1
|
Ortner G, Honis HR, Böhm J, Konschake M, Tokas T, Nagele U. Improved early continence following laparoscopic radical prostatectomy: the urethral hammock technique. World J Urol 2024; 42:168. [PMID: 38492077 DOI: 10.1007/s00345-024-04857-x] [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: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 03/18/2024] Open
Abstract
PURPOSE To introduce and illustrate a novel urethral reconstruction technique-the 'urethral hammock-technique'-and to assess its impact on early postoperative continence following laparoscopic radical prostatectomy (LRP). METHODS 119 patients who underwent LRP between January 2020 and May 2022 (hammock group: n = 43, control group: n = 76) were included in the study. The primary outcome was continence (zero pads or max. one security pad) at 1, 3, and 6 months following surgery. Secondary outcomes were operative time, complications, and histological findings. Univariate and multivariate regression analyses were performed to reveal predictors for continence. p values < 0.05 with a two-sided 95%-confidence interval were considered statistically significant. RESULTS Baseline characteristics were comparable among both groups. The number of patients achieving complete continence in both the hammock and control groups at various time intervals was: 4 weeks 37.2% (16/43) vs. 19.2% (14/73) (p = 0.047); 3 months 60.5% (26/43) vs. 37.3% (28/75) (p = 0.021) and 6 months 72.1% (31/43) vs. 60.3% (44/73) (p = 0.23), respectively. Adjusting for bladder neck preservation status and age, the hammock technique was a significant predictor for continence for the 4-week (OR 0.33, 95% CI 0.13-0.83, p = 0.019) and 3-month (OR 0.28, 95% CI 0.12-0.66, p = 0.004) interval but not for the 6-month interval (OR 0.64, 95% CI 0.27-1.5, p = 0.31). Operative time, complication rates, time till catheter extraction and histological findings were comparable between both groups (all p > 0.05). CONCLUSIONS The hammock technique is a simple and reproducible technique to improve early postoperative continence for at least 3 months following surgery. However, these promising results warrant confirmation through a randomized controlled trial.
Collapse
Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Hanne-Rose Honis
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Julia Böhm
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall I.T., Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| |
Collapse
|
2
|
Washino S, Saito K, Nakamura Y, Miyagawa T. Retrotrigonal Layer Dissection from a Posterior Approach Enables Bladder Neck Preservation in Robot-Assisted Radical Prostatectomy. J Clin Med 2024; 13:1258. [PMID: 38592074 PMCID: PMC10931727 DOI: 10.3390/jcm13051258] [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: 12/20/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND We developed a novel surgical technique: dissection of the retrotrigonal layer from a posterior approach in robot-assisted radical prostatectomy (RARP). This approach enables earlier access to the posterior space during bladder neck dissection and helps preserve the bladder neck. We evaluated the safety and efficacy of this technique in terms of bladder neck preservation Methods: We retrospectively reviewed 238 consecutive patients who underwent RARP using this technique from August 2021 to September 2023. Key metrics included the success rate of accessing the posterior space prior to bladder neck opening during the dissection and the rate of bladder neck preservation. In addition, oncological and surgical safety, as well as continence recovery, were assessed. RESULTS The median age and prostate-specific antigen level were 72 (65-75) years and 7.35 (5.40-11.5) ng/mL, respectively. In 153 (64%) patients, the posterior space was successfully accessed before bladder neck opening, with the success rate increasing from 56% in the series' first half to 72% in the second half (p = 0.015). The bladder neck was preserved in 120 (53%) patients, and this rate increased from 39% in the first half to 63% in the second half (p = 0.0004). Positive surgical margins at the junction between the prostate and bladder were observed in 10 cases (4%). Bladder neck preservation correlated with early continence recovery (hazard ratio 1.37 [95% confidence interval 1.03-1.83], p = 0.030). The grade 3 complication associated with this technique occurred in one case (0.5%). CONCLUSION Retrotrigonal layer dissection from a posterior approach in RARP enhances the safety and ease of bladder neck dissection and aids in its preservation, potentially leading to improved continence recovery.
