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Kominsky HD, Awad MA, Farhi J, Gahan JC, Cadeddu JA. Retzius-sparing vs. posterior urethral suspension: similar early-phase post-robotic radical prostatectomy continence outcomes. J Robot Surg 2024; 18:64. [PMID: 38315436 DOI: 10.1007/s11701-023-01754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/07/2023] [Indexed: 02/07/2024]
Abstract
Stress urinary incontinence (SUI) is a risk of robotic-assisted radical prostatectomy (RP) which can be a frustrating problem for both surgeons and patients. We aim to compare short-term continence outcomes between patients undergoing Retzius Sparing RP (RS-RP) and those undergoing standard RP with the inclusion of a PUS suture technique and suprapubic tube (PUS-RP). A retrospective review of 105 consecutive patients who underwent RP was performed, comparing patients who underwent RS-RP and PUS-RP. Our main outcome was pad usage as a surrogate for SUI. Patients were evaluated 4 weeks following RP and again at approximately 3 months. Continence was defined as no pad usage or up to one safety pad per day. Risk factors associated with not being continent were identified using univariate and multivariate analyses. In our cohort, 52 patients underwent RS-RP and 53 patients underwent PUS-RP. The two groups had similar patient demographics. Although not statistically significant, there was a higher rate of a positive surgical margin in the RS-RP compared to PUS-RP (25% vs 15%, p = 0.204). At one month follow-up for PUS-RP and RS-RP, there was no significant difference in the frequency of continent men (69.2% vs. 76.9%, p = 0.302). At 3-month follow-up for the two groups of patients, again, there was no significant difference in the frequency of continence for PUS-RP and RS-RP (86.2% vs 88%, p = 0.824). Patients who underwent RS-RP had similar rates of continence to those patients undergoing PUS-RP in the short-term post-operative period.
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Affiliation(s)
- Hal D Kominsky
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Mohannad A Awad
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Jacques Farhi
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA.
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Zazzara M, Gardiman MP, Dal Moro F. The bladder neck preservation in robot assisted radical prostatectomy: Surgical and pathological outcome. Arch Ital Urol Androl 2023; 95:12138. [PMID: 38193218 DOI: 10.4081/aiua.2023.12138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. AIM The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. MATERIALS AND METHODS Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. RESULTS According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. CONCLUSIONS The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncological procedure resulting in a good functional outcome, about post-prostatectomy continence, working on two anatomic components responsible for post-prostatectomy continence. The bladder neck PSM are linked to neoplasia with adverse pathological features, rather than the bladder neck preservation.
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Affiliation(s)
- Michele Zazzara
- Urology Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua, Padua.
| | - Marina P Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua.
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua, Padua.
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Yu C, Yao J, He Y, Huang J, Chen M, Qian M, Lou D, Zhou Z, Chen F. Effects of surgery versus radiotherapy in patients with localized prostate cancer in terms of urinary, bowel, and sexual domains. Cancer Med 2023; 12:18176-18188. [PMID: 37519062 PMCID: PMC10524086 DOI: 10.1002/cam4.6395] [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: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with localized prostate cancer (LPCa) after treatment mainly surgery and radiotherapy (RT) has received increasing attention. The aim of this study is to compare the HRQoL of LPCa after surgery and RT. METHODS Web of Science, Embase, PubMed and Cochrane databases were searched after January 2000 to observe the HRQoL scores after surgery and RT at different treatment time points. RESULTS A total of 28 studies were included in this study, and the results showed that LPCa received surgery had better bowel scores than RT at ≤3 (weighted mean differences [WMD] = 4.18; p = 0.03), 3-6 (WMD = 4.16; p < 0.001), 6-12 (WMD = 2.99; p = 0.004), 24-60 (WMD = 1.87; p = 0.06), and ≥60 (WMD = 4.54; p = 0.02) months. However, LPCa received RT had higher urinary scores at ≤3 (WMD = -7.39; p = 0.02), 3-6 (WMD = -6.03; p = 0.02), 6-12 (WMD = -4.90; p < 0.001), 24-60 (WMD = -3.96; p < 0.001), ≥60 (WMD = -2.95; p < 0.001) months and had better sexual scores at ≤3 (WMD = -13.58; p = 0.09), 3-6 (WMD = -12.32; p = 0.06), 6-12 (WMD = -12.03; p = 0.002), 24-60 (WMD = -11.29; p < 0.001), and ≥60 (WMD = -3.10; p = 0.46) months than surgery. The scores difference between surgery and RT decreased over time. CONCLUSION Overall, for LPCa, surgery was associated with better HRQoL in the bowel domain, whereas RT was associated with better HRQoL in the urinary and sexual domains, with the difference between surgery and RT narrowing over time.
