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Abstract
Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management.
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Affiliation(s)
- C Zippe
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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52
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Noguchi M, Shimada A, Nakashima O, Kojiro M, Matsuoka K. Urodynamic evaluation of a suspension technique for rapid recovery of continence after radical retropubic prostatectomy. Int J Urol 2006; 13:373-8. [PMID: 16734853 DOI: 10.1111/j.1442-2042.2006.01313.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND We investigated urodynamic findings involved in the rapid recovery of urinary continence after radical retropubic prostatectomy with a suspension technique. METHODS A total of 45 consecutive patients (mean age 67.6 years) who had undergone radical retropubic prostatectomy for localized prostate cancer were evaluated with multichannel urodynamics including the maximal urethral pressure (MUP), functional urethral length (FUL), maximal cystometric capacity (MCC) and abdominal leak point pressure (ALPP) at base line, 1 week, 1 month, and 3 months postoperatively. The suspension of vesicourethral anastomosis preserving anterior attachments of puboprostatic ligaments to pubic bone was performed in 33 patients. Twelve patients did not undergo the suspension technique. RESULTS The continence rates at 1 week, 1 month, and 3 months after radical prostatectomy in the suspension group were significantly higher than those in the non-suspension group: 67% versus 0% at 1 week (P < 0.001), 82% versus 25% at 1 month (P < 0.001), and 91% versus 50% at 3 months (P < 0.01), respectively. Postoperative ALPP at all points of measurement was significantly higher in the suspension group than in the non-suspension group (P < 0.0002). There was no difference in MUP, FUL or MCC at each point following radical prostatectomy between the two groups. CONCLUSIONS These observations suggest that preserving anterior attachments of puboprostatic ligaments to pubic bone and fixation of urethral hyper-mobility by the suspension of vesicourethral anastomosis promotes rapid recovery of urinary continence after radical retropubic prostatectomy.
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Affiliation(s)
- Masanori Noguchi
- Department of Urology, Kurume University School of Medicine, Kurume, Japan.
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53
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Stavridis S, Georgiev V, Popov Z, Penev M, Lekovski L, Stankov O, Dohcev S, Petrovski D, Saidi S, Kuzmanovski M, Banev S, Stavridis A. Radical retropubic prostatectomy for prostate carcinoma; first results of the Clinic of Urology in Skopje. ACTA ACUST UNITED AC 2006; 52:37-40. [PMID: 16673592 DOI: 10.2298/aci0504037s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this retrospective study is to present our experience and results in the management of prostate carcinoma, with radical retropubic prostatectomy, for a period of seven years. MATERIAL AND METHODS From December 1997 to April 2005, 61 radical retropubic prostatectomies for prostate carcinoma were performed at the Clinic of Urology in Skopje. Mean age of the treated patients was 66.4 years. Mean serum PSA level was 32.75 ng/ml. None of the patients had distant or bone metastases. Mean operative time was 160 minutes and from 2 to 4 units of blood were transfused intra and postoperatively. Mean follow up time was 39 months. RESULTS In all of 61 patients, the RRP was performed for adenocarcinoma of the prostate. The pathological findings postoperatively showed the following pTNM grade: pT2a in 8, pT2b in 10, pT3a in 10, pT3b in 27and pT4 in 6 patients. Positive lymph nodes were found in 14 cases. Intraoperative complications occurred in 6 patients. Early postoperative complications were seen in 12 patients. Urine leakage was seen in 2 patients, incontinence (day and night) in 8 and pulmonary embolia in 2 patients. Late postoperative complications occurred in 11 patients. Stenosis of the vesicourethral anasthomosis was seen in 3 patients and incontinence (during the night only) in 8 patients. The rate of potency was not evaluated but in the last 30 cases we insisted on preservation of the neurovascular bundles in the cases that it was possible. CONCLUSION Radical retropubic prostatectomy is the method of choice and the golden standard for treatment of organ confined prostate carcinoma in patients with long life expectancy, no neither local nor distant metastases and good overall status. With this technique complication rates are minimal, the cure rate is very big and the patients have high quality of life. The experience of the surgeon is very important since the learning curve is crucial for diminishing operative time, postoperative complications and blood transfusions.
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Affiliation(s)
- S Stavridis
- Clinical Centre Skopje, Clinic of Urology, Skopje, Macedonia
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54
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Hadzi-Dokic J, Acimovic M, Dzamic Z, Pejcic T, Radosavljevic T, Basic D, Colovic V, Petrovic M, Obradovic G. Radical retropubic prostatectomy--results in 127 surgically treated patients. ACTA CHIRURGICA IUGOSLAVICA 2006; 52:55-8. [PMID: 16673596 DOI: 10.2298/aci0504055h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Radical prostatectomy represents an optimal therapeutic method in treatment of the localized prostatic carcinoma. It may be performed using retropubic, perineal, transcoccygeal or laparoscopic approach. In a multicenter study, the authors have analyzed 127 patients surgically treated in the period 1992 - 2003. All the patients were preoperatively diagnosed with the localized prostatic carcinoma. The patients were operated at the Clinic of Urology in Belgrade (92 patients) and other departments of urology in Serbia (35 patients). The youngest patient was 49 while the oldest one was 75 (mean age 64 years). The surgical procedure duration ranged between 60 and 120 minutes. Over the last five years, the need for blood transfusion was below 50%. All the patients underwent retropubic radical prostatectomy.
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Sterbis JR, Brassell SA, McLeod DG. Perioperative complications of radical retropubic prostatectomy. Clin Genitourin Cancer 2006; 4:160-6. [PMID: 16425984 DOI: 10.3816/cgc.2005.n.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The opinions and assertions contained herein are the private views of the authors and are not to be construed as reflective of the views of the US Army or the Department of Defense. Radical retropubic prostatectomy has long been considered one of the most difficult procedures in the urologist's armamentarium. Therefore, we performed a thorough review of recent literature regarding intraoperative and postoperative complications. The intent of this effort is to review established data regarding the most frequently seen complications and to highlight recent developments regarding the prevention or treatment of such complications.
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Affiliation(s)
- Joseph R Sterbis
- Center for Prostate Disease Research (CPDR) Department of Surgery Uniformed Services University of the Health Sciences Bethesda, MD, USA.
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56
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Huang G, Lepor H. Factors predisposing to the development of anastomotic strictures in a single-surgeon series of radical retropubic prostatectomies. BJU Int 2006; 97:255-8. [PMID: 16430623 DOI: 10.1111/j.1464-410x.2005.05908.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the rate of anastomotic stricture (AS) after radical retropubic prostatectomy (RRP) performed by one experienced surgeon, and to identify factors predisposing to its formation. PATIENTS AND METHODS In all, 708 men were prospectively monitored for the development of AS after RRP. Potential risk factors for AS were analysed. RESULTS There were no significant differences in age, Gleason score, nerve-sparing status, intraoperative blood loss, degree of extravasation on initial cystography, or duration of the indwelling urinary catheter between men who developed AS and men who did not. The mean postoperative blood loss was significantly higher in men who developed AS. The incidence of AS was also significantly higher in men whose bladder necks were reconstructed more narrowly. CONCLUSION The amount of bleeding and the calibre of the reconstructed bladder neck were significantly associated with AS formation after RRP. The development of a haematoma from bleeding might explain the increased likelihood of AS. The mechanism of AS formation is unrelated to the degree of urinary extravasation on cystography, providing that a urinary catheter is left indwelling until extravasation resolves.
