not listen, 25% that they were talked down to, 20% that they received poorer care than other patients, 19% that the provider acted as superior, and 10% that the provider appeared afraid of them. While most (26.3%) rated the discrimination as "rare" or "sometimes" (EDS=1-3), 20% reported it as more common (EDS≥4). Most attributed the discrimination to their sexual orientation, or to providers being arrogant or too pushed for time. Discrimination was significantly associated with poorer urinary, bowel, and hormonal (but not sexual) EPIC function and bother scores, and with poorer mental health (SF-12). Those who had systemic/combined treatment (versus either radiation only or surgery only) were more likely to report discrimination. This study provides the first evidence that discrimination in prostate cancer treatment, including micro-aggressions, appear a common experience for gay and bisexual patients, and may result in poorer health outcomes.

Expression of transforming growth factor-β1 and autophagy markers in the bladder of rats with neurogenic lower urinary tract injury.

This study was conducted to explore the expression of transforming growth factor-beta 1 (TGF-β1) and its correlation with autophagy markers in the bladder of rats with neurogenic lower urinary tract dysfunction (NLUTD) post spinal cord injury (SCI). A total of 36 male Wistar rats were randomly divided into the SCI group and control group. Rats in the SCI group were subjected to T10-T11 spinal cord transection. At day 1, 4, and 7, 6 rats were euthanized daily and the Basso, Beattie and Bresnahan score (BBB score), post-void residual (PVR), urinary bladder function score (UBFS) and bladder weight were assessed. The expression TGF-β1 and autophagy markers were evaluated by immunofluorescence staining, Western bolt, and qRT-PCR. A total of 36 male Wistar rats were randomly divided into the SCI group and control group, with three time points in each group. Not applicable. SCI modeling impaired the motor function of the hind limbs and the bladder function of rats. NLUTD muscle exhibited a punctated immunostaining pattern for LC3, suggesting the accumulation of autophagosomes. Our results further indicated that compared with the control group, the expression levels of TGF-β1 and LC3 were increased, while the level of P62 was decreased after SCI modeling. TGF-β1 was significantly increased in SCI rats with NLUTD and was correlated with autophagy markers LC3 and p62.

Patient-Related Functional Outcomes After Robotic-Assisted Rectal Surgery Compared With a Laparoscopic Approach: A Systematic Review and Meta-analysis.

Robotic surgery has gained significant momentum in rectal cancer surgery. Most studies focus on short-term and oncological outcomes, showing similar outcomes to laparoscopic surgery. Increasing survivorship mandates greater emphasis on quality of life and long-term function. This study aimed to compare quality of life and urinary, sexual, and lower GI functions between robotic and laparoscopic rectal surgeries. A systematic search of Medline, PubMed, Embase, Clinical Trials Register, and Cochrane Library-identified articles comparing robotic with laparoscopic rectal resections was performed. The outcome measures were quality of life and urinary, sexual, and GI functions between robotic and laparoscopic rectal resection patient groups. Where comparable data were available, results were pooled for analysis. The initial search revealed 1777 papers; 101 were reviewed in full, and 14 studies were included for review. Eleven assessed male sexual function; 7 favored robotic surgery, and the remaining studies showed no significant difference. Pooled analysis of 5 studies reporting rates of male sexual dysfunction at 12 months showed significantly lower rates after robotic surgery (OR, 0.51; p = 0.043). Twelve studies compared urinary function. Six favored robotic surgery, but in 2 studies, a difference was seen at 6 months but not sustained at 12 months. Pooled analysis of 4 studies demonstrated significantly better urinary function scores at 12 months after robotic surgery (OR, 0.26; p = 0.016). Quality of life and GI function were equivalent, but very little data exist for these parameters. A small number of studies compare outcomes between these groups; only 2 are randomized. Different scoring systems limit comparisons and pooling of data. The limited available data suggest that robotic rectal cancer resection improves male sexual and urinary functions when compared with laparoscopy, but there is no difference in quality of life or GI function. Future studies should report all facets of functional outcomes using standardized scoring systems.

Effects of Docetaxel plus Degarelix on Quality of Life and Vascular Endothelial Growth Factor in Patients with Prostate Cancer.