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Affiliation(s)
- Chao Yu
- Department of Urology, Ningbo Medical Center LiHuiLi HospitalNingbo UniversityNingboChina
| | - Jie Yao
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Yujing He
- The Second Clinical Medical CollegeZhejiang Chinese Medical UniversityHangzhouChina
| | - Jianing Huang
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Meiling Chen
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Mingxia Qian
- School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dandi Lou
- The First Clinical Medical CollegeZhejiang Chinese Medical UniversityHangzhouChina
| | - Zhizhen Zhou
- School of Public HealthZhejiang Chinese Medical UniversityHangzhouChina
| | - Feng Chen
- Urology DepartmentNingbo Yinzhou No. 2 HospitalNingboChina
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Zhang H, Ning Z, Jia G, Zhang G, Wang J, Liu H, Tao B, Wang C. Modified hood technique for single-port robot-assisted radical prostatectomy contributes to early recovery of continence. Front Surg 2023; 10:1132303. [PMID: 37206347 PMCID: PMC10189123 DOI: 10.3389/fsurg.2023.1132303] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Background and purpose Urinary incontinence is one of the common side effects of robot-assisted radical prostatectomy (RARP). Here, we described the modified Hood technique for single-port RARP (sp-RARP) and assessed the interest of this new technique for early continence recovery. Methods We retrospectively reviewed 24 patients who underwent sp-RARP modified hood technique from June 2021 to December 2021. The pre-and intraoperative variables, postoperative functional and oncological outcomes of patients were collected and analyzed. The continence rates were estimated at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal. Continence was defined as wearing no pad over a 24 h period. Results Mean time of operation and estimated blood loss were 183 min and 170 ml, respectively. The postoperative continence rates at 0 day, 1 week, 4 weeks, 3 months and 12 months after catheter removal were 41.7%, 54.2%, 75.0%, 91.7% and 95.8%, respectively. There were two patients who detected positive surgical margins and no patients observed complications requiring further treatment. Conclusion The modified hood technique is a safe and feasible method that provides better outcomes in terms of early return of continence, without increasing estimated blood loss and compromising oncologic outcomes.
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Affiliation(s)
- Haoxun Zhang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zikuan Ning
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guang Jia
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guoling Zhang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiuliang Wang
- Department of Operating Room, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hua Liu
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Chunyang Wang
- Department of Urology, First Affiliated Hospital of Harbin Medical University, Harbin, China
- Correspondence: Chunyang Wang
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Investigating the mechanism underlying urinary continence using dynamic MRI after Retzius-sparing robot-assisted radical prostatectomy. Sci Rep 2022; 12:3975. [PMID: 35273228 PMCID: PMC8913653 DOI: 10.1038/s41598-022-07800-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) exhibits better postoperative urinary continence than conventional RARP (C-RARP) via the anterior approach. However, the reasons behind this are unknown. Herein, early postoperative urinary incontinence and anatomical differences of 51 propensity score-matched C-RARP and RS-RARP cases were compared. Dynamic magnetic resonance imaging (MRI) was performed before and after surgery to examine the pelvic anatomical changes under abdominal pressure. The median urine loss ratios in the early postoperative period after C-RARP and RS-RARP were 11.0% and 1.0%, respectively. Postoperative MRI revealed that the anterior bladder wall was fixed in a higher position after RS-RARP compared with its position after C-RARP. Dynamic MRI after C-RARP showed that cephalocaudal compression of the bladder while applying abdominal pressure caused the membranous urethra to expand and the urine to flow out. After RS-RARP, the rectum moved forward during abdominal pressure, and the membranous urethra was compressed by closure from behind. This is the first study using dynamic MRI to reveal the importance of high attachment of the anterior bladder wall for the urethral closure mechanism during abdominal pressure. RS-RARP, which can completely preserve this mechanism, is less likely to cause stress urinary incontinence compared with C-RARP.
