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García Cortés Á, Colombás Vives J, Gutiérrez Castañé C, Chiva San Román S, Doménech López P, Ancizu Marckert FJ, Hevia Suárez M, Merino Narro I, Velis Campillo JM, Guillén Grima F, Torres Roca M, Diez-Caballero Y Alonso F, Rosell Costa D, Villacampa Aubá F, de Fata Chillón FR, Andrés Boville G, Barbas Bernardos G, Miñana López B, Robles García JE, Pascual Piédrola JI. Comparison of surgical approaches to radical prostatectomy in our series beyond oncological and functional outcomes. Actas Urol Esp 2022; 46:275-284. [PMID: 35260370 DOI: 10.1016/j.acuroe.2021.12.001] [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: 10/27/2020] [Revised: 12/10/2020] [Accepted: 01/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate the outcomes of robot-assisted radical prostatectomy (RARP) compared to those of open (ORP) and laparoscopic (LRP) surgery. The interest lies fundamentally in the quality-of-life (QoL) evaluation, postoperative recovery, and personal satisfaction of patients with the intervention (PS) beyond oncological and functional outcomes. METHODS Six hundred eighty-five RPs were performed in our center between 2011-2018 (17,8% ORP, 22,2% LRP and 60% RARP). Patients were prospectively assessed through follow-up until April 2020 and a multiple questionnaire at 12-months post-RP that included ICIQ-SF, SHIM, IPSS, IQL and questions about pain, postoperative recovery and PS. Also baseline and postoperative patient- and treatment-related data were collected, and binomial logistic regressions were performed for the 1 vs.1 comparisons (ORP vs. RARP and LRP vs. RARP). RESULTS RARP patients have overall fewer comorbidities, less tumor aggressiveness, more operative time requirements and more positive surgical margins than ORP and LRP patients. Nevertheless, RARP outperforms ORP in: hospital stay (days) (OR 0,86; 95% CI: 0,80-0,94), hemoglobin loss (OR 0,38; 95% CI: 0,30-0,47), transfusion rate (OR 0,18; 95% CI: 0,09-0,34), early complications (p = 0,001), IQL (OR 0,82; 95% CI: 0,69-0,98), erectile function (OR 0,41; 95% CI: 0,21-0,79), pain control (OR 0,82; 95% CI: 0,75-0,89), postoperative recovery (p < 0,001) and choice of a different approach (OR 5,55; 95% CI: 3,14-9,80). RARP is superior to LRP in: urinary continence (OR 0,55; 95% CI: 0,37-0,82), IPSS (OR 0,96; 95% CI: 0,93-0,98), IQL (OR 0,76; 95% CI: 0,66-0,88), erectile function (OR 0,52; 95% CI: 0,29-0,93), postoperative recovery (p = 0,02 and 0,004), PS (p = 0,005; 0,002; and 0,03) and choice of a different approach (OR 7,79; 95% CI: 4,63-13,13). CONCLUSIONS The findings of our study globally endorse a positive effectiveness of RARP over ORP and/or LRP, both on functional issues, postoperative recovery, QoL and PS. Oncologic results should still be improved.
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Affiliation(s)
- Á García Cortés
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain.
| | - J Colombás Vives
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - C Gutiérrez Castañé
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - S Chiva San Román
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - P Doménech López
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - F J Ancizu Marckert
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Hevia Suárez
- Departamento de Urología, Complejo Asistencial Universitario de León, León, Spain
| | - I Merino Narro
- Departamento de Urología, Hospital Universitario de Araba, Vitoria-Gasteiz, Vizcaya, Spain
| | - J M Velis Campillo
- Departamento de Urología, Hospital Universitario de La Ribera, Alzira, Valencia, Spain
| | - F Guillén Grima
- Departamento de Medicina Preventiva y Salud Pública, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - M Torres Roca
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - F Diez-Caballero Y Alonso
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - D Rosell Costa
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - F Villacampa Aubá
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - F R de Fata Chillón
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - G Andrés Boville
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - G Barbas Bernardos
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - B Miñana López
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - J E Robles García
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
| | - J I Pascual Piédrola
- Departamento de Urología, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Navarra, Spain