Objective To investigate the effects of docetaxel plus degarelix on quality of life and vascular endothelial growth factor in patients with prostate cancer. Methods Between 2018 and 2020, 38 patients with castration-resistant prostate cancer (CRPC) treated in our institution were assessed for eligibility and recruited. They were assigned at a ratio of 1 : 1 to receive either docetaxel plus degarelix (observation group) or degarelix (control group). Outcome measures included treatment efficacy, inflammatory factors level, vascular endothelial growth factor (VEGF) level, and quality of life of patients. Results Docetaxel plus degarelix was associated with a significantly higher treatment efficacy (94.74%, including 9 (47.37%) cases of complete response (CR), 6 (31.58%) cases of partial response (PR), 4 (21.05%) cases of stable disease (SD), and 1 (5.36%) case of progressive disease (PD)) versus degarelix alone (63.16%, including 4 (21.05%) cases of CR, 5 (26.32%) cases of PR, 3 (15.79%) cases of SD, and 7 (36.84%) cases of PD) (P < 0.05). Before treatment, the two groups showed comparable levels of C-reaction protein (CRP), interleukin- (IL-) 6, and IL-10 (P > 0.05). Docetaxel plus degarelix resulted in significantly reduced levels of CRP and IL-6 and a significantly higher IL-10 level (28.84 ± 5.42, 25.31 ± 5.74, and 53.32 ± 11.02) versus degarelix alone (35.17 ± 6.31, 31.54 ± 8.17, and 42.76 ± 11.25) (P < 0.05). There were no significant differences in the urinary function, intestinal function, and hormone function scores between the two groups before treatment (P > 0.05). The patients receiving docetaxel plus degarelix had higher urinary function, intestinal function, and hormone function scores (38.87 ± 4.46, 86.51 ± 8.14, and 76.65 ± 7.15) versus monotherapy of degarelix (29.84 ± 3.58, 78.51 ± 7.31, and 66.78 ± 6.56) (P < 0.05). The two groups had similar pretreatment VEGF levels (P > 0.05). Docetaxel plus degarelix resulted in significantly lower VEGF levels (119.17 ± 21.38) versus degarelix (124.36 ± 23.14) at 6 months after treatment (P < 0.05). Conclusion Docetaxel plus degarelix can enhance the therapeutic efficacy of patients with prostate cancer, mitigate inflammatory response, inhibit the VEGF expression of cancer cells, and improve the patients' quality of life. Further clinical trials are, however, required prior to general use in clinical practice.

The cost of elective nodal coverage in prostate cancer: Late quality of life outcomes and dosimetric analysis with 0, 45 or 54 Gy to the pelvis

PurposeElective pelvic lymph node radiotherapy (PLNRT) in prostate cancer is often omitted from definitive (n = 267) and post prostatectomy (n = 160) radiotherapy (RT) due to concerns regarding toxicity and efficacy. Data comparing patient-reported outcome measures (PROMs) with or without PLNRT is limited. Our long-term supposition is that PLNRT, particularly to higher doses afforded by IMRT, will decrease pelvic failure rate in select patients. We aim to establish the impact of two different PLNRT doses on long term quality of life (QOL). Methods and materialsProstate cancer patients (n = 428) recorded baseline scores using the Expanded Prostate Cancer Index Composite (EPIC), prior to definitive or post-prostatectomy RT. PLNRT, if given, was prescribed to 45 or 54 Gy at 1.8 Gy per fraction. New EPIC scores were recorded 20–36 months after radiotherapy. Absolute change in each domain subscale and summary score was recorded, along with if these changes met minimally important difference (MID) criteria. A separate multivariate analysis (MVA) was performed for each measure. Subsequent dosimetric analysis was performed. ResultsFrequency of a MID decline was significantly greater with PLNRT to 54 Gy for urinary function, incontinence, and overall. No urinary decline was correlated with PLNRT to 45 Gy. PLNRT to 54 Gy was significant for decline in urinary function, bother, irritative, incontinence, and overall score in one or both MVA models while 45 Gy was not. Postoperative status was significant for decline in urinary function, incontinence, and overall. Amongst postoperative patients, there was significantly greater decline in urinary function score in the salvage setting. Neither 54 nor 45 Gy significantly affected bowel subscale or overall score decline. ConclusionsUsing conventional fractionation, adding PLNRT to 54 Gy, but not 45 Gy, correlates with worse urinary QOL, with postoperative patients experiencing a steeper decline. PLNRT had no significant impact on bowel QOL with either dose.

