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Geraghty K, Keane K, Davis N. Systematic review on urinary continence rates after robot-assisted laparoscopic radical prostatectomy. Ir J Med Sci 2024; 193:1603-1612. [PMID: 38200383 PMCID: PMC11128392 DOI: 10.1007/s11845-023-03603-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The objective was to investigate the current evidence and discern urinary continence rates post robot-assisted laparoscopic radical prostatectomy (RALP). METHODS A systematic review of the literature was carried out, searching the Embase, Scopus and PubMed databases between 1 January 2000 and 1 May 2020. The search terms "Robotic prostatectomy AND continence" were employed. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Statistical analysis was performed using the programme R; cumulative analysis of percentage of men continent was calculated. RESULTS A total of 3101 abstracts and 50 full text articles were assessed, with 22 publications included (n = 2813 patients). There were 21 randomised controlled trials and one partly randomised controlled trial with four publications comparing RALP to other prostate cancer treatments. Thirteen studies explored different RALP techniques, and five studies examined vesicourethral anastomosis (VUA). There were statistically significant improvements in early urinary continence rates in three studies analysing reconstructive techniques (83% vs 60%, p = 0.04; 26.5% vs 15.4%, p = 0.016; 77% vs 44.1%, p ≤ 0.001). Long-term continence rates were not significantly improved across all studies assessing reconstruction. One study comparing RALP vs laparoscopic radical prostatectomy (LRP) demonstrated a statistically significant improvement in continence at 3 months (80% vs 73.3%, p < 0.001); 6 months (83.3% vs 81.4%, p < 0.001); 12 months (95% vs 83.3%, p < 0.001) and 24 months (96.7% vs 85%, p < 0.001). Early continence was less favourable for RALP when compared to brachytherapy (BT) patients at 3 months (86% vs 98.7%, p < 0.05) and 6 months (90.5% vs 98.7%, p < 0.05). CONCLUSION Early continence rates were improved across numerous techniques in RALP. These results were not translated into significantly improved long-term outcomes. Continence rates following RALP were favourable compared to LRP, similar to ORP and less favourable compared to BT. Our findings suggest that post-RALP continence can be further improved with alterations in robotic technique.
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Affiliation(s)
| | - Kevin Keane
- Urology Department, Beaumont Hospital, Dublin, Ireland
| | - Niall Davis
- Urology Department, Beaumont Hospital, Dublin, Ireland
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Comparison of Different Invasive Devices for the Treatment of Urinary Incontinence after Radical Prostatectomy. Adv Urol 2022; 2022:8736249. [PMID: 35774194 PMCID: PMC9239822 DOI: 10.1155/2022/8736249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare different forms of invasive treatments for postradical prostatectomy (RP) urinary incontinence (UI) in terms of quantitative and qualitative parameters and continence recovery rate. Methods We distinguished five categories of treatment: A = bulking agents, B = fixed slings, C = adjustable slings, D = circumferential compressor devices (artificial sphincter), and E = noncircumferential compressor devices (ProACT). A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across groups at postoperative follow-up. We compared the available treatment arms using standardized mean difference (SMD) and event rate (ER) for questionnaire results, number of pads/day, and percentage of pad-free patients. Evidence synthesis. 36 clinical trials were selected. At baseline, in the different populations, mean number of pad-day varied from 1.1 to 8.8, 24-hour pad weight varied extremely from 17.3 g to 747.0 g, and mean ICIQ-UI-SF questionnaire score varied from 4.8 to 18.6. Considering a random effect model among eligible studies, ER of continence recovery was 0.33 (95% CI −0.12–0.78), 0.63 (95% CI 0.55–0.71), 0.65 (95% CI 0.58–0.72), 0.50 (95% CI 0.34–0.66), and 0.53 (95%CI 0.36–0.70), respectively, in groups A, B, C, D, and E (I2 85.87%; Q 249.82—P > 0.01) (test of group differences P=0.22). Conclusion In our analysis, the use of adjustable and fixed slings is associated with the highest whereas the use of bulking agents is associated with the lowest recovery rate of continence after treatment. Results are conditioned by an elevated rate of heterogeneity in part explained with a high variability of consistence in urinary leakage at baseline among populations.
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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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Averbeck MA, Marcelissen T, Anding R, Rahnama'i MS, Sahai A, Tubaro A. How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S119-S126. [PMID: 31821626 DOI: 10.1002/nau.23972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023]
Abstract
AIMS To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). METHODS This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" RESULTS Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. CONCLUSIONS Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
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Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Mohammad S Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University 2nd School of Medicine, Sant Andrea Hospital, Rome, Italy
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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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Lombardo R, Bosch JLHR, Burkhard FC, Tubaro A. Re: A Randomized Study of Intraoperative Autologous Retropubic Urethral Sling on Urinary Control After Robotic Assisted Radical Prostatectomy. Eur Urol 2018; 73:980-981. [PMID: 29429803 DOI: 10.1016/j.eururo.2018.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea 'Sapienza' University of Rome, Rome, Italy.
| | - J L H Ruud Bosch
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fiona C Burkhard
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant'Andrea 'Sapienza' University of Rome, Rome, Italy
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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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