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Affiliation(s)
- George Huang
- Department of Urology, New York University School of Medicine, New York, NY 10016, USA
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57
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Nandipati KC, Raina R, Agarwal A, Zippe CD. Erectile Dysfunction Following Radical Retropubic Prostatectomy. Drugs Aging 2006; 23:101-17. [PMID: 16536634 DOI: 10.2165/00002512-200623020-00002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Radical prostatectomy has been the time-honoured and standard treatment option for prostate cancer. Erectile dysfunction (ED) is one of the common quality-of-life issues following radical prostatectomy. The recovery of potency following radical prostatectomy varies from 16% to 86%. Although major modifications in surgical technique appear to be promising, the reported ED rates are still high. The time period required for the recovery of erectile function after surgery varies from 6 to 24 months. During this period of neuropraxia lack of natural erections produces cavernosal hypoxia. This cavernosal hypoxia has been implicated as one of the most important factors in the pathophysiology of ED. Cavernosal hypoxia predisposes to cavernosal fibrosis, ultimately producing venous leak and long-term ED. Interruption of this cascade of events has been the major challenge for physicians. Physicians have several options available for the treatment of ED. However, oral treatment options have quickly become established as first-line treatment options. Sildenafil has been most extensively studied in the radical prostatectomy population. In patients who do not respond to oral therapy alone, standard treatment options (intracavernosal injections, vacuum constriction devices and intraurethral alprostadil) are useful. Use of penile prostheses is one of the oldest treatment options available for the treatment of ED but is used only as a last resort. Initial attempts to promote the earlier recovery of erectile function appear to be promising. However, further confirmatory studies are essential. The roles of gene transfer and growth factors are still in experimental stages. In this review we discuss the epidemiology, pathophysiology and treatment options available for ED following radical prostatectomy.
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Affiliation(s)
- Kalyana C Nandipati
- Glickman Urological Institute and Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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58
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Gousse AE, Tunuguntla HSGR, Leboeuf L. Two-stage management of severe postprostatectomy bladder neck contracture associated with stress incontinence. Urology 2005; 65:316-9. [PMID: 15708045 DOI: 10.1016/j.urology.2004.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2004] [Accepted: 09/09/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report our experience using a two-stage, rather than a synchronous, approach in the management of bladder neck contracture (BNC). Anastomotic BNC associated with urinary incontinence is a major complication after radical prostatectomy. Patients may present with a decreased force of stream, urinary retention, or stress, urge, or overflow urinary incontinence. METHODS The pertinent data of 15 patients (age range 52 to 78 years, mean 62) with postradical prostatectomy BNC associated with stress urinary incontinence (mean pad use 3 per day) were retrospectively reviewed. Video-urodynamic evaluation in 10 of 15 patients revealed a Valsalva leak point pressure of less than 80 cm H2O in all 10 patients. Bladder outlet obstruction was noted in 4 of 10 patients. Of the 15 patients, 2 declined an artificial urinary sphincter (AUS), the other 13 proceeded with our two-stage management. Step one consisted of deep transurethral incision of the BNC (TUIBNC) with Collin's knife electrocautery. Step two consisted of implantation of an AUS (AMS-800) 6 to 8 weeks after TUIBNC once bladder neck patency had been demonstrated cystoscopically. RESULTS During a mean follow-up of 15 months, 3 patients developed early recurrence of BNC: 2 at the 5-week cystoscopy, 1 at 8 weeks discovered at the scheduled AUS placement. All 3 patients underwent repeat TUIBNC and remained clinically patent at a mean follow-up of 9 months. The remaining 10 patients were clinically patent after a single TUIBNC, with good subjective flow and postvoid residual volume of less than 30 mL at a mean follow-up of 11 months. Of the 13 patients who underwent AUS placement, 12 were socially continent (wearing 0 to 1 thin pad daily). The thirteenth patient remained incontinent after AUS placement. One of the 12 continent patients developed an infection at the device 8 months postoperatively and required explantation. CONCLUSIONS We recommend a two-stage approach (TUIBNC followed by AUS insertion) rather than synchronous management for postprostatectomy BNC associated with stress urinary incontinence. Such an approach allows identification of BNC recurrence and its safe management before AUS implantation.
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Affiliation(s)
- Angelo E Gousse
- Division of Female Urology, Voiding Dysfunction and Reconstructive Urology, Department of Urology, University of Miami School of Medicine and Jackson Memorial Hospital, Miami, Florida 33101, USA.
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Rao J, Koay SK, Lau WKO, Cheng CWS. Patient-reported Urinary Continence (Third-party Interview): Results of Post-radical Retropubic Prostatectomy in Singaporeans. Asian J Surg 2005; 28:207-10. [PMID: 16024318 DOI: 10.1016/s1015-9584(09)60345-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine the patient-reported urinary continence rate after retropubic radical prostatectomy (RRP) for prostate carcinoma through a third-party interview and to grade the severity of incontinence. METHODS Between 1997 and 1999, 34 patients were evaluated through an independent third party about the degree of continence as well as the quality of life after RRP. Patients were interviewed either in person or over the telephone. Urinary continence was defined as wearing no diapers, pads or tissue paper. RESULTS Of the 34 patients, 44% achieved immediate continence. Urinary incontinence gradually improved with time after surgery and 82% (n = 28) were fully continent at 12 months. Using the quality-of-life index, 91% of patients characterized their urinary incontinence as not or minimally bothersome. There was no significant difference between urologist- and patient-reported continence rates after RRP. CONCLUSION Based on our grading system, urinary continence gradually improved with time and was 82% at 1 year.
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Affiliation(s)
- Jaideepraj Rao
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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60
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Abstract
PURPOSE After the pioneering period when only few teams were performing the procedure, the laparoscopic approach to radical prostatectomy has become widespread with several technical variations. A comprehensive review of the published literature on laparoscopic radical prostatectomy was performed to determine the current state of the art of this surgical innovation in terms of perioperative parameters, functional results and cancer control. MATERIALS AND METHODS English language, peer reviewed articles published before June 2004 concerning laparoscopic radical prostatectomy were found by MEDLINE query. All articles were analyzed and none were a priori excluded. Conclusions were drawn from series of 50 or more patients. RESULTS Laparoscopic radical prostatectomy is being performed at multiple centers worldwide using various surgical approaches and technologies. Analysis of perioperative parameters, including surgical blood loss, operative time, complications and convalescence, demonstrated low morbidity and showed a clear trend toward improvement with increased experience. The reported positive surgical margin rates were lower in more recent series. As measured by prostate specific antigen recurrence and disease-free intervals, oncological results and cancer control rates are difficult to ascertain in the immature series published to date. Functional results in terms of postoperative urinary and sexual function appear encouraging. CONCLUSIONS Overall the current operative, oncological and functional results of laparoscopic radical prostatectomy appear to approximate those of open radical retropubic prostatectomy. These results justify the considerable interest of the urological community in laparoscopy, as evidenced by its widespread application. Nevertheless, longer followup and more mature data are needed definitively to establish laparoscopic radical prostatectomy as an alternative to the retropubic approach.
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Affiliation(s)
- Edouard J Trabulsi
- Section of Minimally Invasive Surgery, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA
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61
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Noguchi M, Shimada A, Yahara J, Suekane S, Noda S. Early catheter removal 3 days after radical retropubic prostatectomy. Int J Urol 2005; 11:983-8. [PMID: 15509202 DOI: 10.1111/j.1442-2042.2004.00935.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM We investigated the feasibility and safety of the early removal of urethral catheters 3 days after radical retropubic prostatectomy. METHODS Seventy consecutive patients underwent radical retropubic prostatectomy with the intent of early catheter removal on postoperative day (POD) 3. Catheter removal was based on postoperative cystograms performed on POD 2. Patients were analyzed using a validated prostate cancer specific questionnaire (University of California, Los Angeles Prostate Cancer Symptom Index) to determine quality of life outcomes. Multiple logistic regression analysis was also used to evaluate if any of the preoperative or intraoperative parameters were able to predict the success of early catheter removal after radical retropubic prostatectomy. RESULTS The catheter was removed on POD 3 in 67 of 70 patients (97%) excluding three patients with moderate or severe extravasation on postoperative cystograms. Of the 67 patients, 53 (76%) were successful in early catheter removal, but the remaining 14 (24%) patients experienced urinary retention within 48 h and were treated with simple catheter replacement for 1 or 2 days. Two patients developed anastomotic strictures 3 and 4 months postoperatively, which were managed by dilation alone. Multiple logistic regression analysis showed that no leak during an intraoperative leak test was the only independent predictor of success for early catheter removal (P = 0.0069; odds ratio, 6.667; 95% confidence interval, 1.682-26.428). CONCLUSION The present study revealed that early catheter removal 3 days after radical retropubic prostatectomy is feasible in patients who show a negative intraoperative leak test. Postoperative monitoring of more patients is needed to determine if the early catheter removal is widely applicable.