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Colarieti A, Thiruchelvam N, Barrett T. Evaluation of image-based prognostic parameters of post-prostatectomy urinary incontinence: A literature review. Int J Urol 2021; 28:890-897. [PMID: 34101272 DOI: 10.1111/iju.14609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/04/2021] [Indexed: 12/18/2022]
Abstract
Prostate cancer is the second most common male cancer, and radical prostatectomy is a highly effective treatment for intermediate and high-risk disease. However, post-prostatectomy urinary incontinence remains a major functional side-effect in patients undergoing radical prostatectomy. Despite recent improvements in preoperative imaging quality and surgical techniques, it remains challenging to predict or prevent occurrence of this complication. The aim of this research was to review the current published literature on pre- and postoperative imaging evaluation of the prostate and pelvic structures, to identify added value in the prediction of post-prostatectomy urinary incontinence. A computerized bibliographic search of the PubMed library was carried out to identify imaging-based articles evaluating the pelvic floor and surrounding structures pre- and/or postradical prostatectomy to predict post-prostatectomy urinary incontinence. A total of 32 articles were included. Of these, 29 papers assessed the importance of magnetic resonance imaging evaluation, with a total of 16 parameters evaluated. The most common parameters were intravesical protrusion, the membranous urethral length, prostatic volume and periurethral fibrosis. Preoperative membranous urethral length and its preservation after surgery showed the strongest correlation with urinary incontinence. Three studies evaluated ultrasound, with all carried out postoperatively. This technique benefits from a dynamic evaluation, and the results are promising for proximal urethral hypermobility and the degree of bladder neck funneling on the Valsalva maneuver. Several imaging studies evaluated the predictors of post-prostatectomy urinary incontinence, with preoperative membranous urethral length offering the most promise. However, the current literature is limited by the single-center nature of studies, and the heterogeneity in patient populations and methodologies used.
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Affiliation(s)
- Anna Colarieti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nikesh Thiruchelvam
- Department of, Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of, Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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7
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Muñoz-Calahorro C, García-Sánchez C, Barrero-Candau R, García-Ramos JB, Rodríguez-Pérez AJ, Medina-López RA. Anatomical predictors of long-term urinary incontinence after robot-assisted laparoscopic prostatectomy: A systematic review. Neurourol Urodyn 2021; 40:1089-1097. [PMID: 33851426 DOI: 10.1002/nau.24652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
AIMS There is scarce evidence of anatomical risk factors that might affect long-term post-prostatectomy incontinence (PPI) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). This systematic review aims to identify anatomical measurements in preoperative magnetic resonance imaging (MRI) that might be associated with increased risk of urinary incontinence (UI) 1 year after RALP. METHODS A comprehensive search on Pubmed and Scopus databases up to November 2020 was performed. Eight articles met the inclusion criteria and were finally selected. RESULTS The selected studies included 1146 patients. Seven articles focused on membranous urethral length (MUL); all of them related MUL to long-term PPI in univariate analysis and five of them in multivariate analysis. Four studies presented MUL difference to measure the magnitude of the effect. Average MUL (mm) was 15.9 (SD, 2.6), 16.1 (95% confidence interval [CI]: 13.9-18.9), 12.1 (95% CI 9.7-14.9) and 14.5 in continent patients and 13.9 (SD, 2.9), 10 (95% CI: 8.7-12.1), 10.3 (95% CI: 8.7-12.4) and 9.3 in incontinent patients, with statistically significant differences in all cases. Five studies presented the odds ratio as a result; although there was substantial heterogeneity in the methods used to obtain it, there was consistency in finding an inverse association between MUL and PPI. Other measurements including prostatic-urethral angle, membranous urethral thickness, intraprostatic urethral length and intravesical prostatic protrusion have been reported in few studies, and no association with long-term PPI was found. Levator ani muscle thickness was related to long-term PPI in one article. CONCLUSION Greater MUL on preoperative MRI is associated with lower risk of UI 1 year after RALP.
