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Lavadia AC, Hwang JY, Yoon SG, Kim SB, Noh TI, Park MG, Shim JS, Kang SH, Kang SG. Modified apical dissection during robot-assisted laparoscopic radical prostatectomy: a systematic review and meta-analysis. J Robot Surg 2024; 18:293. [PMID: 39068351 DOI: 10.1007/s11701-024-02040-3] [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: 06/16/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALP) has improved patient recovery, but achieving optimal functional outcomes remains a challenge, especially early urinary continence. The Modified Apical Dissection (MAD) technique has been suggested to improve early continence compared to conventional RALP. A comprehensive search of PubMed, Embase, and Cochrane Central databases was conducted to identify studies on MAD from inception to March 2024. The risk of bias was evaluated using the ROBINS-I tool. Primary outcomes assessed included urinary continence, positive surgical margin rate, biochemical recurrence rates, and complication rates. Out of 789 studies screened initially, we selected 8 studies that met our inclusion criteria. Our analysis showed that patients who underwent the MAD technique had a significantly higher likelihood of achieving early urinary continence compared to those undergoing conventional RALP at the initial follow-up (Odds Ratio [OR] = 4.0, 95% CI = 1.87-8.57). This advantage continued at 1 month (OR = 5.44, 95% CI = 2.98-9.92), 3 months (OR = 5.36, 95% CI = 2.26-12.71), and 6 months (OR = 5.18, 95% CI = 1.51-17.75), though no significant difference was noted at 12 months. There were no significant differences in positive surgical margin rate or biochemical recurrence rate between MAD and conventional RALP. The overall complication rate was 10.9% (95% CI = 8.10-14.06), with most complications being classified as minor (Clavien-Dindo I-II). In summary, our meta-analysis suggests that the MAD technique may lead to earlier recovery of urinary continence without compromising oncologic outcomes in patients undergoing RALP. While there are published studies on the outcomes of MAD, only a few have the appropriate design with a comparison group needed for meta-analysis and discussing various endpoints. More randomized controlled trials are necessary, but the current literature still lacks retrospective studies with comparison groups.
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Affiliation(s)
- Alvin Christopher Lavadia
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
- Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
| | - Jae Young Hwang
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sung Goo Yoon
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung Bin Kim
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Tae Il Noh
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Min Gu Park
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ji Sung Shim
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seok Ho Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sung Gu Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Barayan GA, Majdalany SE, Butaney M, Dalela D, Peabody J, Abdolla F, Menon M, Jeong W. Intermediate-Term Oncologic Outcome Assessment for Robot-Assisted Radical Prostatectomy: Comparing Retzius-Sparing with Standard Approach in a Randomized Control Cohort. J Endourol 2024; 38:559-563. [PMID: 38429913 DOI: 10.1089/end.2023.0514] [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] [Indexed: 03/03/2024] Open
Abstract
Introduction: Retzius-sparing prostatectomy was promoted with the early continence result. The long-term oncologic outcome is still unknown. In this study, we aimed to compare the intermediate-term oncologic outcomes of these two approaches in patients' cohort who were treated as part of a randomized controlled trial. Methods: A total of 120 patients were previously randomized equally to receive Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) vs standard robot-assisted laparoscopic radical prostatectomy (S-RARP) between January 2015 and April 2016. Baseline, surgical, and pathologic characteristics as well as oncologic outcomes were assessed. The analysis was done based on the treatment received. Result: Sixty-three patients underwent S-RARP, whereas 57 patients underwent RS-RARP. There was no statistically significant difference in the baseline nor surgical characteristics. The median follow-up was 71.24 (interquartile range: 59.75-75.75) months. There were more pathologic T3 diseases in RS-RARP. There was no significant difference in the positive margin status nor in the biochemical recurrence (BCR) rate among both groups. After S-RARP and RS-RARP, 6 and 10 patients had BCR, and the 5 years BCR-free survival was 91% and 85%, respectively (p = 0.21). Conclusion: In this cohort, there was no difference in BCR in the patients who received either technique. Further multi-institutional studies with a larger sample size and longer follow-up are required.
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Affiliation(s)
- Ghassan A Barayan
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia. Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sami E Majdalany
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohit Butaney
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Deepansh Dalela
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
| | - James Peabody
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Firas Abdolla
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mani Menon
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Mount Sini Health System, New York, New York, USA
| | - Wooju Jeong
- Vattikuti Urology Institute of Urology, Henry Ford Hospital, Detroit, Michigan, USA
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3
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Regis L, Bertholle J, Planas J, Lozano F, Lorente D, Celma A, Cuadras M, Costa M, Morote J, Trilla E. State of art of robotic prostatectomy: the way we do it in Catalonia, Spain. Actas Urol Esp 2024:S2173-5786(24)00066-0. [PMID: 38740264 DOI: 10.1016/j.acuroe.2024.05.006] [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: 12/26/2023] [Accepted: 02/28/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION AND OBJECTIVE Robotic-assisted laparoscopic prostatectomy (PLAR) seems to improve functional outcomes, however there is not a consensus of a standard procedure. The aim of this study was to identify the PLAR "state of art" in Catalonia, Spain. MATERIAL AND METHODS This was a cross-sectional survey-based study conducted among urologists across Catalonia, Spain. The survey was distributed through online platforms and the professional urology society. All statistical analyses were performed using Stata software, v20. RESULTS 59 urologists completed the survey, revealing PLAR as the most commonly used technique (79.7%). Most urologist (70%) create the pneumoperitoneum using a controlled incision with direct access and 78.3% use the Airseal technology. The intraperitoneal approach is performed in >90% of cases. Endopelvic fascia preservation is not routinely performed. 34.5% of the survey not perform the dorsal vein complex suture. All preserves the bladder neck when oncologically safe. Nerve-vascular bundles bleeding control is performed using standard coagulation or suturing. 34% performed posterior reconstruction. Only use hemostatic devices when evident bleeding and 70% does not routinely left a drainage. Multivariable analysis showed that center volume had a significant independent association with dorsal venous complex suturing (OR 0.073, 95%CI 0.07-0.826), nerve-vascular bundles suturing hemostasis (OR 11.67, 95%CI 1.07-127.60) and endopelvic fascia preservation (OR 13.64, 95%CI 1.087-201.27), but there was no correlation with time the bladder catheter or days hospitalized. CONCLUSIONS The study provides an overview of the state of PLAR in Catalonia, Spain, showing significant variability and reflecting a commitment to advancing surgical technology and patient care.
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Affiliation(s)
- L Regis
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - J Bertholle
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - J Planas
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - F Lozano
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - D Lorente
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - A Celma
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - M Cuadras
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - M Costa
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J Morote
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - E Trilla
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Qian J, Fu Y, Marra G, Zhang F, Wu X, Li D, Xu L, Qiu X, Gan W, Guo H. Modified Retzius-sparing robot-assisted radical prostatectomy for cases with anterior tumor: a propensity score-matched analysis. World J Urol 2024; 42:170. [PMID: 38506964 PMCID: PMC10954873 DOI: 10.1007/s00345-024-04807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To compare the outcomes between a modified Retzius-sparing robot-assisted radical prostatectomy (mRS-RARP) technique and conventional robot-assisted radical prostatectomy (Con-RARP) technique for cases with anterior prostate cancer (PCa), especially positive surgical margin (PSM) rates and urinary continence (UC). PATIENTS AND METHODS We retrospectively included 193 mRS-RARP and 473 Con-RARP consecutively performed by a single surgeon for anterior PCa. Perioperative complications, pathology, and continence were compared after propensity score matching using 9 variables. RESULTS After matching (n = 193 per group), PSM were not significantly different in the two groups (16.1% in mRS-RARP group vs. 15.0% in Con-RARP group, p = 0.779). The UC at catheter removal and at 1-month was significantly higher in the mRS-RARP (24.9% vs. 9.8%, p < 0.001; 29.0% vs. 13.5%, p < 0.001, respectively), but not at 3-, 6-, and 12-month follow-ups (p = 0.261, 0.832, and 0.683, respectively). CONCLUSION mRS-RARP seems to be an oncologically safe approach for patients with anterior PCa. Compared with the conventional approach, mRS-RARP approach shows benefits in the short-term postoperative UC recovery.
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Affiliation(s)
- Jiajun Qian
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 211166, China
- Institute of Urology, Nanjing University, Nanjing, 210008, China
| | - Yao Fu
- Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Feifei Zhang
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
- Institute of Urology, Nanjing University, Nanjing, 210008, China
| | - Xiao Wu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Danyan Li
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China
| | - Linfeng Xu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
- Institute of Urology, Nanjing University, Nanjing, 210008, China.
| | - Xuefeng Qiu
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
- Institute of Urology, Nanjing University, Nanjing, 210008, China.
| | - Weidong Gan
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 211166, China.
- Institute of Urology, Nanjing University, Nanjing, 210008, China.
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China.
- Institute of Urology, Nanjing University, Nanjing, 210008, China.
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Shen Z, Yao C, Bai Y, Wang Y, Zhang Q. Transversal approach via a bladder neck and prostate combined longitudinal incision versus standard approach of robotic-assisted radical prostatectomy for localized prostate cancer: a retrospective analysis. BMC Cancer 2024; 24:313. [PMID: 38448829 PMCID: PMC10916070 DOI: 10.1186/s12885-024-12015-0] [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: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Transversal approach for robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision (L-RALP) is a novel surgical method for patients with respectable prostate cancer. METHODS There were 669 patients with prostate cancer underwent L-RALP or S-RALP which identified from April 2016 to April 2020. The perioperative outcomes, Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) scores, sexual function and urinary control ability were included and compared between two groups. RESULTS In the 669 patients, 277 of them were included into the final analysis. 151 patients received S-RALP and 126 received L-RALP. Baseline features were balanced. Patients in the S-RALP group had significantly shorter average surgical time (135.93 vs 150.04 min; p < 0.001) than those in L-RALP group. Intraoperative bleeding volume, early postoperative complications rates, postoperative catheter removal time and hospital stays were comparable between two groups. There was no difference in biochemical recurrence at 3, 6, 12 and 18 months of follow-up. Of note, the urinary control function recovers of patients in the L-RALP group was significantly better than those in the S-RALP group. Moreover, patients in the L-RALP group had much better results of EPIC-CP (including urinary control and total score) than those in the S-RALP group at 6 week and 3, 6, 12 and 18 months. CONCLUSIONS Both S-RALP and L-RALP were safe and effective with similar long-term clinical outcomes in patients with respectable prostate cancer. Patients received L-RALP had significantly better postoperative outcomes including urinary control, and recovery period.
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Affiliation(s)
- Zefan Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310000, China
| | - CenChao Yao
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - YuChen Bai
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - YiFan Wang
- Graduate Department, Bengbu Medical College, Bengbu, Anhui, 233000, China.
| | - Qi Zhang
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China.