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Affiliation(s)
- Masanori Noguchi
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
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Touma NJ, Izawa JI, Chin JL. CURRENT STATUS OF LOCAL SALVAGE THERAPIES FOLLOWING RADIATION FAILURE FOR PROSTATE CANCER. J Urol 2005; 173:373-9. [PMID: 15643174 DOI: 10.1097/01.ju.0000150627.68410.4d] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We reviewed the curative options available to patients with local failure after radical radiotherapy for prostate cancer and identified the patients best suited for such salvage therapies. MATERIALS AND METHODS A literature search of English language publications was done using the key terms salvage, prostatectomy, cryosurgery, brachytherapy and radiation failure. RESULTS Salvage radical prostatectomy offers 5-year biochemical relapse-free rates between 55 and 69%. Higher complication rates are reported with salvage compared to primary radical prostatectomy, including rectal injuries, bladder neck contracture and urinary incontinence. Cryosurgery biochemical response rates vary according to the definition of failure but they are generally lower than those of salvage radical prostatectomy. The local control rates of cryosurgery are acceptable. Major complications related to cryotherapy are urinary incontinence, impotence, pelvic pain and urinary retention. Experience with salvage brachytherapy has been limited but some success has been reported in terms of biochemical control. CONCLUSIONS Salvage prostatectomy for localized radiation failure is a good option in the patient with a life expectancy of at least 10 years, preradiation and preoperative prostate specific antigen less than 10 ng/ml, and localized preoperative stage with the understanding that complication risks are higher. Salvage cryotherapy is a valid option in patients with preoperative prostate specific antigen less than 10 ng/ml and Gleason score less than 8, clinical stage less than T3 who are hormonally naive. Salvage cryotherapy is especially suited for older patients with some comorbidities who are still considered to be at reasonable anesthetic risk. The study of brachytherapy remains in its infancy and the efficacy of this modality remains to be determined.
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Affiliation(s)
- Naji J Touma
- Division of Urology, University of Western Ontario, London, Ontario, Canada
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63
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Colovi V, Hadzi-Djokic J, Filipovic Z, Popovi D, Sola N, Paunkovic P, Masulovic D. Radical retropubic prostatectomy--report on 41 cases. ACTA CHIRURGICA IUGOSLAVICA 2005; 52:75-6. [PMID: 16673600 DOI: 10.2298/aci0504075c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Anatomic radical retropubic prostatectomy is an effective method for long-term control of the prostatic carcinoma. In the current era of the anatomic prostatic surgery, blood loss is reduced, complication rate is low and control of the disease may be excellent. Some authors reported cancer-specific survival rate after the radical retropubic prostatectomy of 85-90% over the 10-year period and 82% over the 15-year period. The survival may be more favorable in the patients with lower Gleason scores. The former indicates that radical retropubic prostatectomy is an excellent therapeutic option for treatment of the localized prostatic carcinoma, while selection of patients is a crucial factor for true success of therapy based on this method.
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Affiliation(s)
- V Colovi
- Department of Urology, CHC Bezanijska kosa, Belgrade
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64
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Selli C, De Antoni P, Moro U, Macchiarella A, Giannarini G, Crisci A. Role of bladder neck preservation in urinary continence following radical retropubic prostatectomy. ACTA ACUST UNITED AC 2004; 38:32-7. [PMID: 15204424 DOI: 10.1080/00365590310017280] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To report our experience of the influence of bladder neck preservation on patient continence. MATERIAL AND METHODS Radical retropubic prostatectomy with bladder neck preservation was performed in 131 patients (age range 48-73 years; mean 64.5 years). Urinary continence was evaluated using a validated questionnaire at follow-up visits and telephone interviews. All patients reporting incontinence were studied using a pad test and urodynamics. RESULTS After a mean follow-up period of 21.7 months (range 4-47 months), 115 patients were continent (87%) and 16 incontinent. According to the International Continence Society criteria, three had severe, three moderate and 10 mild incontinence. Urodynamics revealed sphincter deficiency in 15 cases, which was associated with decreased bladder compliance in four, while decreased compliance was the only abnormality in one. Continence was recovered 0-27 months after surgery (mean 3.2 months): 40% of men were continent within the first month and 74% within the third. Histopathology revealed positive margins in 30/131 patients (22%), but exclusively at the bladder neck level in only seven (5%), and two also had positive nodes. Six patients (4.5%) presented bladder neck stenosis requiring transurethral incision. No statistically significant differences were found between the ages of continent and incontinent men or between the time to continence recovery with two different techniques of retropubic hemostasis; however, use of a nerve-sparing technique significantly reduced the time to continence recovery. CONCLUSIONS Bladder neck preservation during radical retropubic prostatectomy does not improve the long-term results of urinary continence but does contribute substantially to its earlier recovery, thus improving the quality of life. With proper patient selection the risk of positive margins at the bladder neck level only is reasonably low.
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Affiliation(s)
- Cesare Selli
- Department of Urology, University of Pisa, Pisa, Italy.
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65
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Salomon L, Sèbe P, De La Taille A, Vordos D, Hoznek A, Yiou R, Chopin D, Abbou CC. Open versus laparoscopic radical prostatectomy: Part II. BJU Int 2004; 94:244-50. [PMID: 15217417 DOI: 10.1111/j.1464-410x.2004.04951.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Laurent Salomon
- Department of Urology, Henri Mondor Hospital, Creteil, France.
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Singh H, Karakiewicz P, Shariat SF, Canto EI, Nath RK, Kattan MW, Slawin KM. Impact of unilateral interposition sural nerve grafting on recovery of urinary function after radical prostatectomy. Urology 2004; 63:1122-7. [PMID: 15183964 DOI: 10.1016/j.urology.2004.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Accepted: 01/12/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test the hypothesis that unilateral sural nerve graft (SNG) interposition may improve the rate of urinary function (UF) recovery after radical retropubic prostatectomy (RRP) in patients undergoing unilateral nerve resection (UNR). METHODS We studied 111 consecutive patients who underwent RRP with purposeful UNR performed by a single surgeon. Of the 111 patients, 53 underwent unilateral SNG interposition. All patients were invited to complete a questionnaire that included the validated University of California, Los Angeles, Prostate Cancer Index. The time to UF recovery above the median value of the group and urinary control status were evaluated. RESULTS The median follow-up was 26 and 12 months for the UNR and UNR+SNG patients, respectively. At 12 months after RRP, 94.7% of patients with UNR+SNG reported having complete urinary control or leakage of only a few drops of urine compared with 58.3% of patients with UNR alone (P = 0.012). In multivariate Cox regression models, UNR+SNG was associated with a 9.95 times greater rate of reaching a UF score above the median versus UNR alone (P <0.001). In multivariate logistic regression analyses, SNG status increased the odds of having complete urinary control or leakage of only a few drops of urine by 14.99 and 29.19 at 6 and 12 months after RRP, respectively (both P <0.05). CONCLUSIONS In patients undergoing UNR surgery, SNG interposition is associated with a greater rate of UF recovery and a higher likelihood of urinary control after RRP. These findings need to be validated in larger, multicenter, prospective, randomized studies.
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Affiliation(s)
- Herb Singh
- Baylor Prostate Center, Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA
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67
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Rassweiler J, Schulze M, Teber D, Seemann O, Frede T. Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol 2004; 14:75-82. [PMID: 15075834 DOI: 10.1097/00042307-200403000-00005] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Laparoscopic radical prostatectomy has become an accepted alternative to open surgery, however data on the functional and oncological outcome are still lacking. In this study we present an analysis based on a survey of the current literature and the first 500 patients treated with the Heilbronn technique. Additionally, we compare the results of laparoscopy with those of open radical prostatectomy. RECENT FINDINGS We conducted an extensive MEDLINE search of laparoscopic and open radical prostatectomy from 1999 through 2003, focusing on the last 3 years. The articles as well as our own results were analyzed with respect to continence, potency, positive margins, prostatic specific antigen failure, and clinical progression. No significant differences were found between the laparoscopic and open approach with respect to overall continence at 12 months (60-94% versus 61-98%) or at 3 months (51-63% versus 62-69%), varying from 4.1% at pT2, 12% at pT3 to 19% at pT4 stages. We found no significant differences between the two techniques in the recovery of potency (34-67% versus 31-79%), if one excludes the selected series of Walsh with a mean age of 57 years. Furthermore, we did not detect any significant differences in positive margins and short-term prostatic specific antigen recurrence (3 years). SUMMARY At centers of expertise, laparoscopic radical prostatectomy is able to provide similar functional and oncological results as its open counterpart, however with the advantages of minimally invasive surgery.
