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Fu J, Luo W, Ding Y, Liu X, Fang W, Yang X. Clinical study of 3D laparoscopic radical prostatectomy by transperitoneal and extraperitoneal approaches. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:549-558. [PMID: 38148938 PMCID: PMC10749385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Comparison of the clinical effectiveness and safety of three-dimensional transperitoneal laparoscopic radical prostatectomy (3D TLRP) versus 3D extraperitoneal LRP (3D ELRP) for prostate cancer. MATERIALS AND METHODS To retrospectively analyze the clinical and regular postoperative follow-up data of patients who underwent 3D LRP performed by the same attending surgeon at the Affiliated Hospital of Bengbu Medical College between 2017 and 2022. A total of 82 patients who met the criteria were included. They were divided into 3D TLRP (n = 39) and 3D ELRP groups (n = 43) according to the surgical approach. The preoperative, intraoperative, and postoperative data were compared. RESULTS There were no statistically significant differences in preoperative characteristics between the two groups. There were also no statistically significant differences between the 3D TLRP and 3D ELRP groups in terms of intraoperative blood transfusion rate (12.82% vs. 2.33%), positive lymph node rate (11.11% vs. 2.38%), positive surgical margin rate (12.82% vs. 6.98%), pathological Gleason score, postoperative clinical stage, perioperative complication rate (10.26% vs. 4.65%), immediate urinary control rate (56.41% vs. 58.14%), 3-month postoperative urinary control rate (76.92% vs. 74.42%), 6-month postoperative urinary control rate (87.18% vs. 83.72%), 6-month postoperative biochemical recurrence rate (7.69% vs. 9.30%), or 6-month postoperative sexual function recovery rate (2.56% vs. 2.33%) (P > 0.05). Compared with the 3D ELRP group, the 3D TLRP group had a longer operative time (232.36 ± 48.52 min vs. 212.07 ± 41.76 min), more estimated blood loss (150.000 [100.0, 200.0] vs. 100.000 [100.0, 125.0]), longer recovery of gastrointestinal function (2.72 ± 0.89 vs. 2.26 ± 0.88), longer duration of drainage tube retention (5.69 ± 1.79 vs. 4.28 ± 2.68), and longer hospitalization time (12.54 ± 4.07 vs. 10.88 ± 2.97), with statistical significance (P < 0.05). CONCLUSION 3D TLRP and 3D ELRP have similar oncologic and functional outcomes. Clinically, physicians can choose a reasonable procedure according to the patient's specific situation and their own surgical experience.
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Affiliation(s)
- Jie Fu
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Wenhao Luo
- Department of Urology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu 233099, Anhui, China
| | - Yonghui Ding
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Xiao Liu
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Wenge Fang
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
| | - Xuezhen Yang
- Department of Urology, The Second Affiliated Hospital of Bengbu Medical CollegeBengbu 233020, Anhui, China
- Department of Urology, Qingdao West Coast New District People’s HospitalQingdao 266400, Shandong, China
- Affiliated Hospital of Weifang Medical UniversityWeifang 261031, Shandong, China
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Chen Y, Hao H, Chen S, Chen X, Liu Y, Zhang M, Yu W, Shen C, Wu S. Insights into urinary incontinence after robot-assisted radical prostatectomy: urgent urinary incontinence or stress urinary incontinence. World J Urol 2023; 41:3635-3642. [PMID: 37819588 DOI: 10.1007/s00345-023-04584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Urinary incontinence is a common complication following robot-assisted radical prostatectomy (RARP). Few studies have explored the relationships and differences between stress urinary incontinence (SUI) and urgent urinary incontinence (UUI) after RARP. This study aimed to investigate the occurrence rates and risk factors of UUI and SUI in short term after RARP. METHODS We prospectively included prostate cancer patients who underwent RARP by a single surgeon. Demographics, lower urinary tract function, oncology, and follow-ups were recorded. Occurrence rates and risk factors of UUI and SUI within 3 months after catheter withdrawal were calculated. RESULTS The study cohort included 363 subjects with a mean age of 66.05 years. The median preoperative International Prostate Symptom Score (IPSS) was 14 (range 0-35), and the median Overactive Bladder Symptom Score (OABSS) was 3 (range 0-14). The occurrence rate of UUI and SUI at 3 months after catheter withdrawal was 8.5% (31/363) and 15.2% (55/363). Nearly all patients with UUI also had SUI. Diabetes history and high OABSS before RARP were independent risk factors for UUI, especially within 1 month after catheter withdrawal. The Gleason Score was an independent risk factor for SUI at 3 months after catheter withdrawal. Additionally, UUI but not SUI might be an influencing factor for decision-making regarding postoperative radiotherapy. CONCLUSION The occurrence rate of SUI after RARP was persistently higher than that of UUI. Nearly all of the patients with UUI simultaneously had SUI. The risk factors of UUI and SUI after RARP were absolutely different.
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Affiliation(s)
- Yuke Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yue Liu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Meng Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Shiliang Wu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Gaffney CD, Ehdaie B. Thermal Partial Prostate Ablation for Intermediate- and High-risk Prostate Cancer: Con. Eur Urol Focus 2023:S2405-4569(22)00293-0. [PMID: 36604237 DOI: 10.1016/j.euf.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/25/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023]
Abstract
Thermal partial-gland ablation (TPGA) is a promising treatment option for patients with prostate cancer (PCa) that has an excellent side-effect profile. However, the literature on TPGA in high-risk PCa is not robust enough to discount the risk of undertreatment and understaging in this population. Future studies, especially with incorporation of advanced imaging to better select patients, are necessary to understand the safety and efficacy of TPGA in high-risk disease.
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Affiliation(s)
| | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Clements MB. How to present quality of life outcomes after focal therapy: using validated instruments and novel statistical methods. Curr Opin Urol 2022; 32:254-259. [PMID: 35199651 DOI: 10.1097/mou.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an up-to-date summary of widely used patient-reported measures for focal therapy quality of life outcomes and review contemporary analytic methods and recommendations for data visualization. RECENT FINDINGS Measures such as pad-use, or preferably validated instruments such as the International Consultation on Incontinence Questionnaire, MSKCC Prostate Quality of Life Survey, or Expanded Prostate Cancer Index (EPIC) should be used for urinary function assessment. Sexual Function can be assessed with the International Index of Erectile Function or EPIC, but researchers must be careful to account for patients that are not currently sexually active when analyzing outcomes. Measurement of baseline function is crucial for a meaningful understanding of post-treatment outcomes. When multiple measurements are collected, longitudinal models such as generalized estimating equations or linear mixed effects models are preferred. Whenever possible, the data visualization should mirror the hypothesis testing for clarity of interpretation, and use of restricted cubic splines or generalized additive models are preferred to illustrate non-linear trajectories in quality of life after treatment. SUMMARY Advances in both the measurement of patient quality of life with validated instruments and statistical methods have allowed for a more complete understanding and reporting of outcomes, which can be applied to the evaluation of focal therapy for prostate cancer.
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Affiliation(s)
- Matthew B Clements
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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