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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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Ge S, Zeng Z, Li Y, Gan L, Meng C, Li K, Wang Z, Zheng L. Comparing the safety and efficacy of single-port versus multi-port robotic-assisted techniques in urological surgeries: a systematic review and meta-analysis. World J Urol 2024; 42:18. [PMID: 38197961 DOI: 10.1007/s00345-023-04711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/24/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE Comparing the safety and efficacy of single-port (SP) versus multi-port (MP) robotic-assisted techniques in urological surgeries. METHODS A systematic review and cumulative meta-analysis was performed using PRISMA criteria for primary outcomes of interest, and quality assessment followed AMSTAR. Four databases were systematically searched: Embase, PubMed, The Cochrane Library, and Web of Science. The search time range is from database creation to December 2022. Stata16 was used for statistical analysis. RESULTS There were 17 studies involving 5015 patients. In urological surgeries, single-port robotics had shorter length of stay (WMD = - 0.63, 95% Cl [- 1.06, - 0.21], P < 0.05), less estimated blood loss (WMD = - 19.56, 95% Cl [- 32.21, - 6.91], P < 0.05), less lymph node yields (WMD = - 3.35, 95% Cl [- 5.16, - 1.55], P < 0.05), less postoperative opioid use (WMD = - 5.86, 95% Cl [- 8.83, - 2.88], P < 0.05). There were no statistically significant differences in operative time, positive margins rate, overall complications rate, and major complications rate. CONCLUSION Single-port robotics appears to have similar perioperative outcomes to multi-port robotics in urological surgery. In radical prostatectomy, single-port robotics has shown some advantages, but the specific suitability of single-port robots for urological surgical types needs to be further explored.
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Affiliation(s)
- Si Ge
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
- Department of UrologySchool of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhiqiang Zeng
- Department of UrologySchool of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China.
- Department of UrologySchool of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Chunyang Meng
- Department of UrologySchool of Clinical Medicine, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Kangsen Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Zuoping Wang
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Lei Zheng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
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Maruo M, Goto Y, Miyazaki K, Inoue A, Kurokawa K, Enomoto A, Tanaka S, Katsura S, Sugawara S, Fuse M, Chiba K, Imamura Y, Sakamoto S, Nagata M, Ichikawa T. Novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation and long-term outcomes for a single surgeon. Sci Rep 2024; 14:926. [PMID: 38195985 PMCID: PMC10776665 DOI: 10.1038/s41598-024-51598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/07/2024] [Indexed: 01/11/2024] Open
Abstract
Although novel techniques for avoiding incontinence during robot-assisted radical prostatectomy have been developed, long-term oncological outcomes are unknown. The objective of this study was to determine the long-term oncological outcomes and functional outcomes of novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation for a single surgeon. Data from 100 patients who underwent structure-preserving prostatectomies performed by a single surgeon were retrospectively analyzed. The median console time was 123 min. Bilateral nerve-sparing was performed in 43% of patients underwent, and 57% underwent unilateral nerve-sparing surgery. Most patients (96%) reached complete pad-zero urinary continence by one year after surgery. Satisfactory erectile function was achieved in 97% of patients who underwent bilateral nerve-sparing surgery, and 80% of patients who underwent unilateral nerve-sparing surgery. The surgical margin was positive for 25% of patients, and the biochemical recurrence-free rate at 5 years was 77%. The cancer-specific survival rate was 100% during the median follow-up period of 4.5 years. Clavien-Dindo grade III complications occurred in 1% of cases. The outcomes for novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation were similar to previously reported oncological outcomes, with satisfactory functional outcomes. This operative method may be useful for patients who are eligible for nerve-sparing surgery.
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Affiliation(s)
- Masafumi Maruo
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yusuke Goto
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan.
| | | | - Atsushi Inoue
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Koichiro Kurokawa
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Akiko Enomoto
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Satoki Tanaka
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Sota Katsura
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Sho Sugawara
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Miki Fuse
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Kazuto Chiba
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yusuke Imamura
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Maki Nagata
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
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Ferretti S, Dell’Oglio P, Ciavarella D, Galfano A, Schips L, Marchioni M. Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements. Res Rep Urol 2023; 15:541-552. [PMID: 38106985 PMCID: PMC10725648 DOI: 10.2147/rru.s372803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) is the gold standard for localized prostate cancer. Several RARP approaches were developed and described over the years, aimed at improving oncological and functional outcomes. In 2010, Galfano et al described a new RARP technique, known as Retzius-sparing RARP (RS-RARP), a posterior approach through the Douglas space that spares the anterior support structures involved with urinary continence and sexual potency. This approach has been used increasingly in many centers around the world comparing its results with those of the most used standard anterior approach. Several randomized controlled trials, systematic reviews and meta-analyses demonstrated an important advantage relative to standard anterior RARP in terms of early urinary continence recovery, with comparable perioperative and long-term oncological outcomes. Several surgeons are concerned regarding RS-RARP because it appears to increase the risk of positive surgical margins (PSMs). However, this statement is based on low-certainty evidence. Indeed, the available studies compared the results of surgeons who had an initial experience with posterior RARP with those who had a solid experience with anterior RARP. Recent evidence strongly suggests that RS-RARP is feasible and safe not only in low- and intermediate-risk prostate cancer patient but also in challenging scenario such as high-risk setting, salvage prostatectomy and after transurethral resection of the prostate.
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Affiliation(s)
- Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Paolo Dell’Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Davide Ciavarella
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
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Shiota M, Tsukahara S, Ueda S, Mutaguchi J, Goto S, Kobayashi S, Matsumoto T, Blas L, Monji K, Inokuchi J, Eto M. Improved urinary continence recovery after robot-assisted radical prostatectomy with lateral pelvic fascia preservation. J Robot Surg 2023; 17:2721-2728. [PMID: 37634216 DOI: 10.1007/s11701-023-01702-y] [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: 06/25/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023]
Abstract
The novel technique of lateral pelvic fascia preservation (LPFP) in robot-assisted radical prostatectomy (RARP) has been reported to improve urinary continence recovery. We aimed to investigate surgical and oncological outcomes after RARP using the LPFP technique and compare them with conventional RARP. This study included patients who underwent RARP with and without the LPFP technique. Time to urinary continence recovery was compared between the LPFP and non-LPFP groups using univariate, multivariate, and propensity-score matched analysis. Perioperative and postoperative outcomes were compared between the two groups using univariate analysis. We included 139 patients who underwent RARP, 68 in the LPFP group and 71 in the non-LPFP group. The LPFP technique was associated with a shorter time to urinary continence recovery, a shorter operative time and lower estimated blood loss. Surgical and oncological outcomes, including complications, pathological T-stage, surgical margin status, and biochemical recurrence-free survival, were comparable between the two groups. This study demonstrated that the LPFP technique improves urinary continence recovery and operative times without compromising surgical and oncological outcomes. The use of this technique in patients with clinically localized prostate cancer is recommended.
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Affiliation(s)
- Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shigehiro Tsukahara
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shohei Ueda
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Jun Mutaguchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunsuke Goto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Kobayashi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Monji
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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11
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Rodríguez Socarrás M, Gómez Rivas J, Reinoso Elbers J, Espósito F, Llanes Gonzalez L, Monsalve DMC, Fernandez Del Alamo J, Ruiz Graña S, Juarez Varela J, Coria D, Cuadros Rivera V, Gastón R, Gómez Sancha F. Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes. Cancers (Basel) 2023; 15:5442. [PMID: 38001702 PMCID: PMC10670058 DOI: 10.3390/cancers15225442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Radical prostatectomy by lateral approach allows performing a prostatectomy through a buttonhole, with direct access to the seminal vesicle and fully sparing the anterior pubovesical complex. Our aim is to show the results of reproducing the technique of robotic radical prostatectomy by lateral approach, in terms of intraoperative, postoperative, oncological and functional parameters. METHODS We analyzed 513 patients submitted to robotic radical prostatectomy by lateral approach from January 2015 to March 2021, operated on by two surgeons in our institution. The oncological and functional results of both surgeons were compared. RESULTS When comparing both surgeons, the rate of positive surgical margins (PSM) was 32.87% and 37.9% and significant surgical margins (PSM > 2 mm) were 5.88% and 7.58% (p = 0.672) for surgeon 1 and surgeon 2, respectively. Immediate continence was 86% and 85% and sexual potency at one year 73% and 72%, with a similar rate of complications for surgeon 1 and 2. CONCLUSIONS Radical prostatectomy by the lateral approach technique with preservation of the anterior pubovesical complex is reproducible and offers good oncological and functional results.
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Affiliation(s)
- Moisés Rodríguez Socarrás
- Instituto de Cirugía Urológica Avanzada (ICUA), Clínica CEMTRO, 28035 Madrid, Spain; (J.G.R.); (J.R.E.); (F.E.); (L.L.G.); (D.M.C.M.); (J.F.D.A.); (S.R.G.); (D.C.); (V.C.R.); (F.G.S.)
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12
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Shiraishi K. Evaluation of sexual function after robot-assisted radical prostatectomy: A farewell to IIEF questionnaire. Int J Urol 2023; 30:959-967. [PMID: 37526397 DOI: 10.1111/iju.15264] [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: 05/21/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
Longevity with localized prostate cancer (PCa) has been achieved, and the contribution of robot-assisted radical prostatectomy (RARP) to cancer control is evident. The next step to investigate in the treatment of localized PCa is improvement of the quality of life (QOL) after RARP. Erectile dysfunction has been considered a major surgical complication, and patient satisfaction after RARP has not improved despite the development of nerve preservation and penile rehabilitation. To comprehensively understand sexual dysfunction after RARP, we must investigate other complications with regard to sexual health, including low sexual desire, disturbed orgasmic function (i.e., anejaculation, orgasm intensity, painful orgasm, and climacturia), shortening of penile length, penile curvature (Peyronie's disease) and unique psychological alterations after the diagnosis of PCa, which are neglected side effects after prostatectomy. In this context, routine evaluation of erectile function by the International Index of Erectile Function only is not sufficient to understand patients' difficulties. A questionnaire is just one way of enabling patients to evaluate their pre- and postoperative concerns; listening to patients face-to-face is warranted to detect symptoms. Understanding the relationship between symptoms and preserved nerve localization can ultimately provide an individualized nerve-sparing procedure and improve patient satisfaction after RARP. In combination with psychological counseling, including the partner and medical treatment, such as testosterone replacement, it is time to reconsider ways to improve sexual dysfunction after RARP.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Matsuyama N, Naiki T, Hamamoto S, Sugiyama Y, Kubota Y, Hamakawa T, Etani T, Iwatsuki S, Taguchi K, Ota Y, Gonda M, Aoki M, Morikawa T, Kato T, Okada A, Yasui T. Postoperative Bladder Neck to Pubic Symphysis Ratio Predictive for De Novo Overactive Bladder after Robot-Assisted Radical Prostatectomy. Diagnostics (Basel) 2023; 13:3173. [PMID: 37891994 PMCID: PMC10606078 DOI: 10.3390/diagnostics13203173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The aim was to investigate the incidence and clinical predictive factors of de novo overactive bladder (OAB) after robot-assisted radical prostatectomy (RARP), including a Retzius-sparing (RS) approach, in the same period at a single institution. METHODS Of a total of 113 patients with localized prostate cancer, 81 received conventional RARP (CON-RARP) and 32 received RS-RARP at our institution. The basic characteristics data of patients and self-assessment questionnaires, including IPSS and OABSS, were obtained preoperatively and 1, 3, and 6 months after RARP. In addition, a retrospective biomarker analysis was also performed of predictive clinical parameters obtained from cystography that included a postoperative bladder neck to pubic symphysis (BNPS) ratio. RESULTS Patients' basic characteristics were similar between CON-RARP and RS-RARP groups. With respect to the surgical procedure, anastomosing time was found to be significantly longer for patients in the RS-RARP compared to the CON-RARP group (p < 0.01). Compared to the CON-RARP group, the RS-RARP group showed a significantly lower postoperative BNPS and aspect ratio (p < 0.001). The incidence of de novo OAB in patients of the CON-RARP group was greater than for those in the RS-RARP group (40.7% CON-RARP vs. 25.0% RS-RARP), though this was not significant. Regarding the emergence of de novo OAB, the following were revealed in univariate analysis to be independent prognostic factors: age > 64 years (hazards ratio [HR]: 4.32, 95% confidence interval [CI]: 1.51-12.3), postoperative BNPS ratio > 0.44 (HR: 8.7, 95% CI: 6.43-54.5), postoperative aspect ratio > 1.18 (HR: 3.36, 95% CI: 1.49-7.61). Additionally, multivariate analysis identified a sole significant prognostic factor: postoperative BNPS ratio > 0.44 (HR: 13.3, 95% CI: 4.33-41.1). CONCLUSION Our findings indicate that the postoperative BNPS ratio may be a practical predictive indicator of the emergence of de novo OAB after RARP.