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Affiliation(s)
- Jens Rassweiler
- Department of Urology, Klinikum Heilbronn, University of Heidelberg, Am Gesundbrunnen 20, D-74074 Heilbronn, Germany.
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Cathelineau X, Arroyo C, Rozet F, Baumert H, Vallancien G. Laparoscopic radical prostatectomy: The new gold standard? Curr Urol Rep 2004; 5:108-14. [PMID: 15028202 DOI: 10.1007/s11934-004-0022-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Radical prostatectomy is the reference treatment for localized prostate cancer. The minimal invasive approach is gaining support in a large number of centers around the world because the laparoscopic approach seems to maintain the oncological control of open surgery with added benefits for the patient. In this paper, the main aspects of the different laparoscopic approaches, their benefits, difficulties, complications, and results are described and compared with the open radical prostatectomy. A critical review of the literature on radical prostatectomy comparing the open and laparoscopic techniques and the differences between each approach was done.
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Affiliation(s)
- Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75674 Paris cedex, France.
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69
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Oefelein MG. Prospective predictors of urinary continence after anatomical radical retropubic prostatectomy: a multivariate analysis. World J Urol 2004; 22:267-71. [PMID: 14727136 DOI: 10.1007/s00345-003-0388-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 10/16/2003] [Indexed: 10/26/2022] Open
Abstract
The aim of this work was to evaluate variables that predict time to pad-free urinary continence after anatomical radical prostatectomy (ARP). Sixty consecutive prostate cancer patients who underwent ARP by one surgeon were studied. Pad-free urinary continence was prospectively determined by patient interviews and confirmed on physical examination and by the urinary domain of the Extended Prostate Inventory Composite (EPIC) Health Related Quality of Life questionnaire. A time-dependent Cox multivariate regression analysis was performed to determine which variables significantly correlated with time to pad-free urinary continence. Increasing prostate size (cc), increasing prostate urethral length (cm) and surgical technique (wide excision of the neuro-vascular bundle) correlated with a significantly (P<0.05) prolonged time to achieve pad-free urinary continence. In conclusion, prostate size and surgical technique were the most useful variables in predicting time to pad-free urinary continence after ARP.
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Affiliation(s)
- Michael G Oefelein
- Case Western Reserve University, Department of Urology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA.
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70
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Maffezzini M, Seveso M, Taverna G, Giusti G, Benetti A, Graziotti P. Evaluation of complications and results in a contemporary series of 300 consecutive radical retropubic prostatectomies with the anatomic approach at a single institution. Urology 2003; 61:982-6. [PMID: 12736020 DOI: 10.1016/s0090-4295(02)02517-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the complications and results of radical retropubic prostatectomy with the anatomic approach, at our center, to allow a comparison with published studies and precise patient counseling. METHODS We reviewed the charts and records of the follow-up visits of all patients who consecutively underwent radical retropubic prostatectomy for clinically intracapsular prostate cancer between March 1997 and February 2002. RESULTS The pathologic stage was pT0 in 4 patients (1.3%), pT2a in 83 (27.7%), pT2b in 116 (38.7%), pT3a in 52 (17.3%), pT3b in 38 (12.6%), and pT4 in the remaining 7 (2.4%). Extracapsular disease extension was present in 97 specimens (32.3%); it was associated with positive margins in 64 patients (21.3%). Intraoperative and postoperative complications were recorded in 19 patients (6.3%). Immediate surgical repair was necessary in 3 cases (1%) and delayed in 5 (1.7%). A stricture of the vesicourethral anastomosis was observed in 2 patients (0.7%). At a median follow-up of 29 months (range 6 to 57), a total of 262 patients (88.8%) was continent; 26 patients (8.8%) had stress incontinence, and 7 were incontinent (2.3%). Of 262 patients, 128 (48.2%) achieved continence within the first day of catheter removal. CONCLUSIONS Radical retropubic prostatectomy is associated with low complication rates; with the anatomic approach, a limited incidence of incontinence is attainable, consistent with major referral centers.
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Kylmälä T, Tainio H, Raitanen M, Tammela TLJ. Treatment of postoperative male urinary incontinence using transurethral macroplastique injections. J Endourol 2003; 17:113-5. [PMID: 12689406 DOI: 10.1089/08927790360587450] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To study the effect of Macroplastique injection on postoperative stress urinary incontinence (SUI) in male patients. PATIENTS AND METHODS Since 1997, 50 consecutive men with a mean age of 66.0 years (range 51-75 years) suffering from mild to moderate postoperative SUI were treated as outpatients with transurethral Macroplastique injections. Under local anesthesia, 2.5 to 5 mL of Macroplastique was injected adjacent to the external sphincter at 5 or 7 o'clock or both. Forty-six patients had undergone radical prostatectomy, three transurethral prostatic resection, and one cystoprostatectomy with bladder substitution. Patients suffering from detrusor instability were excluded. A standardized 1-hour pad test and the patient's grading of the severity of the incontinence from 0 to 3, where 0 meant leaking took place all the time and 3 that the patient was completely dry, were carried out prior to injection and again at 3 months after each injection. Macroplastique injection was repeated if the initial treatment was not curative. RESULTS The mean 1-hour pad test loss was 48.3 mL at baseline. After the first injection, 6 patients were completely dry and 28 improved; in the rest, no improvement was achieved. Forty patients underwent a second injection after which, 10 more patients became completely dry and 5 improved significantly. Twenty-three patients underwent a third injection, after which, 9 more patients were completely dry. Fourth injections were given to 8 patients, of whom 5 became dry, 1 improved, and 2 patients did not get any benefit. The total volume of Macroplastique injected ranged from 2.5 to 13.5 mL (mean 7.1 mL). A majority of the patients suffered some dysuria following the injection, but there were no significant side effects. CONCLUSIONS The preliminary results of endoscopic treatment of mild to moderate postoperative SUI in males with outpatient Macroplastique injections are encouraging. To achieve satisfactory results, repeated injections are needed.
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Affiliation(s)
- Timo Kylmälä
- Division of Urology, Department of Surgery, Tampere University Hospital and Tampere University, Tampere, Finland
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72
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Katz MS, Zelefsky MJ, Venkatraman ES, Fuks Z, Hummer A, Leibel SA. Predictors of biochemical outcome with salvage conformal radiotherapy after radical prostatectomy for prostate cancer. J Clin Oncol 2003; 21:483-9. [PMID: 12560439 DOI: 10.1200/jco.2003.12.043] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify predictors of biochemical outcome following radiotherapy in patients with a rising prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer. PATIENTS AND METHODS One hundred fifteen patients with a rising PSA after radical prostatectomy received salvage three-dimensional conformal radiotherapy (3D-CRT) alone or with neoadjuvant androgen deprivation. Tumor-related and treatment-related factors were evaluated to identify predictors of subsequent PSA failure. RESULTS The median follow-up time after 3D-CRT was 42 months. The 4-year actuarial PSA relapse-free survival, distant metastasis-free survival, and overall survival rates were 46%, 83%, and 95%, respectively. Multivariate analysis, which was limited to 70 patients receiving radiation without androgen deprivation therapy, showed that negative/close margins (P =.03), absence of extracapsular extension (P <.01), and presence of seminal vesicle invasion (P <.01) were independent predictors of PSA relapse after radiotherapy. Neoadjuvant androgen deprivation did not improve the 4-year PSA relapse-free survival in patients with positive margins, extracapsular extension, and no seminal vesicle invasion (P =.24). However, neoadjuvant androgen deprivation did improve PSA relapse-free survival when one or more of these variables were absent (P =.03). CONCLUSIONS Salvage 3D-CRT can provide biochemical control in selected patients with a rising PSA after radical prostatectomy. Among patients with positive margins and no poor prognostic features, 77% achieved PSA control after salvage 3D-CRT. Salvage neoadjuvant androgen deprivation therapy may improve short-term biochemical control, but it requires further study.