Pad Weight, Pad Number and Incontinence-Related Patient-Reported Outcome Measures After Radical Prostatectomy

Objectives: To evaluate the correlation between 3- and 6-week postoperative 24-hour pad weight, daily pad number, and the International Consultation on Incontinence Questionnaires for Male Lower Urinary Tract (ICIQ-MLUTS), ICIQ-Short Form (ICIQ-SF) and UCLA Prostate Cancer Index (UCLA-PCI) in patients undergoing robotic-assisted radical prostatectomy (RARP). Methods: This prospective study included patients undergoing RARP between February and November 2019. Patients completed a 24-hour pad test, assessing pad weight and number, and 3 validated patient-reported outcome measures (PROMs); the ICIQ-MLUTS, ICIQ-SF and UCLA-PCI, preoperatively and at 3 and 6 weeks postoperatively. Results: A total of 47 patients were included in the study. There was a strong correlation between 24-hour pad weight and the ICIQ-SF at 3 weeks (r = 0.71, P &lt; 0.001) and 6 weeks (r = 0.68, P &lt; 0.001). There was a strong correlation between 24-hour pad weight and ICIQ-MLUTS incontinence (r = 0.80, P &lt; 0.01) and incontinence QoL burden (r = 0.79, P &lt; 0.01) at 6 weeks. There was a moderate correlation between the 24-hour pad weight and UCLA-PCI urinary function (r = 0.58, P &lt; 0.001) and urinary QoL burden (r = 0.66, P &lt; 0.001) at 6 weeks. The correlation between pad number and 24-hour pad weight was weak at 6 weeks (r = 0.34, P &lt; 0.001). Conclusion: PROMs may be used as a substitute for the 24-hour pad weight test for post-prostatectomy incontinence (PPI) assessments in the early post-RARP period. The ICIQ-SF and UCLA-PCI urinary function and QoL scores correlate with 24-hour pad weight. However, the ICIQ-MLUTS incontinence and QoL scores provide the strongest correlation with PPI.

PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP)