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8
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Retrotrigonal muscular layer sling associated with total anatomical reconstruction in robot-assisted radical prostatectomy and early continence. World J Urol 2020; 39:2475-2481. [PMID: 33112984 DOI: 10.1007/s00345-020-03500-9] [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: 06/09/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Urinary continence (UC) represents the main non-oncological goal in patients undergoing robotic-assisted radical prostatectomy (RARP). To evaluate the efficacy in early UC achievement, we described a new sling technique using the retrotrigonal muscular layer (TZ sling) combined with total anatomical reconstruction (TAR). PATIENTS AND METHODS We prospectively enrolled 407 consecutive prostate cancer (PC) patients undergoing RARP between May 2017 and January 2020. The first 250 patients underwent only TAR, while the following 157 patients TAR + TZ sling, by isolating and anchoring the retrotrigonal muscular layer to the pubic bone with 2 bilateral sutures. We defined UC as ≤ 1 pad/die, which was assessed after catheter removal at 1, 4 and 12wk using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. Sling-related operative time and post-operative complications were analyzed. RESULTS In the TAR group, the UC rates at the 1, 4 and 12wk were 58%, 66% and 86%; in the TAR + TZ sling group 72%, 76% and 88%, respectively. A statistically significant difference was observed in the two groups at 1wk (p = 0.0049) and 4wk (p = 0.035) favoring the TZ sling surgical strategy. This difference in UC rates was lost at 12wk (p ≥ 0.05). No statistically significant differences in operative time, acute urinary retentions and other complication rates were observed between the two groups (p = NS). CONCLUSIONS We have described a new, safe, feasible modification of RARP using a sling with the retrotrigonal muscular layer associated with TAR. We have demonstrated a statistically significant improvement in early UC rate in patients who are undergoing TAR and TZ sling compared to undergoing only TAR.
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Cestari A, Zanni G, Fabbri F, Sozzi F, Ghezzi M, Rigatti P. Proper 6-branch suburethral autologous sling tensioning during robotic assisted radical prostatectomy with the intraopeartive use of retrograde perfusion sphincterometry: the technique. J Robot Surg 2020; 15:603-609. [PMID: 32986172 DOI: 10.1007/s11701-020-01148-6] [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: 06/24/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
The aim of this paper is to describe our surgical technique and results of proper 6-branch autologous sling tensioning during RALP employing intraoperatively the Retrograde Perfusion Sphincterometry (RPS). Between May 2016 and February 2020, 374 patients underwent RALP with the 6-branch suburethral autologous sling tensioned under intraoperative guidance of RPS. Surgical procedure: Retrograde Leak Point pressure (RLPP) was evaluated by means of RPS after pneumoperitoneum induction (RLPPp), after urethrovescical anastomosis (RLPPa) and during proper sling tensioning (RLPPs). The goal of the sling tensioning was to obtain at the end of the procedure similar pressures as after pneumoperitoneum induction (RLPPs ≅ RLPPp). Intraoperative variables, postoperative complications, and continence recovery outcomes were assessed. A descriptive statistical analysis was performed. Sling positioning and tensioning was feasible in all patients. Mean operative time was 215 min. Proper sling tensioning allowed for the possibility to restore sphincteric efficacy to preoperative value (RLPPs vs. RLPPp (42.5 vs. 42.6) cmH2O). Urinary continence was achieved, respectively, in 58%, 67%, 74%, 88% and 92% of patients after 24 h, 10 days, 1 month, 6 months and 1 year after catheter removal. In conclusion, RPS revealed a valid option for proper autologous 6-branch sling tensioning during RALP, offering the possibility to restore sphincteric apparatus efficiency to its preoperative status to improve EUC.