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Affiliation(s)
- Matthew S Katz
- Departments of Radiation Oncology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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73
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Hu JC, Gold KF, Pashos CL, Mehta SS, Litwin MS. Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol 2003; 21:401-5. [PMID: 12560426 DOI: 10.1200/jco.2003.05.169] [Citation(s) in RCA: 281] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the effect of hospital and surgeon volume on postoperative outcomes and to determine whether hospital or surgeon volume is the stronger predictor. PATIENTS AND METHODS Using 1997 to 1998 claims data from a national 5% random sample of Medicare beneficiaries, we identified 2,292 men who underwent radical prostatectomy at 1,210 hospitals by 1,788 surgeons. Hospitals were classified as high (> or = 60 per year) or low (< 60 per year) volume according to radical prostatectomy experience over the 2-year period. Surgeons were classified as high (> or = 40 per year) or low (< 40 per year) volume. Multivariate logistic regression was performed to control for patient demographics and comorbidities when assessing the association of hospital and surgeon volume with in-hospital complications, length of stay, and anastomotic stricture rates. In-hospital complications included cardiac, respiratory, vascular, wound, genitourinary, and miscellaneous surgical and medical conditions. RESULTS High-volume surgeons had half the complication risk (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.32 to 0.89) and shorter lengths of stay (4.1 v 5.2 days, P =.03) compared with low-volume surgeons. High-volume hospital patients tended to have fewer anastomotic strictures (OR = 0.72; 95% CI, 0.49 to 1.04). Patient age (> or = 75 years) was associated with more complications (OR = 1.9; 95% CI, 1.39 to 2.70), more anastomotic strictures (OR = 2.2; 95% CI, 1.54 to 3.15), and longer hospital stays (parameter estimate = 2.26; 95% CI, 1.75 to 2.77). CONCLUSION Surgeon volume is inversely related to in-hospital complications and length of stay in men undergoing radical prostatectomy. Hospital volume is not significantly associated with outcomes after adjusting for physician volume. Further study is necessary to elucidate the mechanism of the volume-outcome effect.
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Affiliation(s)
- Jim C Hu
- Departments of Urology and Health Services, University of California, Los Angeles David Geffen School of Medicine and School of Public Health, Los Angeles, CA 90095-1738, USA
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74
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Trabulsi EJ, Scardino PT, Kattan MW. The Decision-making Process for Prostate Cancer. Prostate Cancer 2003. [DOI: 10.1016/b978-012286981-5/50026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Patel R, Lepor H. Removal of urinary catheter on postoperative day 3 or 4 after radical retropubic prostatectomy. Urology 2003; 61:156-60. [PMID: 12559288 DOI: 10.1016/s0090-4295(02)02105-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the feasibility and safety of removing the urinary catheter on postoperative day (POD) 3 or 4 after radical retropubic prostatectomy (RRP). METHODS Between January 2001 and August 2001, gravity cystography was performed on POD 3 or 4 after RRP by a single surgeon (H.L.) on 151 men. The urinary catheter was removed on POD 3 or 4 providing no extravasation was evident on cystography. Urinary catheters were replaced over a guidewire placed into the bladder under flexible cystoscopic guidance in cases of acute urinary retention (AUR). Continence was assessed at 3 months after RRP. RESULTS Of the 151 cystograms performed on POD 3 or 4, 116 (76.8%) revealed no evidence of extravasation. The indwelling catheters were removed in 114 of these cases (98.3%). Twenty-two (19.3%) of the 114 men whose catheters were removed on POD 3 or 4 developed AUR within 48 hours of catheter removal, requiring catheter replacement. Two of these patients required repeated surgery secondary to complications related to AUR. At 3 months after RRP, 75% of the men whose catheters were removed on POD 3 or 4 required no pads or a single pad during a 24-hour interval, and 77.6% reported none or slight bother from incontinence. Of the 37 men whose catheters were removed on POD 7 or later, 1 patient (2.7%) developed AUR, and the catheter was replaced without complications. At 3 months after RRP, 65.7% of men whose catheters were removed on POD 7 or later required no pads or a single pad during a 24-hour interval, and 71.4% reported none or slight bother from incontinence. The incidence of anastomotic stricture in men whose catheters were removed on POD 3 or 4 and POD 7 or later was 12.1% and 22.6%, respectively. CONCLUSIONS Most men will have a watertight anastomosis on POD 3 or 4 after RRP. Early catheter removal does not have a negative impact on continence or the rate of anastomotic strictures. Because of the high incidence of AUR, requiring replacement of the urinary catheter, and the potential for disruption of the anastomosis or bladder neck reconstruction, we currently recommend delaying catheter removal until POD 7 or later.
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Affiliation(s)
- Rupa Patel
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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76
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Diagnosis and Therapy of Urinary Stress Incontinence Following Radical Prostatectomy. Prostate Cancer 2003. [DOI: 10.1007/978-3-642-56321-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gillitzer R, Thüroff JW. Relative advantages and disadvantages of radical perineal prostatectomy versus radical retropubic prostatectomy. Crit Rev Oncol Hematol 2002; 43:167-90. [PMID: 12191739 DOI: 10.1016/s1040-8428(02)00016-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In recent years prostate cancer has become the predominant malignancy in men. With the introduction of prostate specific antigen (PSA) the disease can be diagnosed at an early stage, at which surgical therapy can be curative. In the past century, the retropubic and the perineal routes were established as alternatives of surgical access to the gland for clinically localized prostate cancer. The selection of the operative route is mostly decided individually on the basis of surgical training and experience. The revived interest in perineal radical prostatectomy is explained by the fact that this technique has been associated with low morbidity. The differences of both surgical approaches of radical prostatectomy are elucidated and compared regarding tumor control and short and long term complication rates. Taking these results into consideration, specific advantages and disadvantages of radical perineal prostatectomy are emphasized.
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Affiliation(s)
- R Gillitzer
- Department of Urology, Johannes-Gutenberg University, Langenbeckstrasse 1, Mainz, Germany.
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Grimm MO, Kamphausen S, Hugenschmidt H, Stephan-Odenthal M, Ackermann R, Vögeli TA. Clinical outcome of patients with lymph node positive prostate cancer after radical prostatectomy versus androgen deprivation. Eur Urol 2002; 41:628-34; discussion 634. [PMID: 12074780 DOI: 10.1016/s0302-2838(02)00134-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE(S) To compare the outcome of patients with stage D1 (TxN+M0) prostate cancer undergoing radical prostatectomy or androgen deprivation alone. PATIENTS AND METHODS Eighty-two patients treated for lymph node positive prostate cancer were retrospectively analyzed for time to progression, tumor-specific and overall survival. Furthermore, subsequent tumor and treatment related morbidity requiring intervention including frequency and duration of associated hospital stays was recorded. RESULTS The extent of lymph node metastasis was significantly lower in 50 patients undergoing radical prostatectomy (+/- early androgen deprivation) compared to 32 receiving androgen deprivation only. The treatment groups, however, did not differ with regard to other characteristics including age, comorbidity, stage, grade and preoperative PSA. Mean actuarial progression-free, and tumor-specific survival was significantly longer for the radical prostatectomy patients (36% and 47%, respectively at 10 years) compared to androgen deprivation (15% and 32%, respectively). The latter group required more secondary interventions resulting in more frequent and overall longer hospital stays. CONCLUSIONS Patients undergoing radical prostatectomy for stage D1 prostate cancer possibly benefit with regard to the necessity for secondary interventions and, at least for limited (solitary) nodal disease, in terms of progression-free and tumor-specific survival. However, the latter observation may be biased by a larger extent of lymph node metastasis in the androgen deprivation group.