Collapse
Affiliation(s)
- Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-0834, Japan (T.M.)
| | | | | | | |
Collapse
|
3
|
Singh V, Sharma K, Choudhary GR, Singh M, Tripathi SS, Bhirud DP, Sandhu AS, Navriya SC. Correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy. Urologia 2024; 91:141-146. [PMID: 37632409 DOI: 10.1177/03915603231191269] [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: 08/28/2023]
Abstract
BACKGROUND In addition to ensuring cancer control, prevention of incontinence which significantly impact patients' quality of life, is also an important issue in robot-assisted radical prostatectomy (RARP) operations. In this study, we aimed to find the correlation of urinary continence recovery with various factors after Robot assisted radical prostatectomy. METHODS This study included 162 patients treated with RARP with perioperative data and at least 1 year of follow-up. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. The continence recovery rate in our study was assessed at 6th week, 3rd month, 6th month, 9th month, and 12th month, post-surgery. Logistic regression analysis evaluated the association between the predictive factors and urinary continence recovery in the early and late stages. RESULTS The majority of patients with prostate cancer present in sixth decade of life. The majority of our patients (56.7%) were categorized as high risk using D'Amico classification. The continence rate in our study at 6th week, 3rd month, 6th month, 9th month, and 12th month were 40.1%, 72.2%, 85.2%, 89.5%, and 91.4%, respectively. No improvement in continence status was observed after 1 year in our study. There was significant correlation of age with continence status at 6th week, 3rd month, and 6th month. The young age is associated with early recovery of continence. At 3 and 9 months, the non-diabetics cases achieved significantly higher continence rates than diabetics (p < 0.05) which shows that diabetes causes delay in attainment of continence. CONCLUSION The young age may be associated with early recovery of continence, but further validation requires large number of cases. We attributed good continence recovery rate to meticulous dissection and preservation of good urethral length.
Collapse
Affiliation(s)
- Vikram Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kartik Sharma
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautam Ram Choudhary
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shiv Charan Navriya
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
4
|
Wang J, Hu K, Wang Y, Wu Y, Bao E, Wang J, Tan C, Tang T. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 2023; 17:2617-2631. [PMID: 37721644 DOI: 10.1007/s11701-023-01714-8] [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: 08/02/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
Collapse
Affiliation(s)
- Junji Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Ke Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yu Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yinyu Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Erhao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Jiahao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Chunlin Tan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Tielong Tang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China.
| |
Collapse
|
5
|
Chen Y, Hao H, Chen S, Chen X, Liu Y, Zhang M, Yu W, Shen C, Wu S. Insights into urinary incontinence after robot-assisted radical prostatectomy: urgent urinary incontinence or stress urinary incontinence. World J Urol 2023; 41:3635-3642. [PMID: 37819588 DOI: 10.1007/s00345-023-04584-9] [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: 04/20/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Urinary incontinence is a common complication following robot-assisted radical prostatectomy (RARP). Few studies have explored the relationships and differences between stress urinary incontinence (SUI) and urgent urinary incontinence (UUI) after RARP. This study aimed to investigate the occurrence rates and risk factors of UUI and SUI in short term after RARP. METHODS We prospectively included prostate cancer patients who underwent RARP by a single surgeon. Demographics, lower urinary tract function, oncology, and follow-ups were recorded. Occurrence rates and risk factors of UUI and SUI within 3 months after catheter withdrawal were calculated. RESULTS The study cohort included 363 subjects with a mean age of 66.05 years. The median preoperative International Prostate Symptom Score (IPSS) was 14 (range 0-35), and the median Overactive Bladder Symptom Score (OABSS) was 3 (range 0-14). The occurrence rate of UUI and SUI at 3 months after catheter withdrawal was 8.5% (31/363) and 15.2% (55/363). Nearly all patients with UUI also had SUI. Diabetes history and high OABSS before RARP were independent risk factors for UUI, especially within 1 month after catheter withdrawal. The Gleason Score was an independent risk factor for SUI at 3 months after catheter withdrawal. Additionally, UUI but not SUI might be an influencing factor for decision-making regarding postoperative radiotherapy. CONCLUSION The occurrence rate of SUI after RARP was persistently higher than that of UUI. Nearly all of the patients with UUI simultaneously had SUI. The risk factors of UUI and SUI after RARP were absolutely different.