You have accessJournal of UrologyCME1 May 2022PD45-07 PROSPECTIVE COMPARISON OF FUNCTIONAL OUTCOMES AFTER ENDOSCOPIC SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: THE ROLE OF EJACULATION-SPARING ANATOMIC PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (ESA-PVP) Mattia Sibona, Paolo Destefanis, Federico Vitiello, Eugenia Vercelli, Gabriele Montefusco, Alessandro Mara, Andrea Bosio, Alessandro Bisconti, and Paolo Gontero Mattia SibonaMattia Sibona More articles by this author , Paolo DestefanisPaolo Destefanis More articles by this author , Federico VitielloFederico Vitiello More articles by this author , Eugenia VercelliEugenia Vercelli More articles by this author , Gabriele MontefuscoGabriele Montefusco More articles by this author , Alessandro MaraAlessandro Mara More articles by this author , Andrea BosioAndrea Bosio More articles by this author , Alessandro BiscontiAlessandro Bisconti More articles by this author , and Paolo GonteroPaolo Gontero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ejaculatory Dysfunction (EjD) is still a common event after Benign Prostatic Hyperplasia (BPH) surgery, causing significant bother to younger and sexually active patients (pts). Recently, several ejaculation-sparing techniques were described. Ejaculation-sparing anatomic Photoselective Vaporization of the Prostate (ESa-PVP) with LBO laser has been proposed as a sexual function-sparing evolution of the anatomic PVP technique, showing promising preliminary results. The aim of our study was to present a prospective comparison of functional outcomes from a cohort of ESa-PVP pts versus standard PVP and Transurethral Resection of the Prostate (TUR-P). METHODS: Local Ethics Committee approval was obtained (n. 643/2018). Our study was conceived as a prospective, observational analysis. From 03/2018 to 06/2020, we enrolled pts undergoing endoscopic surgery for BPH at our institution (Molinette Hospital, Turin). Inclusion criteria: age > 50, sexually active, moderate to severe Lower Urinary Tract Symptoms (LUTS) [IPSS > 8]. Urinary and sexual function data were collected at baseline and at 6 and 12 month after surgery. Validated questionnaires were used to assess functional results (IPSS, IIEF5, MSHQ-Ej). Included pts were divided into groups, according to the type of intervention: bipolar TUR-P (group A); standard PVP (group B); ESa-PVP (group C). RESULTS: Globally, 95 pts were included (46 in group A, 26 in group B, 23 in group C). Median (IQR) age was 66 (60-71) years. Median prostate volume was 63 (50-90) cc. Median baseline IPSS score within groups was 25 vs 24.5 vs 28 (p=0.442); median IIEF-5 score was 21 vs 23.5 vs 20 (p=0.339); median MSHQ-Ej score was 30 vs 33.5 vs 34 (p=0.137). Baseline antegrade ejaculation rate was 84.78% vs 80.77% vs 91.30% (p=0.579). At 6-month follow-up, urinary and sexual function scores changed as follows: median IPSS: 6 vs 5 vs 1 (p=0.019); median IIEF5: 21 vs 21.5 vs 19 (p=0.750); median MSHQ-Ej: 4 vs 2 vs 15 (p=0.001). 6-month antegrade ejaculation rate was 28.89% vs 23.08% vs 60.87% (p=0.010). 12 months after surgery, no significant differences in IPSS and IIEF5 scores were detected within groups. Instead, median MSHQ-Ej score was 2 vs 2 vs 25 (p=0.006) and antegrade ejaculation rate was 26.09% vs 13.04% vs 58.82% (p=0.007). At a multivariable logistic regression analysis, pre-operative MSHQ-Ej score was identified as an independent predictor of antegrade ejaculation preservation both at 6 and 12 months, while surgical technique appeared as a significant predictor of the same outcome at 6 months. CONCLUSIONS: The Ejaculation-Sparing anatomic PVP technique (ESa-PVP) showed superiority over standard PVP and TUR-P in preserving antegrade ejaculation both at 6 and 12 month follow-up after BPH surgery. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Sibona More articles by this author Paolo Destefanis More articles by this author Federico Vitiello More articles by this author Eugenia Vercelli More articles by this author Gabriele Montefusco More articles by this author Alessandro Mara More articles by this author Andrea Bosio More articles by this author Alessandro Bisconti More articles by this author Paolo Gontero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Prospective quality of life in men choosing open vs. robotic radical prostatectomy: long-term results from a racially diverse multi-institutional database.

To compare 5-year health-related quality of life (HRQoL) outcomes between prostate cancer (CaP) patients who underwent robotic-assisted laparoscopic radical prostatectomy (RALP) versus open radical retropubic prostatectomy (RRP) and assess for racial disparities between Caucasian American (CA) and African American (AA) men undergoing surgery. A prospective cohort study of HRQoL data was conducted on patients diagnosed with CaP from 2007 to 2017 and enrolled in the Center for Prostate Disease Research (CPDR) Multicenter National Database. Using the EPIC and SF-36 instruments, changes in urinary, sexual, bowel, and hormonal domains, as well as physical and mental component summary scores were compared across surgery type (RALP versus RRP) at pre-treatment ("baseline"), and annually for 5years. We further compared HRQoL outcomes in CA and AA men undergoing surgery. Longitudinal HRQoL patterns were modeled using generalized estimating equations (GEE), adjusting for baseline HRQoL and other characteristics. 448 CaP patients (22% AA) met study inclusion criteria, 66% underwent RALP and 34% underwent RRP. At baseline, HRQoL domains were comparable across treatment group (RALP vs. RRP). In the adjusted low-risk cohort, there were only three time points that met a statistically significant HRQoL difference in EPIC scores between RALP and RRP. Urinary function score during year 4 of follow-up showed a 7.5 (95% CI 3.1-11.9, P = 0.01) points difference in favor of RRP. Bowel bother scores favored RRP in year 1 with a difference of 3.1 (95% CI 0.7-5.4, P = 0.04) points, and in year 5 with a difference of 3.8 (95% CI 1.1-6.4, P = 0.03) points. In the intermediate/high-risk cohort, there were no statistically significant differences in any of the domain scores between RALP and RRP during follow-up. The robotic and open approach to radical prostatectomy led to comparable HRQoL outcomes at a follow-up length of 60months. No HRQoL racial disparities were found between AA and CA men during long-term follow-up.

