1
|
Farraj H, Alriyalat S. Urinary Incontinence Following Robotic-Assisted Radical Prostatectomy: A Literature Review. Cureus 2024; 16:e53058. [PMID: 38410341 PMCID: PMC10896250 DOI: 10.7759/cureus.53058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2024] [Indexed: 02/28/2024] Open
Abstract
Prostate cancer ranks as one of the most prevalent cancers among men in the United States, contributing significantly to cancer-related mortality. Robot-assisted radical prostatectomy (RARP) has become a cornerstone in the management of localized prostate cancer. This literature review delves into the outcomes of RARP, specifically its impact on urinary incontinence (UI) compared to other surgical methods. We also present the importance of patient perception versus medical reports. Recent studies and trials have unveiled that postoperative UI and erectile dysfunction (ED) remain common concerns following prostatectomy. However, studies have shown that RARP has lower occurrences of UI and ED compared to radical retropubic prostatectomy (RRP). While the choice of surgical method may not drastically affect these outcomes, the review emphasizes that urinary incontinence extends beyond physical symptoms. It profoundly impacts patients' psychological well-being, social interactions, and overall quality of life. Differences in symptom recording and interpretation between patients and healthcare professionals can significantly influence the diagnosis and treatment of prostate cancer. Enhanced patient-physician communication and patient-centered care are essential to providing a holistic approach to prostate cancer management. The choice of surgical methods may not significantly impact postoperative urinary incontinence and erectile dysfunction. Continued research and advancements in treatment and patient care are crucial for improving outcomes and the overall well-being of prostate cancer patients.
Collapse
Affiliation(s)
- Hamzeh Farraj
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
| | - Sulieman Alriyalat
- Department of Special Surgery, Division of Urology, Al-Balqa Applied University, Salt, JOR
| |
Collapse
|
2
|
Feloney MP, Klock JA, Zhang Y. Dual balloon adjustable continence therapy for urinary incontinence. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2023; 11:334-338. [PMID: 37645611 PMCID: PMC10461033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
Dual balloon adjustable continence therapy (DBACT) has emerged as a promising option for treating stress urinary incontinence. DBACT is a minimally invasive and easily reversible procedure in which two periurethral balloons are placed just distal to the bladder neck to increase bladder outflow resistance. The device is connected to a small titanium port placed under the scrotal or labial skin. The port is used for adjustment to balloon volume in the clinic setting, allowing for refinement and optimization of urinary continence. DBACT placement is typically performed under general anesthesia and is considered an outpatient procedure. Several studies have evaluated the effectiveness of DBACT in treating urinary incontinence, and the results are promising. DBACT was effective in 91% of patients who underwent the procedure, 80% reported a significant improvement in their symptoms, and 70% reported being completely dry after the procedure. DBACT is a safe procedure with few reported complications. The most common complication is mild pain or discomfort at the site of device placement, which usually resolves within a few days. Overall, DBACT is minimally invasive, adjustable, and highly successful in restoring urinary continence.
Collapse
Affiliation(s)
- Michael P Feloney
- Department of Urology, Creighton University School of MedicineOmaha, NE, USA
| | - Julie A Klock
- Creighton University School of MedicineOmaha, NE, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of MedicineWinston-Salem, NC, USA
| |
Collapse
|
3
|
Bada M, Crocetto F, Barone B, Arcaniolo D, Rapisarda S, Aliberti A, Zeccolini G, Celia A. ProACT in the management of stress urinary incontinence after radical prostatectomy. What happens after 8 years of follow up? monocentric analysis in 42 patients. J Basic Clin Physiol Pharmacol 2023; 34:49-54. [PMID: 35390245 DOI: 10.1515/jbcpp-2021-0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Stress urinary incontinence is defined by a complaint of any involuntary loss of urine on effort or physical exertion or on sneezing or coughing and represents a major complication after radical prostatectomy. According to surgical technique, incidence of post-prostatectomy incontinence varies from open (7-39.5%), laparoscopic (5-33.3%) or robotic-assisted (4-31%) approaches. The ProACT® device (Uromedica, Inc., MN) is a possible surgical option for the treatment of this condition. METHODS We retrospectively analyzed surgical records of consecutive patients underwent ProACT® implantation in our department between January 2006 to November 2010. We collected data at 6 and 12 months after surgical approach about the daily pad use, International Prostatic Symptoms Score and its quality of life domain. RESULTS 42 patients were included in the final analysis. Most patients (92.9%) received minimally invasive surgery for treating prostate cancer. During the follow up after 6 and 12 months, the daily pad, International Prostatic Symptom Score and its quality of life domain significantly improved compared to preoperative outcomes. The logistic regression analysis found that presence of comorbidities was the only predictive factor of low satisfaction rate (PGE-I > 2) in patients who underwent ProACT® implant. CONCLUSIONS ProACT® implant represents an effective and safe treatment for post-prostatectomy stress urinary incontinence with a high satisfaction degree and a low rate of complications.