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Affiliation(s)
- Andrea Cestari
- Department of Urology - Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Giuseppe Zanni
- Department of Urology - Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabio Fabbri
- Department of Urology - Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Francesco Sozzi
- Department of Urology - Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Ghezzi
- Department of Urology - Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Patrizio Rigatti
- Department of Urology - Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Hodges PW, Stafford RE, Hall L, Neumann P, Morrison S, Frawley H, Doorbar-Baptist S, Nahon I, Crow J, Thompson J, Cameron AP. Reconsideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy. Urol Oncol 2019; 38:354-371. [PMID: 31882228 DOI: 10.1016/j.urolonc.2019.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/08/2019] [Accepted: 12/02/2019] [Indexed: 01/20/2023]
Abstract
Urinary incontinence is common after radical prostatectomy. Pelvic floor muscle training provides a plausible solution. Although early trials provided promising results, systematic reviews have questioned the efficacy of this intervention. A major consideration is that most clinical trials in men have applied principles developed for pelvic floor muscle training for stress urinary incontinence in women, despite differences in anatomy between sexes and differences in the mechanisms for continence/incontinence. Literature regarding continence control in men has been conflicting and often based on erroneous anatomy. New understanding of continence mechanisms in men, including the complex contribution of multiple layers of striated pelvic floor muscles, and detailed consideration of the impact of radical prostatectomy on continence anatomy and physiology, have provided foundations for a new approach to pelvic floor muscle training to prevent and treat incontinence after prostatectomy. An approach to training can be designed to target the pathophysiology of incontinence. This approach relies on principles of motor learning and exercise physiology, in a manner that is tailored to the individual patient. The aims of this review are to consider new understanding of continence control in men, the mechanisms for incontinence after radical prostatectomy, and to review the characteristics of a pelvic floor muscle training program designed to specifically target recovery of continence after prostatectomy.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Ryan E Stafford
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Hall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | | - Shan Morrison
- Women's and Men's Health Physiotherapy, Melbourne, Australia
| | | | | | | | - Jason Crow
- Active Rehabilitation, Brisbane, Australia
| | | | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, MI
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Lakhoo J, Khatri G, Elsayed RF, Chernyak V, Olpin J, Steiner A, Tammisetti VS, Sundaram KM, Arora SS. MRI of the Male Pelvic Floor. Radiographics 2019; 39:2003-2022. [PMID: 31697623 DOI: 10.1148/rg.2019190064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The pelvic floor is a complex structure that supports the pelvic organs and provides resting tone and voluntary control of the urethral and anal sphincters. Dysfunction of or injury to the pelvic floor can lead to gastrointestinal, urinary, and sexual dysfunction. The prevalence of pelvic floor disorders is much lower in men than in women, and because of this, the majority of the published literature pertaining to MRI of the pelvic floor is oriented toward evaluation of the female pelvic floor. The male pelvic floor has sex-specific differences in anatomy and pathophysiologic disorders. Despite these differences, static and dynamic MRI features of these disorders, specifically gastrointestinal disorders, are similar in both sexes. MRI and MR defecography can be used to evaluate anorectal disorders related to the pelvic floor. MRI can also be used after prostatectomy to help predict the risk of postsurgical incontinence, to evaluate postsurgical function by using dynamic voiding MR cystourethrography, and subsequently, to assess causes of incontinence treatment failure. Increased tone of the pelvic musculature in men secondary to chronic pain can lead to sexual dysfunction. This article reviews normal male pelvic floor anatomy and how it differs from the female pelvis; MRI techniques for imaging the male pelvis; and urinary, gastrointestinal, and sexual conditions related to abnormalities of pelvic floor structures in men.Online supplemental material is available for this article.©RSNA, 2019.