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Affiliation(s)
- Nayuka Matsuyama
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Taku Naiki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Shuzo Hamamoto
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Yosuke Sugiyama
- Department of Pharmacy, Nagoya City University Hospital, Nagoya 467-8601, Japan;
| | - Yasue Kubota
- Department of Clinical Physiology, Graduate School of Nursing, Nagoya City University, Nagoya 467-8601, Japan;
| | - Takashi Hamakawa
- Department of Urology, Nagoya City University West Medical Center, Nagoya 462-8508, Japan;
| | - Toshiki Etani
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Shoichiro Iwatsuki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Kazumi Taguchi
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Yuya Ota
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Masakazu Gonda
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Maria Aoki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Toshiharu Morikawa
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Taiki Kato
- Department of Urology, Nagoya City University East Medical Center, Nagoya 464-8547, Japan;
| | - Atsushi Okada
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Takahiro Yasui
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
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14
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Moon HW, Rhew SA, Yoon CE, Kwon HJ, Park YH, Lee JY. Impact of modified bladder neck suspension on early recovery of continence after robot-assisted radical prostatectomy (RARP). J Robot Surg 2023; 17:2279-2285. [PMID: 37336839 PMCID: PMC10492743 DOI: 10.1007/s11701-023-01640-9] [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: 05/13/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
The incontinence after RARP significantly decreases the quality of life in prostate cancer patients. A number of techniques have been introduced for the recovery of continence after RARP. Although, the mechanism of the continence recovery is still unclear. We aimed to evaluate the early recovery of continence after RARP by inducing early anterior adhesion and reducing the hypermobility of the urethra through the modified bladder neck suspension (BNS) procedure. From March 2018 to February 2020, a total of 227 consecutive patients who underwent RARP (by single surgeon) were included. Patients were divided into two groups based on operation procedure (Standard procedure vs BNS procedure). Demographics, perioperative variables, and pathologic outcome were analyzed. We assessed recovery of continence at 1, 3, 6 and 9 months after surgery. Postoperative recovery of continence defined as the use of no pad during 24 h. Multivariable logistic regression analyses were performed to evaluate independent predictors of the early recovery of continence at 1 month. We performed RARP with standard procedure (n = 106) or BNS procedure (n = 121). There was no statistical difference in perioperative variables between the two groups except anastomosis time (21.6 ± 12.9 vs 17.0 ± 7.6, p = 0.003). The pad free continence rate were 80.2% (standard group) and 91.3% (BNS group) at 9 month after RARP (p = 0.037). However, early continence rate (1mo) were significantly higher in the BNS group (12.3% vs 29.1%, p = 0.004). On multivariate logistic analyses, BNS procedure (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.03-7.45, p = 0.0426), age (OR 0.92, CI 0.86-0.98, p = 0.0154) were independent factor for early recovery of continence after RARP. The modified bladder neck suspension procedure showed significantly better outcomes than the standard procedure in terms of the early recovery of urinary continence.
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Affiliation(s)
- Hyong Woo Moon
- Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
| | - Seung Ah Rhew
- Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
| | - Chang Eil Yoon
- Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
| | - Hyeok Jae Kwon
- Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
| | - Yong Hyun Park
- Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
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15
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Nunes-Silva I, Hidaka AK, Glina FPA, Hayashi RM, Glina S. Can salvage Retzius-sparing robotic-assisted radical prostatectomy improve continence outcomes? A systematic review and meta-analysis study. World J Urol 2023; 41:2311-2317. [PMID: 37414943 DOI: 10.1007/s00345-023-04505-w] [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: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE Salvage Radical Prostatectomy is challenging and associated with high rates of incontinence. The novel Retzius-sparing RARP (RS-RARP) approach has shown impressive high immediate and 1-year continence rates (> 90%) when applied as primary treatment. The purpose of this study is to evaluate the impact of salvage Retzius-sparing RARP (sRS-RARP) on continence outcomes in the salvage scenario. MATERIALS AND METHODS Using PRISMA guidelines, a systematic review and meta-analysis of articles was conducted on Medline through PubMed and on Cochrane through Central Register of Controlled Trials databases. Inclusion and exclusion criteria were used to select 17 retrospective cohort studies published until April 2023 about sRS-RARP and continence. Data were extracted independently by at least two authors. The International Prospective Register of Systematic Reviews (PROSPERO) was registered. Retrospective studies were subjected to a domain-based risk of bias assessment in accordance with the Newcastle-Ottawa quality assessment scale cohort studies (NOS). Prostate cancer patients were chosen from prospective nonrandomized or randomized sRS-RARP or sS-RARP studies that examined continence outcomes. RESULTS Seventeen studies were included: 14 were retrospectives only and 3 described retrospective comparison cohorts (sRS-RARP vs sS-RARP). All the retrospective studies were of "fair" quality using the NOS. sRS-RARP may increase recovery of urinary continence after surgery compared to sS-RARP [OR 4.36, 95% CI 1.7-11.17; I2 = 46.8%; studies = 4; participants = 87]. CONCLUSIONS sRS-RARP approach has potential to improve continence outcomes in the salvage setting. sRS-RARP approach has potential to positively impact continence function on patients who underwent salvage surgery.
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Affiliation(s)
- Igor Nunes-Silva
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
| | - Alexandre Kyoshi Hidaka
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
| | - Felipe Placco Araujo Glina
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
| | - Renan Murata Hayashi
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil.
| | - Sidney Glina
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
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Kadono Y, Nohara T, Kawaguchi S, Makino T, Naito R, Kadomoto S, Iwamoto H, Yaegashi H, Shigehara K, Izumi K, Mizokami A. Comparison of postoperative urinary continence and incontinence types between conventional and Retzius-sparing robot-assisted radical prostatectomy. Neurourol Urodyn 2023. [PMID: 37096807 DOI: 10.1002/nau.25193] [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: 02/27/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
AIMS This study aimed to investigate the postoperative urinary continence rate and incontinence types compared over time between conventional robot-assisted radical prostatectomy (C-RARP) and Retzius-sparing RARP (RS-RARP). METHODS All 61 cases were selected from the C-RARP and RS-RARP by propensity score matching, and the pad scale, 24-h pad weight test, and International consultation on incontinence questionnaire-short form (ICIQ-SF) were followed-up over time up to 12 months. RESULTS The probability of urinary continence per pad scale evaluation differed according to how it was defined: the continence rate 12 months after C-RARP and RS-RARP were 94% and 95% for 1 pad/day, 85% and 92% for 1 security pad/day, 61% and 85% for no pad use, respectively, which were all significantly better with RS-RARP. The results of the 24-h pad weight test were significantly better with RS-RARP at both 3 and 12 months, with median C-RARP versus RS-RARP values of 5 versus 1 g and 2 versus 0 g, respectively. In terms of types of urinary incontinence, the rates of postoperative stress urinary incontinence (SUI) increased in both procedures but to a lesser extent in RS-RARP. Other types of urinary incontinence, such as urge incontinence and terminal dribbling, did not differ significantly before and after surgery and between the two procedures. CONCLUSIONS Postoperative urinary continence was better with RS-RARP than with C-RARP per all follow-up parameters until 12 months postoperatively. Postoperative SUI was significantly lower with RS-RARP than with C-RARP, which was considered the main reason for better postoperative urinary continence with RS-RARP.
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Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Franco A, Pellegrino AA, De Nunzio C, Salkowski M, Jackson JC, Zukowski LB, Checcucci E, Vourganti S, Chow AK, Porpiglia F, Kaouk J, Crivellaro S, Autorino R. Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand? Curr Oncol 2023; 30:4301-4310. [PMID: 37185441 PMCID: PMC10136812 DOI: 10.3390/curroncol30040328] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | | | - Jamal C Jackson
- Department of Urology, Rush University, Chicago, IL 60612, USA
| | | | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | | | | | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
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18
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Is It Safe to Switch from a Standard Anterior to Retzius-Sparing Approach in Robot-Assisted Radical Prostatectomy? Curr Oncol 2023; 30:3447-3460. [PMID: 36975474 PMCID: PMC10047447 DOI: 10.3390/curroncol30030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/22/2023] Open
Abstract
Background: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to lead to better outcomes regarding early continence compared to standard anterior RARP (SA-RARP). The goal of this study was to assess the feasibility and safety of implementing RS-RARP in a tertiary center with experience in SA-RARP. Methods: From February 2020, all newly diagnosed non-metastatic prostate cancer patients for whom RARP was indicated were evaluated for RS-RARP. Data from the first 100 RS-RARP patients were prospectively collected and compared with data from the last 100 SA-RARP patients. Patients were evaluated for Clavien Dindo grade ≥3a complications, urinary continence after 2 and 6 weeks, 3, 6 and 12 months, erectile function, positive surgical margins (PSMs) and biochemical recurrence (BCR). Results: There was no significant difference in postoperative complications at Clavien-Dindo grade ≥3a (SA-RARP: 6, RS-RARP: 4; p = 0.292). At all time points, significantly higher proportions of RS-RARP patients were continent (p < 0.001). No significant differences in postoperative potency were observed (52% vs. 59%, respectively, p = 0.608). PSMs were more frequent in the RS-RARP group (43% vs. 29%, p = 0.034), especially in locally advanced tumors (pT3: 64.6% vs. 43.8%, p = 0.041—pT2: 23.5% vs. 15.4%, p = 0.329). The one-year BCR-free survival was 82.6% vs. 81.6% in the SA-RARP and RS-RARP groups, respectively (p = 0.567). The median follow-up was 22 [18–27] vs. 24.5 [17–35] months in the RS-RARP and SA-RARP groups, respectively (p = 0.008). Conclusions: The transition from SA-RARP to RS-RARP can be safely performed by surgeons proficient in SA-RARP. Continence results after RS-RARP were significantly better at any time point. A higher proportion of PSMs was observed, although it did not result in a worse BCR-free survival.