Collapse
Affiliation(s)
- Maida Bada
- Department of Urology, Hospital "San Bassiano", Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Napoli (NA), Italy
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Napoli (NA), Italy
| | - Davide Arcaniolo
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131, Napoli (NA), Italy
| | - Sebastiano Rapisarda
- Department of Urology, Hospital "Pederzoli", Via Monte Baldo 24, 37019, Peschiera del Garda (VR), Italy
| | - Antonio Aliberti
- Department of Urology, Hospital "San Leonardo", ASL Napoli 3 Sud, Via Salvador Allende 68, 80053, Castellammare di Stabia (NA), Italy
| | - Guglielmo Zeccolini
- Department of Urology, Hospital "San Bassiano", Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy
| | - Antonio Celia
- Department of Urology, Hospital "San Bassiano", Via dei Lotti 40, 36061, Bassano del Grappa (VI), Italy
| |
Collapse
|
4
|
Sabbagh P, Dupuis H, Cornu JN. State of the art on stress incontinence management after benign prostatic obstruction surgery. Curr Opin Urol 2021; 31:473-478. [PMID: 34397505 DOI: 10.1097/mou.0000000000000924] [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: 11/25/2022]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence (SUI) is mostly seen after prostate surgery (radical prostatectomy or benign prostatic obstruction [BPO] relief). As new surgical techniques (laser, endoscopic enucleation) have been dramatically expanded in the past decade, a focus on postoperative SUI is necessary to provide the best management in this iatrogenic situation. RECENT FINDINGS Surgery is the main option for curative management of SUI after BPO as no oral medication is recommended. Preoperative work-up is mandatory to assess concomitant bladder dysfunction. All available surgical options (peri-urethral injections, periurethral balloons, various male slings, and artificial urinary sphincter) have been studied, but the level of evidence is very low. In this setting, SUI after BPO management is widely inspired from post-PR SUI management, mainly based on clinical experience. SUMMARY The available literature regarding persistent SUI after BPO relief is very scarce and further studies are warranted in this specific population.
Collapse
Affiliation(s)
- Paul Sabbagh
- From the Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | | | | |
Collapse
|
5
|
Bajeot AS, Brierre T, Beauval JB, Roulette P, Bordier B, Zgheib J, Huyghe É, Soulié M, Roumiguié M, Gamé X. [Survival analysis of adjustable continence therapy device (ACT®/proACT®): a new message for patients]. Prog Urol 2020; 31:215-222. [PMID: 33339737 DOI: 10.1016/j.purol.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/18/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The main purpose was to assess the failure free survival of adjustable continence therapy ACT®/proACT® after continence was obtained and to seek factors influencing it. MATERIAL AND METHODS Retrospective, single-center survival study of peri-urethral balloons implanted between 2007 and 2014. Efficacy was defined by the wearing of 0 or 1 safety pad per day. The primary end point was time to failure estimated from a survival curve (Kaplan-Meier). Factors that could influence failure free survival were: sex, age, radiotherapy, diabetes, number of pad before surgery, number of balloon inflation, early complications, mixed urinary incontinence and previous ACT®/proACT® placement. They were analyzed in a COX regression. RESULTS Of the 82 peri-urethral balloons placed, 41 were effective in 36 patients. The failure free survival was 50 % at 60 months. Radiotherapy, diabetes and previous peri-urethral balloon placement appeared to significantly decrease survival (P=0.031;P=0.025;P=0.029, respectively). Fifteen peri-urethral balloons were still effective at the last follow-up, one was lost to follow-up and 25 required re-intervention for loss of efficacy. The main cause of efficacy loss was system leakage. Fifty-two percent of peri-urethral balloons that became ineffective were replaced by new peri-urethral balloons and 28% by an artificial urinary sphincter. CONCLUSION Patients who became continent with adjustable continence therapy (ACT®/proACT®) had a 50 % new surgery probability at 5 years for a loss of efficacy. Radiotherapy seems to be the main risk factor of the efficacy loss. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- A-S Bajeot
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France.