Importance of considering interest in sex when evaluating satisfaction after robot-assisted radical prostatectomy.

To assess the impact of patients' interest in sex on the satisfaction after robot-assisted radical prostatectomy, longitudinal changes of urinary and sexual functions and bothers were evaluated. A total of 101 patients underwent robot-assisted radical prostatectomy in our institution. Based on sexual interest, they were divided into the high-interest and low-interest groups. Overall satisfaction, urinary function, urinary bother, sexual function, and sexual bother were evaluated using the expanded prostate cancer index composite questionnaire preoperatively and at 1, 3, 6, and 12 months after robot-assisted radical prostatectomy. We investigated the associations between the overall satisfaction and urinary function/urinary bother/sexual function/sexual bother scores (with higher score indicating better function and less impairment). In the high-interest group (n = 45), satisfaction correlated with high urinary function and urinary bother scores early after robot-assisted radical prostatectomy (urinary function: 1 and 3 months, urinary bother: 3 months postoperatively; P < 0.05) and then with high sexual bother score thereafter (sexual bother at 6 and 12 months after surgery; P < 0.05). Sexual function score did not correlate with satisfaction. In the low-interest group (n = 56), satisfaction correlated with high urinary function and urinary bother scores over time (urinary function: 3 and 6 months, urinary bother: at 3, 6 and 12 months postoperatively; P < 0.05). Neither sexual function nor sexual bother correlated with satisfaction postoperatively in the low-interest group. The impact of urinary and sexual functions and bothers on patients' overall satisfaction differed between patients with high- and low-interest in sex. The patient's interest in sex should be considered when assessing satisfaction after robot-assisted radical prostatectomy.

Preoperative Prostate MRI Predictors of Urinary Continence Following Radical Prostatectomy.

Background Urinary continence after radical prostatectomy (RP) is an important determinant of patient quality of life. Anatomic measures at prostate MRI have been previously associated with continence outcomes, but their predictive ability and interrater agreement are unclear in comprehensive clinical models. Purpose To evaluate the predictive ability and interrater agreement of MRI-based anatomic measurements of post-RP continence when combined with clinical multivariable models. Materials and Methods In this retrospective cohort study, continence outcomes were evaluated in men who underwent RP from August 2015 to October 2019. Preoperative MRI-based anatomic measures were obtained retrospectively by four abdominal radiologists. Before participation, these radiologists completed measure-specific training. Logistic regression models were developed with clinical variables alone, MRI variables alone, and combined variables for predicting continence at 3, 6, and 12 months after RP; some patient data were missing at each time point. Interrater agreement of MRI variables was assessed by using intraclass correlation coefficients (ICCs). Results A total of 586 men were included (mean age ± standard deviation: 63 years ± 7). The proportion of patients with incontinence was 0.2% (one of 589) at baseline, 27% (145 of 529) at 3 months, 14% (63 of 465) at 6 months, and 9% (37 of 425) at 12 months. Longer coronal membranous urethra length (MUL) improved the odds of post-RP continence at all time points (odds ratio per 1 mm: 0.86 [95% CI: 0.80, 0.93], P < .001; 0.86 [95% CI: 0.78, 0.95], P = .003; and 0.79 [95% CI: 0.67, 0.91], P = .002, respectively) in models that incorporated both clinical and MRI predictors. No other MRI variables were predictive. Age and baseline urinary function score were the only other predictive clinical variables at every time point. Interrater agreement was moderate (ICC, 0.62) for MUL among readers with measure-specific prostate MRI training and poor among those without the training (ICC, 0.38). Conclusion Preoperative MRI-measured coronal membranous urethra length was an independent predictor of urinary continence after prostatectomy. © RSNA, 2022 Online supplemental material is available for this article.