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19
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Tay LJ, Makin R, Saxionis I, Dokubo I, Patel K, Sivathasan S, Smart S, Warren A, Shah N, Lamb BW. Comparative analysis of early post-operative outcomes between retzius-sparing and anterior approach robotic radical prostatectomy for a single surgeon. JOURNAL OF CLINICAL UROLOGY 2023. [DOI: 10.1177/20514158231156314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Introduction: The aim of this study was to compare intraoperative and early post-operative outcomes between retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) versus standard approach for RARP (S-RARP). Patients and methods: All RARPs by a single surgeon were included and divided into two groups: (1) standard approach including combined anterior–posterior approach (S-RARP); (2) retzius-sparing posterior approach (RS-RARP). Allocation was based on prostate size and location of index lesion on MRI. Initial post-operative follow-up was at 6 weeks. Results: Overall, 169 RARPs were performed between March 2018 and October 2021: S-RARP = 99 versus RS-RARP = 70. There was no significant difference in pre-operative body mass index (BMI), prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group and clinical T stage. Intraoperative differences were found in blood loss (300 versus 200 mL, p = 0.008), console time (180 versus 135 minutes, p < 0.001) favouring RS-RARP, with no differences in nerve-spare or lymph node dissection. Post-operatively, no difference was found in ISUP grade, pathological T stage, positive surgical margins, number of lymph nodes sampled, readmissions or complications. Gland size in the RS group was smaller (38 versus 29 g, p = 0.001). Early (6 weeks) post-op follow-up showed a significant difference between groups for both pad-free continence (35% versus 53%, p = 0.011) and social continence (79% versus 89%, p = 0.024), but no difference for erectile function recovery (27% versus 50% of baseline) and post-op PSA levels < 0.1 ng/mL (85% versus 93%). Conclusion: Even early in the learning curve, continence recovery, operative time and blood loss were significantly better for RS-RARP than S-RARP. Margin status and PSA levels are comparable to published literature for both groups. Standardised training in RS-RARP might help to improve the uptake of this novel technique. Level of evidence: 2.
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Affiliation(s)
- Li June Tay
- Department of Urology, Cambridge University Hospitals, UK
| | - Robert Makin
- Department of Urology, Cambridge University Hospitals, UK
| | | | - Ibi Dokubo
- Department of Urology, Cambridge University Hospitals, UK
| | - Keval Patel
- Department of Urology, University Hospitals Birmingham, UK
| | | | - Sonny Smart
- Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - Anne Warren
- Department of Pathology, Cambridge University Hospitals, UK
| | - Nimish Shah
- Department of Urology, Cambridge University Hospitals, UK
| | - Benjamin W Lamb
- Department of Urology, University College London Hospitals NHS Trust, London, UK
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, UK
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20
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Yılmaz K, Ölçücü MT, Özsoy Ç, Aksaray EE, Kılıç Ş, Ateş M. Comparison of Early Urinary Continence, Oncological Outcomes, and Postoperative Complications in Retzius-Sparing and Standard Approach Robot-Assisted Radical Prostatectomy. J Laparoendosc Adv Surg Tech A 2023; 33:150-154. [PMID: 36257651 DOI: 10.1089/lap.2022.0409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of the study is to compare the results of early urinary continence (UC), pathological results, console time (CT), and perioperative morbidity in patients who underwent transperitoneal robot-assisted radical prostatectomy (TR-RARP) and Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) surgeries in the treatment of clinically localized prostate cancer. Methods: A total of 120 patients, 60 (Group 1) with the TR-RALP technique and 60 (Group 2) with the RS-RALP technique, who had no statistical difference in their preoperative demographic data, were selected retrospectively. Perioperative and postoperative data, and continence rates in the first, third and sixth months were compared between the 2 groups. Results: There was no significant difference between the groups in terms of CT, hemoglobin change, and perioperative and postoperative data. There was a statistically significant difference between the 2 groups in favor of RS-RARP in terms of UC in the first and third months, whereas there was no statistically significant difference between the groups at month 6 (P = .001, P = .002, and P = .245, respectively). Conclusion: This study demonstrates that the RS-RARP technique is a promising approach to achieve early continence without compromising oncological principles and without increased complication rates.
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Affiliation(s)
- Kayhan Yılmaz
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Mahmut Taha Ölçücü
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Çağatay Özsoy
- Abdulkadir Yüksel Public Hospital, Gaziantep, Turkey
| | - Eren Erdi Aksaray
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Şahin Kılıç
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
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21
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Fonseca J, Moraes-Fontes MF, Rebola J, Lúcio R, Almeida M, Muresan C, Palmas A, Gaivão A, Matos C, Santos T, Dias D, Sousa I, Oliveira F, Ribeiro R, Lopez-Beltran A, Fraga A. Retzius-sparing robot-assisted radical prostatectomy in a medium size oncological center holds adequate oncological and functional outcomes. J Robot Surg 2023; 17:1133-1142. [PMID: 36633734 DOI: 10.1007/s11701-022-01517-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as a surgical option for patients with prostatic cancer in high-volume centers. The objective is to assess oncological and functional outcomes when implementing RS-RARP in a medium-volume center without previous experience of robotic surgery. This is a prospective observational single-center study. Patients operated between July 2017 and April 2020 were divided into two consecutive groups, A and B, each with 104 patients. The surgeons had prior experience in laparoscopic surgery and underwent robotic training. Positive surgical margin (PSM) status, urinary continence, and erectile function projected by Kaplan-Meier curves, together with patient reported quality of life outcomes at 12 months post-surgery were documented. Median patient age was 63 years (IQR = 59-67), overall PSM rate were 33%, 28% for pT2 disease. Pre-operative values showed no significant difference between both groups. The rate of urinary continence dropped from 81 to 78% (SE = 5.7) (Group A) and from 90 to 72% (SE = 6.3) (Group B) using the International Consultation on Incontinence Questionnaire-Short Form. Baseline sexual function was regained in 41% (Group A) and 47% (Group B) of patients. The median Expanded Prostate Index Composite-26 total score decreased from 86 to 82. These outcomes relate favorably to prior reports. There was a clinically significant decrease in median operative time in the successive groups with post-operative complications occurring in less than 2% of surgical procedures overall. A 12-month follow-up suggests that RS-RARP may be safely introduced in a medium-volume center without previous experience of robotic surgery.
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Affiliation(s)
- Jorge Fonseca
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal. .,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal.
| | | | - Jorge Rebola
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Rui Lúcio
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Miguel Almeida
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Ciprian Muresan
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Artur Palmas
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Ana Gaivão
- Centro Clínico Champalimaud, Serviço de Imagiologia, Champalimaud Foundation, Lisbon, Portugal
| | - Celso Matos
- Centro Clínico Champalimaud, Serviço de Imagiologia, Champalimaud Foundation, Lisbon, Portugal
| | - Tiago Santos
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Daniela Dias
- Centro Clínico Champalimaud, Unidade de Próstata, Champalimaud Foundation, Av. Brasília, 1400-038, Lisbon, Portugal
| | - Inês Sousa
- Centro Clínico Champalimaud, Unidade de Investigação Clínica, Champalimaud Foundation, Lisbon, Portugal
| | - Francisco Oliveira
- Centro Clínico Champalimaud, Serviço de Medicina Nuclear, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Ribeiro
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal
| | - Antonio Lopez-Beltran
- Centro Clínico Champalimaud, Unidade de Anatomia Patológica, Champalimaud Foundation, Lisbon, Portugal
| | - Avelino Fraga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Oporto, Portugal
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22
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Yang Y, Wang J, Zhang D, Zhang Q. Efficacy of the transvesical approach for robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision for the treatment of localized prostate cancer. Front Surg 2023; 9:1053140. [PMID: 36684143 PMCID: PMC9852527 DOI: 10.3389/fsurg.2022.1053140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Objective This study explores the feasibility and safety of the transvesical approach of robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision. Methods From June 2017 to May 2021, 41 patients aged from 51 to 69 years underwent the transvesical approach of robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision (L-RALP). The prostate volume was 22.0-57.8 ml (mean: 36.3 ± 11.1 ml), with a preoperative PSA value of 3.7-12.3 ng/ml (mean: 7.3 ± 1.2 ng/mL). All preoperative Gleason scores were less than or equal to 7 points, and the preoperative TNM stage ranged from T2a to T2b. All patients were diagnosed with prostate cancer by preoperative prostate biopsy or postoperative pathological specimens after prostatectomy. The operation, blood loss, hospitalization, erectile function and postoperative urinary continence were recorded. Patients were defined as continent if they answered "zero pad" per day, and they were invited to fill out The International Consultation on Incontinence Questionnaire (ICI-Q-SF) after the catheter removal at 4 and 24 weeks. Results All the operations were completed by robotic-assisted radical prostatectomy without transition to open surgery. The surgery time was 105-131 min (mean: 111.3 ± 14.9 min), with an estimated blood loss of 50-220 ml (mean: 95.5 ± 27.3 ml). The postoperative hospital stay was 3-8 days (mean: 5.2 ± 1.7 days), and the postoperative catheter was removed after 5-7 days (mean: 6.3 ± 1.1 days). After 24 weeks of follow-up, 35 cases (85.4%, 35/41) obtained immediate urinary continence after the catheter removal in 24h. All patients had regained continence 24 weeks postoperatively (100%, 41/41). Conclusion The transvesical approach of robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision is a safe and effective surgical technique, beneficial for early continence recovery and erectile function, and it is also suitable for prostate cancer patients after prostate enucleation.