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Ogawa S, Hasegawa A, Makabe S, Onagi A, Matsuoka K, Kayama E, Koguchi T, Hata J, Sato Y, Akaihata H, Kataoka M, Haga N, Kojima Y. Impacts of Neoadjuvant Hormonal Therapy Prior to Robot-Assisted Radical Prostatectomy on Postoperative Hormonal- and Sexual-Related Quality of Life – Assessment by Patient-Reported Questionnaire. Res Rep Urol 2022; 14:39-48. [PMID: 35223660 PMCID: PMC8865904 DOI: 10.2147/rru.s342063] [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: 10/18/2021] [Accepted: 02/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Neoadjuvant hormonal therapy (HT) before radical prostatectomy (RP) is not recommended by current guidelines in terms of oncological outcomes. Despite this, neoadjuvant HT is sometimes conducted before RP for a small proportion of patients in clinical practice. This study evaluated the impacts of neoadjuvant HT on hormonal- and sexual-related quality of life (QOL) among patients who underwent robot-assisted RP (RARP). Materials and Methods Participants comprised 470 patients divided into a non-neoadjuvant HT group (n = 408) and a neoadjuvant HT group (n = 62). Hormonal- and sexual-related QOL were measured using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. Results Hormonal summary scores at 6 and 9 months, function scores before and 3, 6, and 9 months and bother score at 6 months after RARP were significantly lower in the neoadjuvant HT group than in the non-neoadjuvant HT group. Sexual function scores were decreased in the neoadjuvant HT group compared to the non-neoadjuvant HT group before and 6 months after RARP. In the neoadjuvant HT group, sexual function at 3 months after RARP was significantly worse in patients with >5 months of neoadjuvant HT than in patients with ≤5 months of neoadjuvant HT. Conversely, sexual bother at 3 months after RARP was significantly worse in patients with ≤5 months of neoadjuvant HT than in patients with >5 months of neoadjuvant HT. Conclusion Vintage neoadjuvant HT prior to RARP should not be recommended due to not only oncological outcomes, but also the impacts on postoperative hormonal- and sexual-related QOL.
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Affiliation(s)
- Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Correspondence: Soichiro Ogawa, Department of Urology, Fukushima Medical University School of Medicine, 1, Hikarigaoka, Fukushima, 960-1295, Japan, Tel +81 24 547 1316, Fax +81 24 548 3393, Email
| | - Akihisa Hasegawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shunta Makabe
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akifumi Onagi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Emina Kayama
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoyuki Koguchi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Sharma G, Darlington D, Ahluwalia P, Gautam G. Development and internal validation of preoperative and postoperative nomograms predicting quadrifecta outcomes following robotic radical prostatectomy. Indian J Urol 2022; 38:197-203. [PMID: 35983118 PMCID: PMC9380461 DOI: 10.4103/iju.iju_381_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/17/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Literature on the factors predicting functional and oncological outcomes following robot-assisted radical prostatectomy (RARP) is sparse for the Indian population. Hence, the primary objective of this study was to develop preoperative and postoperative nomograms predicting these outcomes in patients with prostate cancer undergoing RARP. METHODS This retrospective analysis identified the predictors of quadrifecta outcomes, i.e., the patients who did not have complications, were continent, had negative surgical margins, and were biochemical recurrence free with at least 1 year of follow-up following RARP. We excluded the return of sexual potency as the majority of the patients in our series were sexually inactive preoperatively. We used the backward stepwise logistic regression analysis method to identify the predictors of quadrifecta. Preoperative and postoperative nomograms using these predictors were developed and validated with bootstrapping, goodness of fit, calibration plot, decision curve analysis (DCA), and theits receiver operating characteristic (ROC) analysis. RESULTS Of the 688 patients who underwent RARP, 399 were included in this study, and 123 (30.8%) of these achieved the quadrifecta outcomes. Preoperative nomogram was developed using four variables, i.e., prostate-specific antigen (PSA), Charlson Comorbidity Index (CCI), biopsy Gleason score, and clinical stage. Postoperative nomogram included PSA, CCI, pathological tumor stage, tumor grade, and positive lymph node. Both the models were internally valid on bootstrapping, calibration plots, and goodness of fit. On the ROC analysis, preoperative and postoperative nomograms had an area under the curve of 0.71 and 0.79, respectively. On the DCA, at a threshold probability of 5%, both the models showed a net benefit. CONCLUSIONS We developed and validated accurate nomograms for predicting quadrifecta outcomes following RARP for the Indian population.