| | - T Brierre
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - J-B Beauval
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - P Roulette
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - B Bordier
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - J Zgheib
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - É Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - M Soulié
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - M Roumiguié
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, université Paul-Sabatier Toulouse III, TSA50032, 31059 Toulouse, France
| |
Collapse
|
6
|
Efficacy and safety of adjustable balloons (Proact™) to treat male stress urinary incontinence after prostate surgery: Medium and long‐term follow‐up data of a national multicentric retrospective study. Neurourol Urodyn 2019; 38:1979-1984. [DOI: 10.1002/nau.24103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/25/2019] [Indexed: 11/07/2022]
|
7
|
Noordhoff TC, Finazzi-Agrò E, Scheepe JR, Blok BFM. Outcome and complications of adjustable continence therapy (ProACT TM ) in the treatment of urinary incontinence after transurethral resection of the prostate: A multicenter study. Neurourol Urodyn 2019; 38:1111-1119. [PMID: 30848845 PMCID: PMC6850145 DOI: 10.1002/nau.23966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/28/2018] [Accepted: 02/07/2019] [Indexed: 11/11/2022]
Abstract
Aim To evaluate the outcome of adjustable continence balloons in the treatment of stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods In two tertiary centers, adjustable continence balloons were implanted in 29 patients with post‐TURP SUI between 2007 and 2018. Endpoints of this retrospective multicenter study were patient‐reported changes in pad count and complications. Dry was defined as no pad or one security pad. Results Preoperative urinary incontinence was mild in 7 (24%), moderate in 12 (41%), and severe in 10 (35%) patients. The median follow‐up duration was 21 (interquartile range [IQR], 11‐43) months. Within 30 days postoperatively, a Clavien‐Dindo grade less than or equal to II complication occurred in 24% of the patients. Reintervention rate was 24%. Six and 12 months after implantation, the International Prostate Symptom Score (IPSS) quality‐of‐life item improved significantly from 5 (IQR, 5‐6) preoperatively to 3 (IQR, 1‐4.5) and 1 (IQR, 0‐3), respectively. At last visit (median 21 months after implantation), the outcome on continence had improved in 76% of the patients, including, 45% dry patients. After a median follow‐up of 28 months (IQR, 13‐63; N = 23), all but one patient reported improvement on the Patient Global Impression of Improvement (PGI‐I) scale. In detail, 10 patients reported “very much better” condition compared with before the implantation, 10 patients “much better,” two patients “a little better,” and one patient “no change.” Daily pad use decreased from three (IQR, 2‐5) to one (IQR, 0‐2) pads/day (P < 0.001). Conclusions This is hitherto, the first study reporting results of adjustable continence balloons in the treatment of post‐TURP SUI. The therapy was found to be safe and efficient. The majority of our study population reported improvement on their condition and greater than or equal to 50% reduction in daily pad use.
Collapse
Affiliation(s)
- Toscane C Noordhoff
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Enrico Finazzi-Agrò
- Department of Eperimental Medicine and Surgery, University of Rome "Tor Vergata", Urology Unit, Policlinico Tor Vergata, Rome, Italy
| | - Jeroen R Scheepe
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|