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Affiliation(s)
- YunKai Yang
- Department of Graduate Student, Second Clinical Medical School, Zhejiang Chinese Medical University, The 2nd Clinical Medical College, Hangzhou, China,Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, China
| | - Jingyun Wang
- Graduate Department, Bengbu Medical College, Bengbu, China
| | - DaHong Zhang
- Graduate Department, Bengbu Medical College, Bengbu, China,Correspondence: Qi Zhang DaHong Zhang
| | - Qi Zhang
- Urology & Nephrology Center, Department of Urology, Zhejiang Provincial People’s Hospital, Hangzhou, China,Correspondence: Qi Zhang DaHong Zhang
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23
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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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24
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Shiang AL, Palka JK, Balasubramanian S, Figenshau RS, Smith ZL, Kim EH. Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy. J Robot Surg 2022; 17:835-840. [PMID: 36316538 PMCID: PMC9628306 DOI: 10.1007/s11701-022-01464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
Dissemination of robotic surgical technology for robot-assisted laparoscopic prostatectomy (RALP) has yielded advancements including the Retzius-sparing (RS) approach and the single-port (SP) platform. The safety and feasibility of each individual advancement have been evaluated, yet there is a lack of literature comparing SP RS-RALP to conventional multi-port (MP) RS-RALP. All patients who underwent RS-RALP at our institution between January 2019 and February 2021 were retrospectively reviewed. Data regarding baseline patient and tumor characteristics, operative characteristics, and surgical outcomes were collected and analyzed using the Fisher's exact test and two-tailed unpaired t tests. 62 patients were evaluated: 31 received SP RS-RALP and 31 received MP RS-RALP. Differences in patient age, BMI, and initial PSA were not observed. Lower median lymph node yield (SP: 4 vs MP: 12, p < 0.01), lower estimated blood loss (SP: 111.2 vs. MP 157.8 mL, p < 0.01), shorter operative time (SP: 207.7 vs. MP: 255.9 min, p < 0.01) and decreased length of stay (SP: 0.39 vs. MP: 1.23 days, p < 0.01) were observed in the SP RS-RALP cohort. No differences in positive surgical margins, complications, or biochemical recurrence rates were observed. SP RS-RALP is non-inferior to MP RS-RALP in terms of both perioperative and early oncologic outcomes. Despite the small sample size, the SP platform is a safe and feasible option for RS-RALP and confers potential benefits in the form of shorter operative time and reduced length of stay.
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Affiliation(s)
- Alexander L. Shiang
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Joshua K. Palka
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Shiva Balasubramanian
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Zachary L. Smith
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110 USA
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25
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Palma-Zamora I, Abdollah F, Rogers C, Jeong W. Robot-assisted radical prostatectomy: Advancements in surgical technique and perioperative care. Front Surg 2022; 9:944561. [PMID: 36238861 PMCID: PMC9551271 DOI: 10.3389/fsurg.2022.944561] [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: 05/15/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022] Open
Abstract
We reviewed the evolving strategies, practice patterns, and recent advancements aimed at improving the perioperative and surgical outcomes in patients undergoing robot-assisted radical prostatectomy for the management of localized prostate cancer.
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26
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Sood A, Grauer R, Jeong W, Butaney M, Mukkamala A, Borchert A, Baumgarten L, Hensley PJ, Abdollah F, Menon M. Evaluating post radical prostatectomy mechanisms of early continence. Prostate 2022; 82:1186-1195. [PMID: 35579026 DOI: 10.1002/pros.24371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/11/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To identify the periprostatic structures associated with early return of urinary continence after radical prostatectomy (RP). METHODS We compared total continence results between four different techniques of robot-assisted radical prostatectomy (RARP). Specifically, we studied 1-week and 1-month zero-pad continence rates of anterior (n = 60), posterior (n = 59), a novel hybrid posterior-anterior (n = 12), and transvesical (n = 12) approaches of RARP. Each technique preserved a unique set of periprostatic anatomic structures, thereby, allowing evaluation of the individual impact of preservation of nerves, bladder neck, and space of Retzius with associated anterior support structures on early continence. Urethral length was preserved in all approaches. The space of Retzius was preserved in posterior and transvesical approaches, while the bladder neck was preserved in posterior and hybrid approaches. Nerve sparing was done per preoperative oncological risk. For all patients, 24-h pad usage rates and 24-h pad weights were noted at 1 week and 1 month after catheter removal. Multivariable logistic regression analysis was performed to identify predictors of early continence. Data were obtained from prospective studies conducted between 2015 and 2021. RESULTS At 1 week, 15%, 42%, 45%, and 8% of patients undergoing anterior, posterior, hybrid, and transvesical RARP approaches, respectively, were totally continent (p = 0.003). These rates at 1 month were 35%, 66%, 64%, and 25% (p = 0.002), respectively. The transvesical approach, which preserved the space of Retzius but not the bladder neck, was associated with the poorest continence rates, while the posterior and hybrid approaches in which the bladder neck was preserved with or without space of Retzius preservation were associated with quickest urinary continence recovery. Bladder neck preservation was the only significant predictor of 1-week and 1-month total continence recovery in adjusted analysis, Odds ratios 9.06 (p = 0.001) and 5.18 (p = 0.004), respectively. CONCLUSIONS The beneficial effect of the Retzius-sparing approach on early continence recovery maybe associated with bladder neck preservation rather than space of Retzius preservation.
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Affiliation(s)
- Akshay Sood
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York CIty, New York, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anudeep Mukkamala
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alex Borchert
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lee Baumgarten
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Patrick J Hensley
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Firas Abdollah
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mani Menon
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York CIty, New York, USA
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GALFANO A, TAPPERO S, EDEN C, DELL’OGLIO P, FRANSIS K, GUO H, KOWALCZYK K, LONGONI M, MADI R, RHA KH, SECCO S, QIU X, SAYYID R, BOCCIARDI AM. Multicentric experience in Retzius-sparing robot-assisted radical prostatectomy performed by expert surgeons for high-risk prostate cancer. Minerva Urol Nephrol 2022; 74:607-614. [DOI: 10.23736/s2724-6051.22.04857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Balbay MD, Köseoğlu E, Canda AE, Özkan A, Kılıç M, Kiremit MC, Musaoğlu A, Tarım K, Sarıkaya AF. Endopelvic Fascia Sparing Robotic Radical Cystectomy with Intracorporeal Studer Pouch with Balbay's Technique. JSLS 2022; 26:JSLS.2022.00031. [PMID: 35967959 DOI: 10.4293/jsls.2022.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Robotic radical cystectomy (RARC) with intracorporeal urinary diversion is a technically complicated, time-consuming procedure. The aim of this study was to present the operative, pathological, oncological, and functional outcomes of patients who underwent endopelvic fascia sparing (EPFS) RARC with intracorporeal Studer pouch formation. To the best of our knowledge, this is first series in the literature that includes EPFS RARC. Methods Between October 1, 2019 and April 30, 2022, 10 bladder cancer patients underwent EPFS RARC, bilateral extended pelvic lymph node dissection with intracorporeal Studer pouch reconstruction with Balbay's technique. Patient demographics, operative, and post-operative parameters were recorded. Results Among 10 patients, 8 were male and 2 were female. Mean operative time, median estimated blood loss, and median duration of hospital stay was 530 minutes, 316 ml, and 8 days, respectively. One month postoperatively, the mean maximum flow, average flow rate, mean voided, and post-voided urine volume were 20.2 ml/sec, 4.4 ml/sec, 273.6 ml, and 3.5 ml, respectively. All of the patients were fully continent during day-time, three had mild night-time incontinence requiring pad use (both patients 1 pad per night). During a mean 11.5 months of follow up, zero patients died. One patient with a pathological, stage 4 tumor, had nodal recurrence at six months postoperatively. No distant metastasis were detected. Conclusion Endopelvic fascia sparing RARC has very promising early functional results with safe oncological outcomes and low complication rates.
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Affiliation(s)
| | - Ersin Köseoğlu
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Arif Özkan
- Urology Clinic, Koç University Hospital, Istanbul, Turkey
| | - Mert Kılıç
- VKF American Hospital, Urology Clinic, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Kayhan Tarım
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
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Moschovas MC, Brady I, Noel J, Zeinab MA, Kaviani A, Kaouk J, Crivellaro S, Joseph J, Mottrie A, Patel V. Contemporary techniques of da Vinci SP radical prostatectomy: multicentric collaboration and expert opinion. Int Braz J Urol 2022; 48:696-705. [PMID: 35363459 PMCID: PMC9306371 DOI: 10.1590/s1677-5538.ibju.2022.99.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The da Vinci SP robot consists of an innovative single port trocar that houses a flexible camera and three biarticulated arms, which minimizes the number of incisions to assess the surgical site, allowing a less invasive procedure. However, due to its recent release in the market, the current literature reporting SP-RARP is still restricted to a few centers. In this scenario, after performing a literature search with all available techniques of SP-RARP, our objective is to report a multicentric opinion of referral centers on different techniques to approach SP-RARP. Results The SP literature is provided by only a few centers due to the limited number of this new console in the market. Five different approaches are available: transperitoneal, extraperitoneal, Retzius-Sparing, transperineal and transvesical. None of the current studies describe long-term functional or oncological outcomes. However, all approaches had satisfactory operative performance with minimum complication rates. Conclusions Several techniques of SP-RARP have been reported in the literature. We performed a multicentric collaboration describing and illustrating the most challenging steps of this surgery. We believe that the details provided in this article are useful teaching material for new centers willing to adopt the SP technology.
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Affiliation(s)
- Marcio Covas Moschovas
- AdventHealth Global Robotics Institute (GRI), Celebration, USA.,University of Central Florida (UCF), Orlando, USA
| | - Isabella Brady
- AdventHealth Global Robotics Institute (GRI), Celebration, USA
| | - Jonathan Noel
- AdventHealth Global Robotics Institute (GRI), Celebration, USA
| | | | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA
| | | | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute (GRI), Celebration, USA.,University of Central Florida (UCF), Orlando, USA
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Takahashi H, Maeda A, Harata S, Watanabe K, Yanagita T, Suzuki T, Ushigome H, Maeda Y, Shiga K, Ogawa R, Matsuo Y, Takiguchi S. Robot-assisted laparoscopic abdominoperineal resection with en bloc prostatectomy using the Retzius-sparing robot-assisted radical prostatectomy technique. Asian J Endosc Surg 2022; 15:688-692. [PMID: 35297181 DOI: 10.1111/ases.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The best surgical technique for rectal cancer invading the prostate remains controversial. Rectal resection with en bloc prostatectomy using a standard retropubic approach is an option but has disadvantages. We report a new surgical procedure applying Retzius-sparing robot-assisted radical prostatectomy. MATERIALS AND SURGICAL TECHNIQUE First, the rectum was mobilized mainly at its dorsal side. Next, the prostate was separated from the bladder and urethra via the pouch of Douglas approach without opening the Retzius cavity, after which the surgical specimen was extracted through the perineal wound. Lateral pelvic lymph node dissection was performed after vesicourethral anastomosis. DISCUSSION This new robotic procedure minimizes surgical trauma and preserves normal pelvic anatomy. Furthermore, this approach makes it easy to perform subsequent lateral pelvic lymph node dissection.