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Affiliation(s)
- Gopal Sharma
- Department of Uro-Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Danny Darlington
- Department of Uro-Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Puneet Ahluwalia
- Department of Uro-Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Department of Uro-Oncology, Max Institute of Cancer Care, New Delhi, India,
E-mail:
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García Cortés Á, Colombás Vives J, Gutiérrez Castañé C, Chiva San Román S, Doménech López P, Ancizu Marckert F, Hevia Suárez M, Merino Narro I, Velis Campillo J, Guillén Grima F, Torres Roca M, Diez-Caballero y Alonso F, Rosell Costa D, Villacampa Aubá F, de Fata Chillón F, Andrés Boville G, Barbas Bernardos G, Miñana López B, Robles García J, Pascual Piédrola J. Comparación entre abordajes quirúrgicos de prostatectomía radical en nuestra serie, más allá de los resultados oncológicos y funcionales. Actas Urol Esp 2021. [DOI: 10.1016/j.acuro.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prevalence of post-prostatectomy erectile dysfunction and a review of the recommended therapeutic modalities. Int J Impot Res 2020; 33:401-409. [PMID: 33204007 DOI: 10.1038/s41443-020-00374-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/22/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Radical prostatectomy (RP) represents one of the most commonly used first-line treatment modalities in men with localized prostate cancer. One of the most feared post-surgical complications is erectile dysfunction (ED), usually caused by direct damage to the cavernous nerves or due to neuropraxia. Penile rehabilitation is an emerging concept that was proposed to stimulate and accelerate recovery of erectile function after RP. The goal is to improve blood flow to the penis, increasing cavernous oxygenation and avoiding fibrosis. The most common used modalities include oral phosphodiesterase type 5 inhibitors (PDE5-I), vacuum erection devices (VEDs), intracorporeal injection (ICI) therapy, medicated urethral system for erections (MUSE), and a combination of these treatments. For those patients with severe ED, ED refractory to medical therapy and/or seeking long term reliable results, the penile prosthesis implant remains an excellent alternative. We conducted a broad review of post-prostatectomy ED prevalence with different techniques and the success rates of the different therapeutic approaches.
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Xu B, Peng YJ, Ma GZ, Zhang Q. A novel "three-port" trocar placement technique for laparoscopic radical prostatectomy. World J Surg Oncol 2020; 18:279. [PMID: 33109205 PMCID: PMC7592506 DOI: 10.1186/s12957-020-02051-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients. Methods We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A, three-port LRP; group B, conventional four-five-port LRP; group C, open RP (ORP); and group D, robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages. Results All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases of conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0 days, the mean hospitalization was 5.1 days, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization, and transfusion in group A were statistically significant among the majority of the other groups (p < 0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased. Conclusions Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization, and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice.
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Affiliation(s)
- Ben Xu
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Yi-Ji Peng
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Guo-Zhong Ma
- Department of Urology, Affiliated Hospital of Heze Medical College, 777 Zhujiang Road, Mudan District, Heze City, 274000, Shandong, China
| | - Qian Zhang
- Department of Urology, National Urological Cancer Center, Peking University First Hospital and Institute of Urology, Peking University, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
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Liu QL, Yang L. Comparison of the Transurethral Resection of the Prostate by Traditional Versus Preserved Urethral Mucosa of the Prostatic Apex. J Endourol 2020; 34:482-486. [PMID: 31964193 DOI: 10.1089/end.2019.0804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Benign prostatic hyperplasia (BPH) is a common disease in elderly men. Transurethral resection of the prostate (TURP) is still the standard treatment for BPH. However, postoperative urinary incontinence (UI) is still one of the complications. Objective: This study aims to evaluate the clinical efficacy and safety of the TURP by traditional compared with preserved urethral mucosa of the prostatic apex (PUMPA). Materials and Methods: From July 2015 to June 2016, 80 patients with TURP were included and divided into the two groups: traditional nonpreserved urethral mucosa group (TURP group, n = 40) and the PUMPA group (PUMPA-TURP group, n = 40). This study identified the apex of the prostate and determined the cut position of mucosa. Then, we separated the preserved urethral mucosa, excised the hyperplastic prostate tissue, and trimmed the preserved urethral mucosa. Results: The rate of UI after PUMPA-TURP was significantly lower than that traditional TURP (0% vs 22.5%). The operative time was significantly shorter in the PUMPA-TURP group than traditional TURP group (50 ± 16.5 minutes vs 65 ± 18.5 minutes). The intraoperative bleeding loss was lower in the PUMPA-TURP group than traditional TURP group (280 ± 33 mL vs 190 ± 35 mL). International prostate symptom score, quality of life (QoL), and peak uroflowmetry data (Qmax) were similar between two groups. Conclusions: When compared with traditional TURP, PUMPA-TURP can reduce the occurrence of UI and intraoperative blood loss. Besides, PUMPA-TURP could shorten the operative time.
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Affiliation(s)
- Qing-Li Liu
- Department of Urology, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Long Yang
- Department of Urology, First Hospital of Qinhuangdao, Qinhuangdao, China
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Leaver RB. Technology and the urology nurse. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2019. [DOI: 10.1111/ijun.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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