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Affiliation(s)
- M-O Grimm
- Department of Urology, Heinrich-Heine-University, Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Santucci RA, McAninch JW. Urethral reconstruction of strictures resulting from treatment of benign prostatic hypertrophy and prostate cancer. Urol Clin North Am 2002; 29:417-27, viii. [PMID: 12371233 DOI: 10.1016/s0094-0143(02)00031-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Urethral strictures commonly result from treatments for prostate disease, such as transurethral resection, radical prostatectomy, and radiotherapy. Treating these strictures can be difficult: it may be complicated by previous irradiation, and endoscopy often fails. We review the risk factors for development of strictures resulting from the treatment of prostate disease and discuss the success rates of both endoscopic and open therapies.
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Affiliation(s)
- Richard A Santucci
- Department of Urology, University of California School of Medicine, San Francisco, CA 94143-0738, USA
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Wei JT, Dunn RL, Sandler HM, McLaughlin PW, Montie JE, Litwin MS, Nyquist L, Sanda MG. Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. J Clin Oncol 2002; 20:557-66. [PMID: 11786586 DOI: 10.1200/jco.2002.20.2.557] [Citation(s) in RCA: 200] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Health-related quality-of-life (HRQOL) concerns are pivotal in choosing prostate cancer therapy. However, concurrent HRQOL comparison between brachytherapy, external radiation, radical prostatectomy, and controls is hitherto lacking. HRQOL effects of hormonal adjuvants and of cancer control after therapy also lack prior characterization. PATIENTS AND METHODS A cross-sectional survey was administered to patients who underwent brachytherapy, external-beam radiation, or radical prostatectomy during 4 years at an academic medical center and to age-matched controls. HRQOL among controls was compared with therapy groups. Comparison between therapy groups was performed using regression models to control covariates. HRQOL effects of cancer progression were evaluated. RESULTS One thousand fourteen subjects participated. Compared with controls, each therapy group reported bothersome sexual dysfunction; radical prostatectomy was associated with adverse urinary HRQOL; external-beam radiation was associated with adverse bowel HRQOL; and brachytherapy was associated with adverse urinary, bowel, and sexual HRQOL (P < or =.0002 for each). Hormonal adjuvant symptoms were associated with significant impairment (P <.002). More than 1 year after therapy, several HRQOL outcomes were less favorable among subjects after brachytherapy than after external radiation or radical prostatectomy. Progression-free subjects reported better sexual and hormonal HRQOL than subjects with increasing prostate-specific antigen (P <.0001). CONCLUSION Long-term HRQOL after prostate brachytherapy showed no benefit relative to radical prostatectomy or external-beam radiation and may be less favorable in some domains. Hormonal adjuvants can be associated with significant impairment. Progression-free survival is associated with HRQOL benefits. These findings facilitate patient counseling regarding HRQOL expectations and highlight the need for prospective studies sensitive to urinary irritative and hormonal concerns in addition to incontinence, sexual, and bowel HRQOL domains.
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Affiliation(s)
- John T Wei
- Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Medical Center, USA
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Affiliation(s)
- J A Eastham
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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83
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Carlson KV, Nitti VW. Prevention and management of incontinence following radical prostatectomy. Urol Clin North Am 2001; 28:595-612. [PMID: 11590816 DOI: 10.1016/s0094-0143(05)70165-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Incontinence after radical prostatectomy can have a significant impact on quality of life. Although several risk factors have been identified, the surgical technique and advancing age are important factors associated with postprostatectomy incontinence. Despite advances in technique, incontinence still occurs in a small group of men. Sphincteric dysfunction is the most common cause of postradical prostatectomy incontinence, but bladder dysfunction cannot be discounted. Treatments range from conservative to surgical and should be tailored to the individual based on the degree of bother and patient willingness to accept different therapeutic options.
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Affiliation(s)
- K V Carlson
- Department of Urology, New York University School of Medicine, New York, New York, USA
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Shekarriz B, Upadhyay J, Wood DP. Intraoperative, perioperative, and long-term complications of radical prostatectomy. Urol Clin North Am 2001; 28:639-53. [PMID: 11590819 DOI: 10.1016/s0094-0143(05)70168-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With improved surgical technique and perioperative care, the intraoperative and early postoperative complications of radical prostatectomy have decreased over the last 2 decades. Incontinence and impotence are two of the most significant long-term complications related to this procedure. Although the wide range of incontinence and impotence rates reported has been attributed to multiple factors, including the method of data collection and patient selection, it is apparent that the surgeon's experience is a significant factor, and that lower long-term morbidity can be expected from centers with more experience with radical prostatectomies. The impact of long-term complications, including urinary and sexual dysfunction, on the quality of life may be less than previously reported and should be discussed with patients.
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Affiliation(s)
- B Shekarriz
- Department of Urology, University of California, San Francisio, California, USA
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Ruiz-Deya G, Davis R, Srivastav SK, M Wise A, Thomas R. Outpatient radical prostatectomy: impact of standard perineal approach on patient outcome. J Urol 2001; 166:581-6. [PMID: 11458072 DOI: 10.1016/s0022-5347(05)65988-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE As managed care becomes more prevalent, urologists must critically evaluate the economic aspect of and patient satisfaction with urological practice patterns. We have previously reported the advantages of radical perineal prostatectomy, which decreases hospitalization and morbidity, and provides a more rapid return to normal activity, translating into cost savings. We have since evaluated the satisfaction of patients who underwent outpatient radical prostatectomy with and without laparoscopic pelvic lymph node dissection. MATERIALS AND METHODS We evaluated the charts of 250 consecutive patients who underwent outpatient radical perineal prostatectomy with less than 24 hours of hospitalization from 1992 to 1997. Complications, pain management, blood transfusion, and bowel and urinary dysfunction were assessed. Validated quality of life questionnaires were mailed to 200 patients several months postoperatively and a 62% response rate was achieved. RESULTS Mean followup in the series was 30 months. In the perioperative period there were rectal perforation in less than 2% of patients, anastomotic stricture in 3%, perineal fistula in 0.4% and blood transfusion in 11%. Some problems with bowel movements immediately after the procedure, such as diarrhea, constipation or soiled underwear, developed in 17% of patients, of whom up to 20% had had some bowel dysfunction before surgery. In the majority bowel problems resolved in an average of 7.3 weeks. Persistent new onset bowel trouble developed in 9 of the 124 patients (7%). The questionnaire demonstrated persistent significant urinary incontinence in 8 cases (7%). Nerve sparing was attempted in 54 patients, including 22 (41%) who achieve erection sufficient for vaginal penetration and are satisfied with sexual function. Of the patients 17% reported problems after hospital discharge that were mostly related to Foley catheter management. Overall 94.8% of patients were satisfied with treatment. Physical and social/family well-being appeared to be excellent according to the questionnaire. Only 12% of patients would have preferred longer hospitalization. The preferred method of pain control was nonsteroidal anti-inflammatory drugs. CONCLUSIONS Radical perineal prostatectomy is a low morbidity alternative for localized prostate cancer. Outpatient radical perineal prostatectomy may be performed with good patient satisfaction and safety. There appear to be few bowel problems after long-term followup.
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Affiliation(s)
- G Ruiz-Deya
- Department of Urology, Health Sciences Center and Department of Biostatistics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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86
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Elliott DS, Boone TB. Combined stent and artificial urinary sphincter for management of severe recurrent bladder neck contracture and stress incontinence after prostatectomy: a long-term evaluation. J Urol 2001; 165:413-5. [PMID: 11176385 DOI: 10.1097/00005392-200102000-00014] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Concurrent incontinence and severe recurrent bladder neck contracture following radical prostatectomy are difficult to manage. Recurrent anastomotic strictures following repeat transurethral incisions and resections, and the need for frequent instrumentation are contraindications for artificial urinary sphincter placement. Usually treatment alternatives for these patients consist of some form of urinary diversion or chronic catheter drainage. We evaluated our results using a UroLume stent across the bladder neck contracture followed by placement of an artificial urinary sphincter. MATERIALS AND METHODS After failed multiple (mean incisions 4.4) attempts at conservative management of anastomotic stricture 9 men were treated with a UroLume urethral stent across the contracture followed by artificial urinary sphincter placement after appropriate epithelialization of the stent was confirmed. RESULTS All patients were followed for a mean of 17.5 months. Mean pad use per day decreased from 6.5 to 0.7 before and after artificial urinary sphincter placement, respectively. Two patients reported mild persistent perineal discomfort and 1 had a recurrent contracture after stent placement, which was successfully managed with placement of a second overlapping stent. Overall, 89% of the patients were satisfied with the results. CONCLUSIONS UroLume stent placement followed by artificial urinary sphincter can be a successful method for treating recurrent severe bladder neck contracture and incontinence. There is minimal morbidity with the procedures, and the combination offers a much more attractive treatment alternative compared to urinary diversion or chronic catheter drainage.