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Affiliation(s)
- Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Anri Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinnosuke Harata
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kaori Watanabe
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takeshi Yanagita
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Suzuki
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hajime Ushigome
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuzo Maeda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuyoshi Shiga
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Tahra A, Sen UT, Sobay R, İnkaya A, Kucuk EV, Boylu U. Comparison of Retzius-sparing versus standard robot-assisted radical prostatectomy for prostate cancer. Actas Urol Esp 2022; 46:293-300. [PMID: 35221232 DOI: 10.1016/j.acuroe.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES We aim to compare the first year oncological and functional outcomes of Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) and standard robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS Eighty-eight patients who underwent robotic radical prostatectomy between 2018-2019 were included. We compared the minimum one-year follow-up results of patients who underwent Rs-RARP or RARP in terms of oncological and functional outcomes. Potency was assessed with the Sexual Health Inventory for Men (SHIM) score and was defined as an erection sufficient for penetration. Continence was defined as the absence of urinary incontinence with no safety pad. Patients were evaluated in the first month of follow-up and subsequently, every three months. RESULTS Forty-six patients in Rs-RARP and 42 patients in the RARP group were enrolled. Catheter removal time was shorter in the Rs-RARP group (12 vs. 14 days, p = 0.001). At the 1st month visit, 41 patients (%89) were continent (no pads) in the Rs-RARP group while 25 patients (%59) were continent in the RARP group (p = 0.001). Patients who underwent Rs-RARP achieved faster recovery of urinary continence (Log-rank, p = 0.001). After one year of follow-up, 43 patients (93%) in Rs-RARP group and 38 patients (90%) in RARP group were continent (p = 0.6). Potency rates were 38.7% in Rs-RARP and 34.4% in RARP group (p = 0.28). There were no cases of biochemical recurrence in any group. CONCLUSIONS Rs-RARP is a feasible technique, providing early return of continence. However, overall continence rates were similar at the end of the one-year follow-up.
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Affiliation(s)
- A Tahra
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey.
| | - U Tolga Sen
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
| | - R Sobay
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
| | - A İnkaya
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
| | - E Veli Kucuk
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
| | - U Boylu
- Department of Urology, Health Sciences University, Umraniye Training & Research Hospital, Istanbul, Turkey
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Hem-o-lok-free and Retzius-sparing robot-assisted laparoscopic radical prostatectomy with retrograde release of the neurovascular bundle. Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chung DY, Jung HD, Kim DK, Lee MH, Lee SW, Paick S, Lee JY, Jeon SH. Outcomes of Retzius-sparing versus conventional robot-assisted radical prostatectomy: A KSER update series systematic review and meta-analysis. PLoS One 2022; 17:e0268182. [PMID: 35617274 PMCID: PMC9135208 DOI: 10.1371/journal.pone.0268182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/24/2022] [Indexed: 12/01/2022] Open
Abstract
Background Robotic‐assisted radical prostatectomy(RARP) is widely used to surgically treat of localized prostate cancer. Among RARP, retzius-sparing techniques(RS-RARP) are implemented through douglas pouch, not the existing conventional approach(C-RARP). We conducted an updated systematic review and meta-analysis including recent published papers. Materials & methods Systematic review was performed following the PRISMA guideline. PubMed, EMBASE, and Cochrane Library were searched up to August 2021. We conducted meta-analysis as follows; Participants, patients with biopsy-proven PCa; Interventions, Patients underwent C-RARP or RS-RALP; Outcomes, comparison of continence recovery rate, positive surgical margins(PSM), complication, operation time and estimated blood loss(EBL) included for analysis. Results Thirteen studies with a total of 2917 patients were included for meta-analysis. Among them, three were randomized controlled trials (RCT) studies and the rest were non-RCT studies. Incontinence was analyzed with zero pad and safety pad, respectively. There showed a statistically significant advantage for RS-RARP in terms of continence recovery at 1 month(0 pad; OR 0.28, (0.16–0.47), safety-pad; OR 0.12 (0.07–0.22), p<0.001), as well as at 3 months(0 pad; OR 0.31 (0.18–0.53), safety-pad; OR 0.23 (0.14–0.40) p<0.001), 6 months(0 pad; OR 0.29 (0.17–0.51), safety-pad; OR 0.13 (0.06–0.27), p<0.001). And after 12 months, RS-RARP showed better results only in the safety-pad(0 pad; OR 0.64 (0.35–1.18), p = 0.15, safety-pad; OR 0.12 (0.04–0.36), p<0.001). In PSM, there was no statistical difference between two group at overall stage, but RS-RARP was observed to be higher than C-RARP in pT3 subgroup analysis(OR 0.74 (0.55–0.99), p = 0.047) (Fig 1). Whereas, there was no significant difference between the two groups in complication, operation time, and EBL. Conclusions Our analysis showed that RS-RARP is superior about early continence recovery than C-RARP. However, RS-RARP showed relatively high PSM in locally advanced PCa of pT3 or above. Therefore, although RS-RARP has few advantages about functional outcomes, we think that caution should be exercised when approaching patients with high-risk local diseases.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Hae Do Jung
- Department of Urology, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Do Kyung Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Sin Woo Lee
- Department of Urology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Sunghyun Paick
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
- * E-mail: (JYL); (SHJ)
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
- * E-mail: (JYL); (SHJ)
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Turkolmez K, Akpınar Ç, Kubilay E, Süer E. Retzius-sparing versus modified anatomical structures preserving and retzius repairing robotic-assisted radical prostatectomy: A prospective randomized comparison on functional outcomes with a 1-year follow-up. J Endourol 2022; 36:1214-1222. [PMID: 35546454 DOI: 10.1089/end.2022.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives; To compare the short-term and 1-yr follow-up functional outcomes of modified anatomical structures preserving and retzius-repairing robot-assisted radical prostatectomy (APR-RARP) compared with retzius-sparing (RS) RARP. Methods; 80 consecutive patients aged 40-75 yr with low-intermediate risk prostat cancer (PCa) were prospectively randomized to APR-RARP or RS-RARP. Urinary continence (UC) recovery rates were evaluated from catheter removal up to 1 yr follow-up. Postoperative UC was defined as 0 pads/one security pad per day. UC recovery rates from catheter removal to 1 yr were calculated by Kaplan-Meier curve; log-rank test was used for the curve comparison. Postoperative potency was evaluated at 3 and 12 months after surgeries. Perioperative complications, positive surgical margin (PSM), and biochemical recurrence rates represent secondary outcomes reported in the study. Results; At the catheter removal, 1, 3, 6 and 12 months after surgery, 52.5% (CI% 95% 37.6-67), 82.5% (CI% 95% 70.8-94), 95% (CI% 95% 88.3-99.1), 97.5% (CI% 95% 92.5-99.9) and 97.5% (CI% 95% 92.5-99.9) of men undergoing the APR-RARP were continent (0 pads/one security pad per day), compared with 61.5% (CI% 95% 46.5-76.6), 89.7% (CI% 95% 80.3-98.1), 97.5% (CI% 95% 92.6-99.9), 97.5% (CI% 95% 92.6-99.9) and 97.5% (CI% 95% 92.6-99.9) undergoing the RS-RARP, respectively, and the Kaplan Meier curve showed no statistically significant difference for both technique at any time point (log-rank p = 0.556). The median (95% confidence interval [CI]) time to UC recovery was 9.8 (5.2-14.4) days for the APR-RARP versus 6.7 (3.2-10.2) days for the RS-RARP group. Potency rates were similar in both groups at 3 and 12 months after surgeries. The two compared approaches, in terms of rate of complications, PSM were similar. Conclusions; Surgeons can achieve functional results comparable to the retzius-sparing technique with the modified reconstructive anterior approach, without changing the surgical technique they are used to.
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Affiliation(s)
- Kadir Turkolmez
- Ankara University Faculty of Medicine, 63990, Urology, Ankara, Ankara, Turkey;
| | - Çağrı Akpınar
- Ankara University Faculty of Medicine, 63990, Urology, Ankara, Ankara, Turkey;
| | - Erlap Kubilay
- Ankara University Faculty of Medicine, 63990, Urology, Ankara, Ankara, Turkey;
| | - Evren Süer
- Ankara University Faculty of Medicine, 63990, Urology, Ankara, Ankara, Turkey;
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Dell'Oglio P, Tappero S, Longoni M, Buratto C, Scilipoti P, Secco S, Olivero A, Barbieri M, Palagonia E, Napoli G, Strada E, Petralia G, Di Trapani D, Vanzulli A, Bocciardi AM, Galfano A. Retzius-sparing Robot-assisted Radical Prostatectomy in High-risk Prostate Cancer Patients: Results from a Large Single-institution Series. EUR UROL SUPPL 2022; 38:69-78. [PMID: 35265866 PMCID: PMC8898917 DOI: 10.1016/j.euros.2022.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background Retzius-sparing (RS) robot-assisted radical prostatectomy represents a valid surgical treatment option for prostate cancer (PCa) patients. However, the available evidence on the role of RS in high-risk (HR) PCa setting is sparse. Objective To describe our RS technique for HR-PCa patients and to evaluate intra-, peri-, and postoperative oncological and functional outcomes. Design, setting, and participants A total of 340 D’Amico HR-PCa patients underwent RS at a single high-volume centre between 2011 and 2020. Surgical procedure Surgical procedures were performed by five experienced robotic surgeons. Measurements Complications were collected according to the standardised methodology proposed by the European Association of Urology guidelines. Postoperative outcomes were evaluated in patients with complete follow-up data (n = 320). Biochemical recurrence (BCR) was defined as two consecutive prostate-specific antigen values of ≥0.2 ng/ml. Urinary continence (UC) recovery was defined as the use of zero or one safety pad. Kaplan-Meier and multivariable logistic and Cox regression models were performed. Results and limitations Fourteen patients (4%) experienced intraoperative complications and 52 90-d complications occurred in 44 patients (14%), of whom 24 had Clavien-Dindo 3a/b. Final pathology reported 49% International Society of Urological Pathology (ISUP) grade 4–5, 55% ≥pT3a, and 28.8% positive surgical margins (PSMs; 9.4% focal and 19.4% extended PSMs). The median follow-up was 47 mo. Overall, 35.3% and 1.3% harboured BCR and died from PCa. At 4 yr of follow-up, BCR-free survival and additional treatment-free survival were 63.6% and 56.6%, respectively. ISUP 4–5 at biopsy (odds ratio [OR]: 2.6), prostate volume (OR: 1.03), partial or full nerve sparing (OR: 1.9), and full bladder neck preservation (OR: 2.2) were independent predictors of PSMs. Pathological ISUP 4–5 (hazard ratio [HR]: 1.5) and PSMs (HR: 2.3) were independent predictors of BCR. Pathological ISUP 4–5 (HR: 1.5), PSMs (HR: 2.4), pT ≥3b (HR: 1.8), and pN ≥1 (HR: 1.8) were independent predictors of additional treatment. Immediate UC recovery was recorded in 53% patients. The 1- and 2-yr UC recovery and erectile function recovery were, respectively, 84% and 85%, and 43% and 50%. Conclusions RS in HR-PCa patients allows optimal intra-, peri-, and postoperative outcomes. The RS approach should be considered a valid surgical treatment option for HR-PCa patients in expert hands. Patient summary Relying on the largest cohort of high-risk prostate cancer patients treated with Retzius sparing (RS), we observed that the RS approach is safe and allows optimal cancer control, without significantly compromising functional outcomes.