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Affiliation(s)
- Janesh Lakhoo
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Gaurav Khatri
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Rania F Elsayed
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Victoria Chernyak
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Jeffrey Olpin
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Ari Steiner
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Varaha S Tammisetti
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Karthik M Sundaram
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
| | - Sandeep S Arora
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave South, CCC1121, Nashville, TN 37232 (J.L., K.M.S., S.S.A.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.); Department of Radiology, Faculty of Medicine, Cairo University Hospitals, Cairo, Egypt (R.F.E.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology, University of Utah School of Medicine, Salt Lake City, Utah (J.O.); Department of Radiology, South Nassau Communities Hospital, Oceanside, NY (A.S.); and Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center at Houston, Houston, Tex (V.S.T.)
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12
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Sauer M, Tennstedt P, Berliner C, Well L, Huland H, Budäus L, Adam G, Beyersdorff D. Predictors of short and long term urinary incontinence after radical prostatectomy in prostate MRI: Significance and reliability of standardized measurements. Eur J Radiol 2019; 120:108668. [DOI: 10.1016/j.ejrad.2019.108668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/29/2022]
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13
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Zattoni F, Artibani W, Patel V, Montorsi F, Porpiglia F, Hampton LJ, Rocco B, Dasgupta P, Hemal AK, Mottrie A, Tewari A, Dal Moro F. Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy. MINERVA UROL NEFROL 2019; 71:324-338. [DOI: 10.23736/s0393-2249.19.03395-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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14
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Ha HK, Luiting HB, Graham PL, Patel MI, Sandhu JS, Akin O, Mungovan SF. Three novel methods to measure the postoperative displacement of lower urinary tract structures following radical prostatectomy in a sample of Korean patients. BMC Urol 2019; 19:54. [PMID: 31215416 PMCID: PMC6582582 DOI: 10.1186/s12894-019-0472-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is a change in the position of the remaining anatomical structures of the lower urinary tract system following radical prostatectomy. The aims of this investigation were to describe three novel methods used to measure the displacement of i) the vesico-urethral junction (VUJ), proximal membranous urethra (PMU) and anorectal junction (ARJ) and ii) the VUJ angle of displacement in men following radical prostatectomy and determine their intra- and interrater reliability. METHODS Retrospective comparative measurement of twenty pre- and postoperative MRI scans was undertaken by one observer on two separate occasions and on one occasion by another observer. Three standardized midsagittal pelvimetry reference lines were used to describe three X, Y axis measurement systems. The displacement (mm) of the VUJ, PMU and ARJ, and the angle of displacement (degrees) of the VUJ was measured for each of the three methods. Interrater reliability of VUJ, PMU and ARJ displacement and the VUJ angle of displacement measurements was assessed using a two-way mixed-effects agreement intra-class correlation coefficient (ICC) with 95% confidence intervals (CI). Test-retest (intrarater) reliability was calculated using a two-way random effects consistency ICC with 95% CI for all displacement measures of the VUJ, PMU and ARJ for one observer between two days. RESULTS The pubococcygeal line (PCL) axis measurement system demonstrated good to excellent intrarater and interrater reliability (ICC 95% interval lower bound > 0.75) for the VUJ and PMU displacement and the VUJ angle of displacement measurements. Other measurement systems were less reliable and more variable. CONCLUSIONS In this sample of 20 Korean patients with median prostate volume 27.5 mL and maximum volume 70 mL, the measurement methodology using the PCL consistently demonstrated good to excellent reliability and the lowest variability for the measurement of the displacement of the VUJ and PMU and the VUJ angle of displacement. The PCL methodology is recommended as the method of choice. Further studies should validate these results in patients with large prostate volumes.
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Affiliation(s)
- Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Busan, South Korea.,Pusan National University School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Henk B Luiting
- The Clinical Research Institute, Sydney, Australia.,Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie University, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Jaspreet S Sandhu
- Urology Service, Department of Surgery, Memorial Sloan- Kettering Cancer Center, New York, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan- Kettering Cancer Center, New York, USA
| | - Sean F Mungovan
- The Clinical Research Institute, Sydney, Australia. .,Westmead Private Physiotherapy Services, Westmead Private Hospital, Suite 6, 16-18 Mons Road, Westmead, NSW, 2145, Australia. .,Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia.