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Affiliation(s)
- D S Elliott
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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Benoit RM, Naslund MJ, Cohen JK. Complications after radical retropubic prostatectomy in the medicare population. Urology 2000; 56:116-20. [PMID: 10869638 DOI: 10.1016/s0090-4295(00)00539-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Radical prostatectomy is the standard of care for the treatment of clinically localized prostate cancer in the appropriate patient. However, the morbidity associated with this procedure remains controversial, since complications from centers of excellence are low but nationwide surveys have reported a much higher risk of complications. This study reports the complication rates after radical retropubic prostatectomy (RRP) for men in the Medicare population. METHODS All men in the Medicare population who underwent RRP in 1991 were identified. All inpatient, outpatient, and physician (Part B) Medicare claims for these men for 1991 to 1993 were then analyzed to determine outcomes. Procedures performed for complications resulting from RRP were recorded, as were the diagnosis codes that may have heralded a complication after RRP. RESULTS In 1991, 25,651 men in the Medicare population underwent RRP. The mean age of these men was 70.5 years. Procedures for the relief of bladder outlet obstruction or urethral strictures after RRP occurred in 19.5% of these men. A penile prosthesis was implanted in 718 men (2.8%) after prostatectomy, and 593 men (2.3%) had an artificial urinary sphincter placed after prostatectomy. A diagnosis of urinary incontinence was reported in 5573 men (21.7%) after radical prostatectomy, but only 2025 of these men (7.9%) continued to carry this diagnosis more than 1 year after prostatectomy. A diagnosis of erectile dysfunction was reported in 5510 men (21.5%) after radical prostatectomy, but only 3276 of these men (12.8%) continued to carry this diagnosis more than 1 year after surgery. CONCLUSIONS A review of a large, nationwide, heterogenous cohort of men revealed a morbidity rate that is slightly higher than that reported by major centers that perform large numbers of radical retropubic prostatectomies but is lower than complication rates obtained by patient surveys. The limitations of claim information in determining patient outcomes, however, must be considered when evaluating these data.
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Affiliation(s)
- R M Benoit
- Division of Urology, Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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88
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WALSH PATRICKC. RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER PROVIDES DURABLE CANCER CONTROL WITH EXCELLENT QUALITY OF LIFE: A STRUCTURED DEBATE. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67547-7] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- PATRICK C. WALSH
- From the James Buchanan Brady Urological Institute, The Johns Hopkins Hospital and Department of Urology, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
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89
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RADICAL PROSTATECTOMY FOR LOCALIZED PROSTATE CANCER PROVIDES DURABLE CANCER CONTROL WITH EXCELLENT QUALITY OF LIFE:. J Urol 2000. [DOI: 10.1097/00005392-200006000-00039] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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90
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Walsh PC, Marschke P, Ricker D, Burnett AL. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 2000; 55:58-61. [PMID: 10654895 DOI: 10.1016/s0090-4295(99)00397-0] [Citation(s) in RCA: 511] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES After radical prostatectomy, the rates for recovery of urinary continence and sexual function reported by experienced surgeons are much higher than the patient-reported outcomes from other centers. It is uncertain whether this represents differences in surgical technique or in the collection of data. This study was performed to determine patient-reported rates of continence and potency after radical prostatectomy performed by an experienced surgeon at a high-volume referral center for the treatment of localized prostate cancer. METHODS Sixty-four men with localized prostate cancer who were potent preoperatively and who had sexual partners underwent anatomic radical prostatectomy between March 1997 and January 1998. A validated disease-targeted quality-of-life survey that assesses function and bother in two organ systems (urinary and sexual) was administered preoperatively and at 3, 6, 12, and 18 months postoperatively. RESULTS Urinary continence, which was defined as wearing no pads, gradually improved during the first 12 months after surgery, and at 1 2 and 18 months, 93% of the patients were dry. Throughout the study, 93% to 98% of the patients characterized their urinary bother as none or small. Potency, defined as the ability to have unassisted intercourse with or without the use of sildenafil, improved gradually, and by 18 months, 86% of patients were potent and 84% considered sexual bother as none or small. Although one third of patients at 18 months were using sildenafil intermittently, only 2 patients were not able to have intercourse without its use. CONCLUSIONS Patient-reported rates of continence and potency after radical prostatectomy performed by an experienced surgeon are high.
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Affiliation(s)
- P C Walsh
- James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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91
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Walsh PC, Marschke P, Ricker D, Burnett AL. Use of intraoperative video documentation to improve sexual function after radical retropubic prostatectomy. Urology 2000; 55:62-7. [PMID: 10654896 DOI: 10.1016/s0090-4295(99)00363-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether arbitrary minor variances in surgical technique can have a major impact on the recovery of sexual function after radical retropubic prostatectomy. METHODS The surgical procedures of 62 potent men were videotaped prospectively. Eighteen months after the study was initiated, the videotapes were reviewed and specific steps in the surgical procedure correlated with patient-reported potency rates. RESULTS Four steps were identified that appeared to correlate with the recovery of sexual function: over-sewing back-bleeders from the proximal dorsal vein on the anterior surface of the prostate, division of the striated sphincter when placing urethral sutures, division of the posterior striated sphincter, and hemostasis at the end of the case. CONCLUSIONS We believe that retrospective review of intraoperative videotapes has great promise. Because many surgeons use different techniques, it is likely that each individual may be able to identify other important arbitrary variations that may improve their patients' outcomes. Similarly, for surgeons with less than optimal outcomes, the review of early successful cases may enable them to identify ways that modification of their surgical technique can improve the outcome of future patients. To the best of our knowledge, the use of retrospective review of intraoperative videotapes has not been commonly used in any other surgical field.
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Affiliation(s)
- P C Walsh
- James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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92
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Roberts RO, Jacobsen SJ, Reilly WT, Pemberton JH, Lieber MM, Talley NJ. Prevalence of combined fecal and urinary incontinence: a community-based study. J Am Geriatr Soc 1999; 47:837-41. [PMID: 10404928 DOI: 10.1111/j.1532-5415.1999.tb03841.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the prevalence of combined fecal and urinary incontinence. DESIGN A cross-sectional, community-based study. SETTING Olmsted County, Minnesota. PARTICIPANTS Men (n = 778) and women (n = 762), aged 50 years or older, selected randomly from the population. MEASUREMENTS Participants completed a previously validated self-administered questionnaire that assessed the occurrence of fecal and urinary incontinence in the previous year. RESULTS The age-adjusted prevalence of incontinence was 11.1% (95% Confidence Interval (CI), 8.8-13.5) in men and 15.2% (95% CI, 12.5-17.9) in women for fecal incontinence; 25.6% (95% CI, 22.5-28.8) in men and 48.4% (95% CI, 44.7-52.2) in women for urinary incontinence; and 5.9% (95% CI, 4.1-7.6) in men and 9.4% (95% CI, 7.1-11.6) in women for combined urinary and fecal incontinence. The prevalence of fecal incontinence increased with age in men but not in women, from 8.4% among men in their fifties to 18.2% among men in their eighties (P for trend = .001). For women, the prevalence increased from 13.1% among 50-year-old women to 20.7% among women 80 years or older (P for trend = .5). Among persons with fecal incontinence, the prevalence of concurrent urinary incontinence was 51.1% among men and 59.6% among women (P = .001 and P = .003, respectively). Cross-sectionally, the age-adjusted, relative odds of fecal incontinence among persons with urinary incontinence was greater in men than in women (Odds Ratio (OR) = 3.0; 95% CI, 1.9-4.8 in men and OR = 1.8; 95% CI, 1.2-2.7 in women, P = .04). CONCLUSIONS These findings suggest that persons with one form of incontinence are likely to have the other form as well. Despite the higher prevalence of urinary and fecal incontinence among women, the association between fecal incontinence and urinary incontinence was stronger among men than women. This finding, and the significant association between fecal incontinence and age observed in men but not in women, suggest that the etiologies may be more closely linked in men than in women.