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Affiliation(s)
- Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Corresponding author. Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands. Tel. +39 02 6444 4617; Fax: +39 02 6444 7896.
| | - Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Mattia Longoni
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo Buratto
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Pietro Scilipoti
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Secco
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alberto Olivero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele Barbieri
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erika Palagonia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Division of Urology, University Hospital “Ospedali Riuniti”, School of Medicine, Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giancarlo Napoli
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elena Strada
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Petralia
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Di Trapani
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram. Cancers (Basel) 2022; 14:cancers14071644. [PMID: 35406416 PMCID: PMC8997126 DOI: 10.3390/cancers14071644] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Many men fear urinary leakage after radical surgery for prostate cancer and may even choose against operation for unrealistic fears of leakage. Many urologists are unaware of their own results, and some urologists who collect their results do so in different ways. We collected urinary leakage data from 680 men in a uniform and simple way at 6, 12, and 24 months after operation: no pads, 1–2 pads, or ≥3 pads required daily. We used many patient characteristics to identify the key factors that predict recovery of urinary control after operation: age, race, height and weight, and preoperative erectile function. Easy-to-use nomograms were constructed that should be tested by other urologists to make sure they perform equally well in their patients. Nomograms like these allow men and the urologists counseling them to share patient-specific information about the timeline for, and the chance of, recovery of urinary control after operation. Abstract Incontinence after robot-assisted radical prostatectomy (RARP) is feared by most patients with prostate cancer. Many risk factors for incontinence after RARP are known, but a paucity of data integrates them. Prospectively acquired data from 680 men who underwent RARP January 2008–December 2015 and met inclusion/exclusion criteria were queried retrospectively and then divided into model development (80%) and validation (20%) cohorts. The UCLA-PCI-Short Form-v2 Urinary Function questionnaire was used to categorize perfect continence (0 pads), social continence (1–2 pads), or incontinence (≥3 pads). The observed incontinence rates were 26% at 6 months, 7% at 12 months, and 3% at 24 months. Logistic regression was used for model development, with variables identified using a backward selection process. Variables found predictive included age, race, body mass index, and preoperative erectile function. Internal validation and calibration were performed using standard bootstrap methodology. Calibration plots and receiver operating curves were used to evaluate model performance. The initial model had 6-, 12-, and 24-month areas under the curves (AUCs) of 0.64, 0.66, and 0.80, respectively. The recalibrated model had 6-, 12-, and 24-month AUCs of 0.52, 0.52, and 0.76, respectively. The final model was superior to any single clinical variable for predicting the risk of incontinence after RARP.
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Kyriazis I, Spinos T, Tsaturyan A, Kallidonis P, Stolzenburg JU, Liatsikos E. Different Nerve-Sparing Techniques during Radical Prostatectomy and Their Impact on Functional Outcomes. Cancers (Basel) 2022; 14:cancers14071601. [PMID: 35406373 PMCID: PMC8996922 DOI: 10.3390/cancers14071601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Optimum preservation of potency and continence after radical prostatectomy (RP) are equally important surgical endpoints as cancer control itself. Nerve-sparing technique during RP has a major impact to both oncological and functional outcomes of the procedure and various different techniques have been developed aiming to optimize its outcomes. This literature review aims to summarize all different nerve-sparing techniques applied during RP from its first description from Patrick C. Walsh to its newer trends. The review underlines that optimum nerve-sparing expands far beyond recognising and preserving the anatomical integrity of the neurovascular bundles. It also emphasises that nerve-sparing is a field under constant development, with new technologies entering continuously the nerve-sparing field corresponding to the evolving open, laparoscopic and robotic-assisted RP approaches. Abstract The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.
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Affiliation(s)
- Iason Kyriazis
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Theodoros Spinos
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Arman Tsaturyan
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
| | | | - Evangelos Liatsikos
- Department of Urology, University of Patras, 26504 Patras, Greece; (I.K.); (T.S.); (A.T.); (P.K.)
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Correspondence: ; Tel.: +30-2610-999-386
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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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Liu J, Zhang J, Yang Z, Liu Q, Zhang W, Qing Z, Wang D. Comparison of Retzius-sparing and conventional robot-assisted laparoscopic radical prostatectomy regarding continence and sexual function: an updated meta-analysis. Prostate Cancer Prostatic Dis 2022; 25:47-54. [PMID: 34697432 DOI: 10.1038/s41391-021-00459-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/24/2021] [Accepted: 09/09/2021] [Indexed: 02/04/2023]
Abstract
ABSTACT BACKGROUND: Studies comparing C-RARP and RS-RARP have reported different results and the choice between the two operation methods remains controversia. METHODS We present the meta-analysis on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The meta-analysis was carried out using Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom) and Stata SE 14.0. The mean difference (MD) with 95% confidence intervals (CI) were used to describe the results of continuous data; odds ratio (OR) with 95% CI were used to describe dichotomous data. Statistical significance was set at P < 0.05. RESULTS The meta-analysis revealed that RS-RARP had a statistically significant advantage in terms of continence recovery immediately after operation (OR: 0.40, 95% CI: 0.20-0.77; P = 0.007) (Fig. 2a), after 1 month (OR: 0.17, 95% CI: 0.10-0.29; P < 0.00001) (Fig. 2b), after 3 months (OR: 0.18, 95% CI: 0.09-0.36; P < 0.00001) (Fig. 2c), after 6 months (OR: 0.26, 95% CI: 0.15-0.46; P < 0.00001) (Fig. 2d) and after 12 months (OR: 0.50, 95% CI: 0.28-0.89; P = 0.02) (Fig. 2e). CONCLUSIONS This meta-analysis found that RS-RARP had better postoperative continence recovery than C-RARP, while sexual function recovery rates were not significantly different. There were also no significant differences in operation time, intraoperative blood loss, length of stay, positive margin rate and complications.
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Affiliation(s)
- Junyan Liu
- Chongqing Medical University, Chongqing, 400016, China
| | - Jindong Zhang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zongke Yang
- Department of Urology, Dianjiang People's Hospital of Chongqing, Chongqing, 408399, China
| | - Qingyuan Liu
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Weiyang Zhang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zizhen Qing
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Delin Wang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Karşıyakalı N, Özgen MB, Özveren B, Durak H, Sağlıcan Y, Türkeri L. The Comparison of Conventional and Retzius-Sparing Robot-Assisted Radical Prostatectomy for Clinical, Pathological, and Oncological Outcomes. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0048] [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] Open
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Retzius-sparing technique independently predicts early recovery of urinary continence after robot-assisted radical prostatectomy. J Robot Surg 2022; 16:1419-1426. [DOI: 10.1007/s11701-022-01383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
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Kumar S, Soni PK, Chandna A, Parmar K, Gupta PK. Mucosal coaptation technique for early urinary continence after robot-assisted radical prostatectomy: a comparative exploratory study. Cent European J Urol 2022; 74:528-534. [PMID: 35083072 PMCID: PMC8771134 DOI: 10.5173/ceju.2021.r1.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Urinary incontinence is a troublesome complication following radical prostatectomy. Various robot-assisted radical prostatectomy (RARP). We describe our technique (Santosh-PGI) of urethral and urinary bladder mucosa coaptation for early continence following RARP. Material and methods We performed a prospective comparative study of patients planned for RARP between July 2018 and December 2019 at our centre. A total of 40 patients were enrolled in the study protocol. Following prostatectomy, patients were alternatively assigned into two groups. In one group, urethral and urinary bladder coaptation sutures were placed in a purse string manner using 3-0 Monocryl sutures and none in the another group. All patients underwent standard end to end vesico-urethral anastomosis as described by Van Velthoven. The urinary catheter was removed on day 10 after surgery. All patients were evaluated on day 1, 30 and 90 after catheter removal. Results The two groups, each with 20 patients, were comparable in terms of age, clinical staging and D’Amico risk classification. The operative time, blood loss and surgical margin positivity were comparable. Following catheter removal, 75% of patients in Group A (Mucosal coaptation) and 50% in Group B (Standard technique) were continent (p = 0.264). At 30 and 90 days, 90% and 95% in Group A and 60% and 80% in Group B reported continence respectively (p-0.078). Four patients in group B reported bothersome incontinence at 90 days follow-up. Conclusions Urethral and urinary bladder mucosal coaptation is a simple innovative technique for early continence following RARP.
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Tahra A, Sen U, Sobay R, İnkaya A, Kucuk E, Boylu U. Comparación entre la prostatectomía con preservación del espacio de Retzius y la prostatectomía radical estándar asistida por robot para el cáncer de próstata. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bassett J, Salibian S, Crivellaro S. Single-port, Retzius-sparing robotic-assisted radical prostatectomy: feasibility and early outcomes. J Endourol 2021; 36:620-625. [PMID: 34931527 DOI: 10.1089/end.2021.0542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Determine safety and feasibility of single-port, Retzius-sparing robot-assisted radical prostatectomy (SP-rsRARP) using the da Vinci® SP (Intuitive Surgical, Sunnyvale, CA, USA) robotic platform in men with adenocarcinoma of the prostate. PATEINTS AND METHODS Twenty-eight consecutive men with prostate cancer underwent SP-rsRARP by one of two surgeons (J.B., S.C.). Data for peri-operative, pathologic, and functional outcomes were collected prospectively and retrospectively analyzed. RESULTS Mean (SD) follow-up was 6 (3) months. Mean age was 65.3 years old with an average body mass index of 25.2 kg/m2. Mean preoperative PSA was 10.2 ng/mL. Average prostate weight was 42 grams. Three patients (11%) had prior radiation to the prostate. There were no intraoperative complications or conversions of technique. Lymphadenectomy was performed in twenty-four (86%) patients and nerve-sparing in fourteen (46%). Mean operative time (skin to skin) was 234 minutes with an average estimated blood loss of 148 mL. Length of hospital stay averaged 23 hours. Seventeen (61%) of the patients did not require opioids for post-operative pain. Two Clavien Grade IIIa complications occurred (lymphocele aspiration, dilation of bladder neck contracture). Pathological grade group was group 1 (0%), grade 2 (57%), group 3 (29%) and group 4-5 (14%). Pathologic stage was T2 (15/28, 54%) and T3a,b (13/28, 46%). Five patients (18%) had a positive surgical margin, four (80%) of whom had T3 disease. One patient (4%) had a detectable PSA in follow-up and opted for adjuvant radiation. Twenty-three patients (82%) were continent at foley removal. Post-operative mean SHIM scores in those who underwent nerve-sparing was 18 at 3-months follow-up. CONCLUSIONS SP-rsRARP appears safe and feasible. Early continence rates are promising. Full characterization of outcomes require longer follow-up and larger cohort validation.