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15
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Manfredi M, Fiori C, Amparore D, Checcucci E, Porpiglia F. Technical details to achieve perfect early continence after radical prostatectomy. MINERVA CHIR 2019; 74:63-77. [DOI: 10.23736/s0026-4733.18.07761-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Sridhar AN, Abozaid M, Rajan P, Sooriakumaran P, Shaw G, Nathan S, Kelly JD, Briggs TP. Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer. Curr Urol Rep 2018; 18:71. [PMID: 28718165 PMCID: PMC5514172 DOI: 10.1007/s11934-017-0717-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose of Review A variety of different surgical techniques are thought to impact on urinary continence (UC) recovery in patients undergoing robot assisted radical prostatectomy (RARP) for prostate cancer. Herein, we review current evidence and propose a composite evidence-based technique to optimize UC recovery after RARP. Recent Findings A literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. The available data from studies ranging from randomized control trials to retrospective cohort studies suggest that minimizing damage to the internal and external urinary sphincters and their neural supply, maximal sparing of urethral length, creating a secure vesicourethral anastomosis, and providing anterior and posterior myo- fascio-ligamentous support to the anastomosis can improve early UC recovery post RARP. Summary A composite evidence-based surgical technique incorporating the above principles could optimize early UC recovery post RARP. Evidence from randomized studies is required to prove benefit.
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Affiliation(s)
- Ashwin N. Sridhar
- Department of Urology, University College London Hospital, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Mohammed Abozaid
- Department of Urology, University College London Hospital, London, UK
| | - Prabhakar Rajan
- Department of Urology, University College London Hospital, London, UK
| | - Prasanna Sooriakumaran
- Department of Urology, University College London Hospital, London, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, UK
| | - Senthil Nathan
- Department of Urology, University College London Hospital, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - John D. Kelly
- Department of Urology, University College London Hospital, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Tim P Briggs
- Department of Urology, University College London Hospital, London, UK
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17
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Argun OB, Tuna MB, Doganca T, Obek C, Mourmouris P, Tufek I, Erdogan S, Cetinel B, Kural AR. Prevention of Urethral Retraction with Stay Sutures (PURS) During Robot-Assisted Radical Prostatectomy Improves Early Urinary Control: A Prospective Cohort Study. J Endourol 2018; 32:125-132. [DOI: 10.1089/end.2017.0460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omer Burak Argun
- Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Tunkut Doganca
- Department of Urology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Can Obek
- Department of Urology, Acibadem Taksim Hospital, Istanbul, Turkey
| | - Panagiotis Mourmouris
- 2nd Urology Department, Athens Medical School, Sismanogleio General Hospital, University of Athens, Athens, Greece
| | - Ilter Tufek
- Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Sarper Erdogan
- Department of Public Health and Occupational Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bulent Cetinel
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Rıza Kural
- Department of Urology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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18
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Cestari A, Soranna D, Zanni G, Zambon A, Zanoni M, Sangalli M, Ghezzi M, Fabbri F, Sozzi F, Dell'Acqua V, Rigatti P. Intraoperative Retrograde Perfusion Sphincterometry to Evaluate Efficacy of Autologous Vas Deferens 6-Branch Suburethral Sling to Properly Restore Sphincteric Apparatus During Robot-Assisted Radical Prostatectomy. J Endourol 2017; 31:878-885. [DOI: 10.1089/end.2017.0250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Cestari
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Davide Soranna
- Department of Statistics and Quantitative Methods, Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Zanni
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Istituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
| | - Matteo Zanoni
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Mattia Sangalli
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Ghezzi
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Fabio Fabbri
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Francesco Sozzi
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Vincenzo Dell'Acqua
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Patrizio Rigatti
- Department of Urology, Advanced Urotechnology Center, IRCCS Istituto Auxologico Italiano, Milan, Italy
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19
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Jiang YH, Hong YL, Kuo HC. Urodynamic changes in patients with prostate cancer undergoing robotic-assisted radical prostatectomy: A comparison with laparoscopic radical prostatectomy. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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20