Anxiety, depression and urological cancer outcomes: A systematic review.

The interplay between physical and mental aspects of a cancer diagnosis are well recognised. However, little consensus exists on the impact of depression and anxiety on urological cancer outcomes. Therefore, this systematic review aimed to investigate the relationship between these conditions and functional or oncological outcomes in urological malignancy. A systematic search was conducted using PubMed, Embase, PsycINFO and Global Health databases up to June 2020. Studies evaluating the relationship of anxiety and depression disorders or symptoms on functional and mortality outcomes were included. Outcome measures included validated urinary, sexual, body image questionnaire scores and all-cause or disease-specific mortality. Of 3,966 studies screened, 25 studies with a total of 175,047 urological cancer patients were included. Significant anxiety and depressive symptoms and disorders were found to impact functional outcomes in several cancer types. A consistent negative association existed for sexual function in prostate, testicular and penile cancer patients. Additionally, poorer urinary function scores were seen in prostate cancer, with increased body image issues in testicular and prostate cancer. Importantly, both overall and disease-specific mortality outcomes were poorer in bladder and prostate cancer patients. Co-existing depression and anxiety appears to be negatively associated with functional and mortality outcomes in urological cancers. This appears especially evident in male cancers, including prostate and testicular cancer. Although not proving causation, these findings highlight the importance of considering mental wellbeing during follow-up for early recognition and treatment. However, current evidence remains heterogenous, with further studies required exploring patients at risk.

Functional Outcomes With Dose-Escalated, Conventionally Dosed, or Without Nodal Irradiation in Prostate Cancer

Despite the potential for improved local control, there is little data on long term quality of life (QoL) outcomes using dose escalated nodal radiotherapy (RT) in prostate cancer with conventional fractionation. We compare QOL following RT with conventional, dose-escalated, or no nodal irradiation.From 2009 to 2017, 445 patients with low-risk to high-risk prostate cancer recorded baseline scores using the Expanded Prostate Cancer Index Composite (EPIC), prior to definitive or post-prostatectomy (PP) radiation. Each subsequently completed a new EPIC 18-36 months after intensity modulated RT. Absolute change in each domain summary and subscale score was recorded as well as if the change met minimally important difference (MID) criteria. All baseline comparisons were done using bivariate analysis methods. Multivariate analysis (MVA) was performed using a generalized linear model to assess changes in each domain summary and sub-scale score. MVA was performed with a proportional odds model to assess MID changes. Variables were age, RT setting (definitive or PP), pre-treatment score, and nodal dose. P-value significance was set to < 0.05.Prescribed nodal dose was 0 Gy, 45-51 Gy, and ≥54 Gy in 31%, 8%, and 61% of patients, respectively. Radiation was given PP in 37% of patients. PP patients had significantly worse baseline urinary function, incontinence, and overall scores. In each MVA, PP was associated with greater decreases of urinary function, incontinence, and overall scores following RT. Prior prostatectomy was not associated with a significant difference in the bowel, hormonal, or sexual domains. Including all RT settings, median changes reported in urinary function, bother, incontinence, and overall scores were: for 54 Gy, -4.1, 0.0, -6.3, and -2.4; for 45-51 Gy, 0.0, -3.6, 0.0, and -0.7; for 0 Gy 0.0, 0.0, 0.0, and 0.0. MVA showed that nodal irradiation to ≥ 54 Gy was significantly correlated with greater decreases of urinary function, bother, incontinence, and overall score in one or both models. Nodal irradiation to ≥ 54 Gy was not found to be significantly correlated with changes in the bowel, hormonal, or sexual domains. Nodal irradiation to 45 Gy was not significantly associated with any domain or subscale change.Compared to no nodal irradiation, escalated nodal irradiation to ≥54 Gy was associated with a small but significantly worse urinary QOL while 45 Gy was not. Escalated nodal irradiation to ≥54 Gy was not associated with worse bowel QOL. Prior prostatectomy was associated with a greater decrease in urinary QOL following RT. Clinical judgement should be used to balance the benefits and toxicities of nodal irradiation in prostate cancer.