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Affiliation(s)
- Jeffrey Bassett
- Hoag Memorial Presbyterian Hospital, 6011, Hoag Urologic Oncology, 1525 Superior Ave, Suite 210, Newport Beach, Newport Beach, California, United States, 92663;
| | - Salpi Salibian
- Hoag Memorial Presbyterian Hospital, 6011, Hoag Urologic Oncology, Newport Beach, California, United States;
| | - Simone Crivellaro
- University of Illinois at Chicago College of Medicine, 12247, Urology, Chicago, Illinois, United States;
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Anıl H, Karamık K, Yıldız A, Savaş M. Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes? Arch Ital Urol Androl 2021; 93:399-403. [PMID: 34933525 DOI: 10.4081/aiua.2021.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. MATERIALS AND METHODS The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. RESULTS Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). CONCLUSIONS Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.
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Affiliation(s)
- Hakan Anıl
- Department of Urology, Adana Seyhan State Hospital, Adana.
| | - Kaan Karamık
- Department of Urology, Antalya Korkuteli State Hospital, Antalya.
| | - Ali Yıldız
- Department of Urology, Okan University Hospital, Faculty of Medicine, Istanbul.
| | - Murat Savaş
- Department of Urology, Antalya Memorial Hospital, Antalya.
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Albisinni S, Dasnoy C, Diamand R, Mjaess G, Aoun F, Esperto F, Porpiglia F, Fiori C, Roumeguère T, DE Nunzio C. Systematic review comparing Anterior vs Retzius-sparing robotic assisted radical prostatectomy: can the approach really make a difference? Minerva Urol Nephrol 2021; 74:137-145. [PMID: 34714037 DOI: 10.23736/s2724-6051.21.04623-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Retzius-Sparing Robotic Assisted Radical Prostatectomy (RS-RARP) is a novel surgical approach to radical prostatectomy. Its pioneers have suggested an improved recovery of urinary continence, while maintaining adequate cancer control. Aim of this systematic review is to explore available data on RS-RALP and compare functional, oncologic and perioperative results of RS-RARP compared to anterior RARP. EVIDENCE ACQUISITION A search following PRISMA guidelines was performed including the combination of the following words: retzius AND sparing AND radical AND prostatectomy. 93 articles were identified and 13 were included in the systematic review, including 3 randomized controlled trials (RCT), 4 prospective studies and 6 retrospective studies. EVIDENCE SYNTHESIS All available randomized trials confirmed an improved immediate continence for RS-RARP, with rates ranging 51-71%, compared to 21-48% for anterior RARP. However, this advantage was progressively lost with no significant difference found after 6 months. Moreover, a prospective study found no discrepancy in terms of quality of life across the two techniques. Erectile function was difficult to compare, as patients had different baseline erectile function across studies and rate of neurovascular preservation was not comparable. Surgical approach remains controversial regarding positive margin rate, although related to the surgeon's experience and clinical stage. Biochemical recurrence-free survival appears similar between the two approaches. CONCLUSIONS RS-RARP improves early urinary continence recovery compared to anterior RARP, with this advantage being lost after 3 to 6 months. Erectile function and quality of life were however comparable between the two techniques. The results concerning the rate of positive margins remained controversial. Future studies with longer follow-up are needed to better assess oncologic outcomes.
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Affiliation(s)
- Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium -
| | - Cyrielle Dasnoy
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Romain Diamand
- Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Georges Mjaess
- Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon
| | - Fouad Aoun
- Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.,Urology Department, Hôtel Dieu de France - Université Saint Joseph, Beyrouth, Lebanon
| | | | - Francesco Porpiglia
- Division of Urology- San Luigi Hospital (Orbassano), Turin.,Department of Oncology, University of Turin, Turin, Italy
| | - Cristian Fiori
- Division of Urology- San Luigi Hospital (Orbassano), Turin.,Department of Oncology, University of Turin, Turin, Italy
| | - Thierry Roumeguère
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium.,Urology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Cosimo DE Nunzio
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
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Yoo S, Lim B, Choi SY, You D, Kim CS. Width of spared neurovascular bundle after robot-assisted laparoscopic prostatectomy in patients with prostate cancer: is it a reliable factor for predicting postoperative sexual outcome? Prostate Int 2021; 9:119-124. [PMID: 34692583 PMCID: PMC8498713 DOI: 10.1016/j.prnil.2020.07.005] [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: 01/29/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose To investigate the relationship between the width of spared neurovascular bundle (NVB) measured during robot-assisted laparoscopic prostatectomy and postoperative sexual outcomes. Methods Patients with localized prostate cancer with erectile hardness score ≥2 (N = 105) who underwent NVB-sparing robot-assisted laparoscopic prostatectomy were included. Patients were divided into three groups [first (Q1) vs. second and third (Q2-3) vs. fourth (Q4) quartile] according to width of spared NVB measured with a flexible ruler after prostate removal. Preoperative and postoperative sexual function was evaluated according to erectile hardness score and Expanded Prostate Cancer Index Composite questionnaires. Results The proportion of patients with postoperative erectile hardness score ≥2 at postoperative 6 months was as follows: 38.9% (Q1), 48.6% (Q2–3), and 83.3% (Q4) (P = 0.016). The preoperative/postoperative 6-month sexual function score was 40.7/16.9 (Q1), 48.1/19.0 (Q2–3), and 51.2/28.1 (Q4). Postoperative sexual function was significantly associated with preoperative sexual function in Q4 (P = 0.006) and Q2–3 (P = 0.030) but not in Q1. On multivariate analysis, the width of spared NVB was a significant predictor for postoperative 6-month erectile hardness score ≥2. Limitation includes selection bias and short follow-up duration. Conclusions Not only the performance but also the degree and quality of NVB sparing thought to be important for postoperative sexual function. Measurement of the width of NVB during surgery could be an easy intraoperative method for assessing the quality of NVB sparing.
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Affiliation(s)
- Sagnjun Yoo
- Department of Urology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yee CH, Liu AQ, Chiu PKF, Teoh JYC, Hou SSM, Ng CF. A propensity score-matching study on retzius-sparing robotic-assisted radical prostatectomy: Evidence of continence advantage in the early learning curve. Asian J Surg 2021; 45:1403-1407. [PMID: 34690053 DOI: 10.1016/j.asjsur.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/07/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the outcome of retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) compared with conventional RARP in the early learning curve. METHODS Consecutive patients with prostate cancer who underwent RS-RARP were included to compare against conventional RARP of the same period. Propensity-score matching was performed based on age, prostate size, nerve-sparing approach, and final pathological risk categories. All patients were re-admitted to undergo trial without Foley catheter from post-operative day 7-10. Clinical follow-up was performed with monitoring of continence (day 0, 3 months, and the latest continence during the study period) and surveillance of PSA level. RESULTS Between July 2017 and August 2019, 24 consecutive patients received RS-RARP in our centre. Propensity score matching was performed with the best matched 24 controls receiving conventional RARP. Overall median follow-up duration was 15.5 months. A majority of the patients belonged to the intermediate-risk group, with most of them harbouring pT2 disease (RS-RARP: 87.5%; conventional RARP: 79.2%). More patients in RS-RARP group achieved day-0 continence (33.3% vs 0%, p = 0.002) and 3-month continence (66.7% vs 12.5%, p = 0.001). During the whole study period, more RS-RARP achieved continence with 0 pad (91.7% vs 66.7%, p = 0.033). The mean months to continence is shorter in RS-RARP group (4.0 months vs 13.6 months, p = 0.002). No statistically significant differences between the two groups with respect to surgical margins, post-operative PSA detection, and the use of adjuvant radiotherapy. CONCLUSIONS RS-RARP showed better continence rates when compared to conventional RARP even during the learning curve phase.
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Affiliation(s)
- Chi Hang Yee
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Alex Q Liu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Peter K F Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Simon S M Hou
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chi Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Hayee A, Lugo I, Iakymenko OA, Kwon D, Briski LM, Zhao W, Nemov I, Punnen S, Ritch CR, Pollack A, Jorda M, Stoyanova R, Parekh DJ, Gonzalgo ML, Kryvenko ON. Anterior or Posterior Prostate Cancer Tumor Nodule Location Predicts Likelihood of Certain Adverse Outcomes at Radical Prostatectomy. Arch Pathol Lab Med 2021; 146:833-839. [PMID: 34669939 DOI: 10.5858/arpa.2021-0104-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Effect of tumor nodule (TN) location in the prostate on adverse radical prostatectomy (RP) outcomes is not well studied in contemporary cohort. OBJECTIVE.— To investigate the significance of TN location with respect to extraprostatic extension (EPE), seminal vesicle invasion (SV+), and positive margin status (SM+) in 1388 RPs. DESIGN.— Each TN at RP was independently graded, staged, and volumetrically assessed. TNs with at least 80% of their volume occupying either the anterior or posterior part of the prostate were categorized accordingly and included in our study, while all other TNs were excluded. RESULTS.— A total of 3570 separate TNs (median = 3 per RP; range = 1-7 per RP) were scored. There were 1320 of 3570 (37%) anterior TNs and 2250 of 3570 (63%) posterior TNs. Posterior TNs were more likely to be higher grade, and exhibit EPE (18% versus 9.4%) and SV+ (4% versus 0.15%), all P < .001. Anterior TNs with EPE were more likely to exhibit SM+ than posterior TNs with EPE (62% versus 30.8%, P < .001). TN location, grade, and volume were significant factors associated with adverse RP outcomes in our univariable analysis. When we controlled for grade and tumor volume in a multivariable analysis using anterior TN location as a reference, posterior TN location was an independent predictor of EPE and SV+ and was less likely to be associated with SM+ (odds ratio = 3.1, 81.5, and 0.7, respectively). CONCLUSIONS.— These associations may be useful in preoperative surgical planning, particularly with respect to improving radiographic analysis of prostate cancer.
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Affiliation(s)
- Amin Hayee
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Isabella Lugo
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksii A Iakymenko
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Deukwoo Kwon
- Department of Public Health Sciences (Kwon), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Laurence M Briski
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Ivan Nemov
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Sanoj Punnen
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Chad R Ritch
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Alan Pollack
- Radiation Oncology (Pollack, Stoyanova), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Radka Stoyanova
- Radiation Oncology (Pollack, Stoyanova), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Dipen J Parekh
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Mark L Gonzalgo
- Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oleksandr N Kryvenko
- From the Department of Pathology and Laboratory Medicine (Hayee, Lugo, Iakymenko, Briski, Nemov, Jorda, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Department of Urology (Punnen, Ritch, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (Kwon, Zhao, Punnen, Ritch, Pollack, Jorda, Parekh, Gonzalgo, Kryvenko), at the University of Miami Miller School of Medicine, Miami, Florida
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Xu JN, Xu ZY, Yin HM. Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis. Front Surg 2021; 8:738421. [PMID: 34660680 PMCID: PMC8514829 DOI: 10.3389/fsurg.2021.738421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial. Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis. Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P < 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P < 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P < 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function. Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.
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Affiliation(s)
- Jiang-Nan Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhen-Yu Xu
- Department of Urology, Kunshan Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Hu-Ming Yin
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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