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Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review. Eur Urol 2017; 71:936-944. [DOI: 10.1016/j.eururo.2016.09.031] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/16/2016] [Indexed: 11/18/2022]
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21
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Simple vs six-branches autologous suburethral sling during robot-assisted radical prostatectomy to improve early urinary continence recovery: prospective randomized study. J Robot Surg 2017; 11:415-421. [PMID: 28078523 DOI: 10.1007/s11701-017-0672-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
We have recently described the use of a retropubic suburethral autologous sling created and placed during robotic radical prostatectomy (RARP). In this study, we assess the effectiveness of newly designed six-branches compared to two-branches suburethral autologous sling in improving early urinary continence (UC) recovery. 120 patients submitted to RARP were prospectively randomized according to the intraoperative positioning of six-branches (group 1, n = 60) or two-branches autologous sling (group 2, n = 60) obtained by different configuration of a same tract of vas deferens removed. Early UC recovery was assessed at 5 (catheter removal), 10 and 30 days postoperatively through the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. UC was defined as the non-use of pad. Chi square test and Wilcoxon test were used to investigate UC recovery between the two groups. Moreover, post-voiding residual was evaluated in each patient at the same time. At catheter removal, UC rate was in groups 1 and 2, 60 and 35% (p = 0.02); at 10 days 70 and 46% (p = 0.03); at 30 days 87 and 70% (p = 0.04), respectively. One patient in group 1 experienced acute urinary retention at the time of catheter removal and was treated uneventfully with a further 7-day catheterization. These preliminary data indicate that newly designed six-branches suburethral autologous sling is able to increase the rate of early UC recovery compared to the two-arms sling previously described by us.
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22
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Canvasser NE, Lay AH, Koseoglu E, Morgan MS, Cadeddu JA. Posterior Urethral Suspension During Robot-Assisted Radical Prostatectomy Improves Early Urinary Control: A Prospective Cohort Study. J Endourol 2016; 30:1089-1094. [DOI: 10.1089/end.2016.0220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Noah E. Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron H. Lay
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ersin Koseoglu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Monica S.C. Morgan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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23
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Soljanik I, Brocker K, Solyanik O, Stief CG, Anding R, Kirschner-Hermanns R. [Imaging for urinary incontinence]. Urologe A 2015; 54:963-71. [PMID: 26162272 DOI: 10.1007/s00120-015-3872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ultrasonography and functional cine magnetic resonance imaging (MRI) are noninvasive and x-ray free tools, which are currently widely used in clinical diagnostics and scientific research of male and female urinary incontinence. The increasing use and improving techniques of modern imaging tools are closely linked to rapid development of minimally invasive surgery in patients with urinary incontinence and insights gained in continence mechanisms. METHODS Whereas ultrasonography is a cost-efficient and readily available diagnostic tool for a routine use, the more expensive functional MRI, as a tool with more precise visualization of functional interactions and spatial representation of anatomical structures of the pelvic floor, is suitable for complex diagnostic purposes and scientific research. Both tools are already well established for evaluations of the female pelvic floor. For evaluation of the male pelvic floor, and in particular postprostatectomy incontinence, perineal ultrasonography and functional cine MRI are becoming increasingly evident. CONCLUSION Further development of both imaging tools will contribute to new insights into the continence mechanism and improve the techniques of radical prostatectomy and minimally invasive surgery of male and female urinary incontinence in the future.
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Affiliation(s)
- I Soljanik
- Neuro-Urologie, Klinik für Paraplegiologie, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universität Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland,
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24
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Momozono H, Miyake H, Miyazaki A, Fujisawa M. Significance of urethral fibrosis evaluated by preoperative magnetic resonance imaging as a predictor of continence status after robot-assisted radical prostatectomy. Int J Med Robot 2015; 12:496-501. [DOI: 10.1002/rcs.1673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Hiroyuki Momozono
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| | - Hideaki Miyake
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| | - Akira Miyazaki
- Division of Urology; Kobe University Graduate School of Medicine; Japan
| | - Masato Fujisawa
- Division of Urology; Kobe University Graduate School of Medicine; Japan
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