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Affiliation(s)
- R O Roberts
- Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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93
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Affiliation(s)
- M R Feneley
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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94
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95
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96
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Brown JA, Elliott DS, Barrett DM. Postprostatectomy urinary incontinence: a comparison of the cost of conservative versus surgical management. Urology 1998; 51:715-20. [PMID: 9610584 DOI: 10.1016/s0090-4295(98)00123-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Post-radical prostatectomy stress incontinence occurs in up to 20% of patients. Postprostatectomy incontinence is initially treated with undergarments, pads, or drip collectors. Patients with persistent leakage are often treated with a transurethral bulking agent (Contigen) or placement of an artificial genitourinary sphincter (AGUS). We have compared the direct costs of each treatment at our institution over 10 years. METHODS The Mayo Clinic estimating office provided the Medicare and non-Medicare charges for patients receiving both collagen injection (outpatient) and AGUS placement (2-day hospitalization) during August 1995. The Mayo Store provided the current price of all undergarments, pads, and drip collectors carried. Two local grocery stores provided the cost of Depends undergarments. RESULTS The following items were the least expensive carried at the Mayo Clinic Store: Entrust undergarments, Active Style pads, and Conveen drip collectors at $0.99, $0.52, $1.05 each, respectively. The average cost of Depends undergarments was $0.52 each. The cost of wearing 5 of the least expensive undergarments or pads per day for 10 years is $9497. The average estimated Medicare and non-Medicare cost for outpatient (general anesthesia) collagen injection is $4300 and $5625, respectively. The average Medicare and non-Medicare cost for AGUS placement is $15,400 and $20,300, respectively. Factoring in our current 22.4% reoperation rate, the average per patient Medicare and non-Medicare cost for AGUS placement is $18,850 and $24,847, respectively. CONCLUSIONS The cost of the AGUS placement compares favorably with the cost of transurethral collagen injection (under general anesthesia) in patients requiring several (more than three) collagen injection treatments or requiring the continued use of undergarments after collagen injection. Whereas the cost of transurethral collagen injection, when effective, compares favorably with conservative treatment, AGUS placement is significantly more expensive than conservative management for almost all patients except the exceedingly rare patient wearing more than 9 undergarments or pads per day. When the psychosocial benefit of urinary continence is considered, however, transurethral injection of collagen or AGUS placement often becomes the preferred treatment.
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Affiliation(s)
- J A Brown
- Division of Urology, David Grant Medical Center, Travis Air Force Base, California, USA
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97
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Simonato A, Galli S, Romagnoli A, Traverso P, Pizzorno R, Corbu C, Carmignani G. Retropubic Radical Prostatectomy and Immediate Continence. Urologia 1998. [DOI: 10.1177/039156039806501s01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim Temporary urinary incontinence after removing the catheter in patients who have undergone radical prostatectomy is commonly accepted and considered inevitable. Detailed information can be found in literature regarding continence at 3, 6 and 12 months after operation, but few reports mention the immediate results upon removing the catheter. We have collected together data from our patients regarding continence upon removal of the catheter, in order to assess this important aspect. Materials and methods Between November ‘94 and August ‘98, 156 patients underwent retropubic radical prostatectomy for histologically diagnosed prostatic adenocarcinoma (average age 65 years, range 49–74). Out of 156 patients, the bladder neck was removed in 72 (46%) (RCV), in 43 (28%) the bladder neck circular fibres (CCV) were preserved and in 41 (26%) a new technique was used to anatomically dissect the bladder-prostate junction, preserving the mucous of the prostatic urethra (CUP). Continence immediately after removal of the catheter was assessed in all patients in orthostatism and under stress by filling the bladder with 150 cc of saline solution. Results Upon removal of the catheter, 59/130 patients (45.5%) were perfectly continent. Of these 26/72 (36%) had undergone ample removal of the bladder neck, the bladder neck circular fibres were spared in 18/43 (43%), whilst the proximal tract of the prostatic urethra had been preserved in 26/41 (63%). There was infiltration of the bladder neck in 11/156 patients (7%), none of whom had the bladder neck circular fibres or the end section of the prostatic urethra spared. Conclusions Our experience shows that in correctly selected patients, if the bladder neck circular fibres and the proximal tract of the prostatic urethra are preserved, the possibility of immediate continence is high without increasing the oncological risk.
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Affiliation(s)
- A. Simonato
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
| | - S. Galli
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
| | - A. Romagnoli
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
| | - P. Traverso
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
| | - R. Pizzorno
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
| | - C. Corbu
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
| | - G. Carmignani
- Istituto di Clinica Urologica “Luciano Giuliani” - Università degli Studi - Genova
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98
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Sánchez-Ortiz RF, Broderick GA, Chaikin DC, Malkowicz SB, Van Arsdalen K, Blander DS, Wein AJ. Collagen injection therapy for post-radical retropubic prostatectomy incontinence: role of Valsalva leak point pressure. J Urol 1997; 158:2132-6. [PMID: 9366329 DOI: 10.1016/s0022-5347(01)68177-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We retrospectively evaluated the role of Valsalva leak point pressure as a predictor of successful management of post-radical retropubic prostatectomy incontinence with collagen injection. MATERIALS AND METHODS Urodynamic studies and Valsalva leak point pressures of 31 men who received retrograde collagen injection for post-radical retropubic prostatectomy incontinence were reviewed. Patients were interviewed before and after treatment to assess pad use and the American Urological Association quality of life index (scale 0 to 6). Parameters for success were postoperative quality of life score 3 or less or 50% or greater decrease in pad use and that the patient would recommend collagen therapy to someone else. RESULTS Of 31 patients 11 (35%) met the criteria for success, 2 (6%) were completely dry and 9 (29%) were improved. Successfully treated patients had a mean Valsalva leak point pressure of 64.0 cm. water compared to 42.2 cm. water in the failure group (p <0.01). Of patients with Valsalva leak point pressure of 60 cm. water or greater, 70% responded favorably to collagen injection (positive predictive value), while 81% with Valsalva leak point pressure less than 60 cm. water had treatment failure (negative predictive value) (p <0.02). There were no other statistically significant differences between those successfully treated with collagen injection and those in whom treatment failed, including mean age (62.7 to 68.1 years), mean volume of collagen (26.1 to 28.9 ml.), mean number of treatment sessions (2.45 to 2.65), mean followup (14.9 to 15.1 months), preoperative quality of life score (5.1 to 4.9), and preoperative pads per day (4.0 to 3.37). CONCLUSIONS Our data suggest that collagen injection improves 35% but cures a minority of patients (less than 10%) with post-radical retropubic prostatectomy incontinence. A pretreatment Valsalva leak point pressure of 60 cm. water or greater has high predictive value for a beneficial outcome after collagen injection. We propose a role for Valsalva leak point pressure to select men cost-effectively with post-radical retropubic prostatectomy incontinence for therapy with collagen injection.
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Affiliation(s)
- R F Sánchez-Ortiz
- Division of Urology, University of Pennsylvania Health System, Philadelphia, USA
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100
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Weldon VE, Tavel FR, Neuwirth H. CONTINENCE, POTENCY AND MORBIDITY AFTER RADICAL PERINEAL PROSTATECTOMY. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64245-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Vernon E. Weldon
- From the Department of Urology, University of California, San Francisco and Division of Urology, Marin General Hospital, San Rafael, California
| | - Frank R. Tavel
- From the Department of Urology, University of California, San Francisco and Division of Urology, Marin General Hospital, San Rafael, California
| | - Harry Neuwirth
- From the Department of Urology, University of California, San Francisco and Division of Urology, Marin General Hospital, San Rafael, California
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