Collapse
Affiliation(s)
- Yuke Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Xu Chen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yue Liu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Meng Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Wei Yu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Shiliang Wu
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Soputro NA, Ferguson EL, Ramos-Carpinteyro R, Chavali JS, Geskin A, Kaouk J. Vesicourethral Anastomosis in Transvesical Single-Port Robotic Radical Prostatectomy: A Technical Description and Perioperative Outcomes. J Endourol 2023; 37:1001-1011. [PMID: 37463019 DOI: 10.1089/end.2023.0269] [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: 08/16/2023] Open
Abstract
Objective: To describe the technical evolution and perioperative outcomes of vesicourethral anastomosis (VUA) in transvesical (TV) single-port robot-assisted radical prostatectomy (SP-RARP). Materials and Methods: A retrospective review was performed on 189 patients who underwent TV SP-RARP by a single surgeon using the purpose-built SP robotic platform. VUA was completed from within the bladder using two unidirectional V-loc sutures in a continuous, semicircular manner with greater emphasis posteriorly. The most recent 20 cases of TV SP-RARP were selected to evaluate the anastomosis technique and to compare the perioperative outcomes with the first 20 cases of TV SP-RARP performed at our institution. Demographic and clinical data were collected from the prospectively maintained database and statistical analysis was performed. Results: VUA was effectively completed in all cases using the aforementioned technique without any suture breaks, need for conversion, or evidence of intraoperative complication, including urine leak. Marked improvement in the learning curve was observed, which translated to significant reduction in the number of VUA sutures (median: 13 vs 15, p < 0.05) and faster anastomosis time (median: 19.1 vs 33.5 minutes, p < 0.05). The number of anastomotic sutures did not correlate with the prostatectomy specimen weight or volume, especially with both being significantly greater in the latest cases (median weight: 45.1 vs 37.6 g, p < 0.05; median volume: 40.9 vs 36.2 mL, p < 0.05). Postoperative outcomes were favorable with immediate continence achieved in 51.3% of our total cohort and with no patients demonstrating evidence of bladder neck contracture. Conclusion: We provided a detailed technical description of VUA in TV SP-RARP. The improved maneuverability of the SP robotic platform allowed for unique movements to facilitate suture placements from within the confined space of the bladder. The learning curve of a single surgeon was shown in our study, which resulted in notable reduction in the number of sutures, faster anastomosis time, and improved perioperative outcomes.
Collapse
Affiliation(s)
- Nicolas A Soputro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ethan L Ferguson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Roxana Ramos-Carpinteyro
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaya S Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Albert Geskin
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
8
|
Antonelli L, Afferi L, Mattei A, Fankhauser CD. Anterior Sphincter-sparing Suturing of the Vesicourethral Anastomosis During Robotic-assisted Laparoscopic Radical Prostatectomy. EUR UROL SUPPL 2023; 52:109-114. [PMID: 37213237 PMCID: PMC10192927 DOI: 10.1016/j.euros.2023.04.007] [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] [Accepted: 04/05/2023] [Indexed: 05/23/2023] Open
Abstract
Background Continence is an important functional outcome after robotic-assisted laparoscopic radical prostatectomy (RARP), and modifications of the surgical technique may improve outcomes. Objective To illustrate a novel RARP technique and to describe the observed continence outcomes. Design setting and participants A retrospective study of men treated with RARP between 2017 and 2021 was conducted. Surgical procedure During RARP, periprostatic structures are preserved, the intraprostatic urethra is partially spared, and the anterior anastomosis stitches involve the plexus structures but not the anterior urethra. Measurements A descriptive analysis of the pathological, functional, and short-term oncological outcomes was performed. Results and limitations Of 640 men, 448 (70%) with at least 1 yr of follow-up and a median age of 66 yr were included. The median operative time was 270 min and the prostatic volume 52 ml. The transurethral catheter was removed after a median of 3 d, and leakage of urine in the first 24 h after catheter removal was observed in 66/448 patients (15%). Positive surgical margins were reported in 104/448 (23%). Prostate-specific antigen persistence after prostatectomy was observed in 26/448 (6%). During a median follow-up of 2 yr (interquartile range 1-3 yr), the biochemical recurrence after prostatectomy was observed in 19/448 patients (4%). One year after prostatectomy, 406/448 patients (91%) were continent and required no pad at all, while 42/448 (9%) required at least one pad per day. Conclusions Not stitching the anterior urethra is a novel technical modification and may improve continence outcomes. Patient summary We describe a novel way to stitch the bladder neck to the urethra after removal of the prostate using a surgical robotic system. Our technique appeared safe, with promising urinary continence results.
Collapse
Affiliation(s)
- Luca Antonelli
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Urology, Policlinico Umberto I, Rome, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christian Daniel Fankhauser
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- University of Zurich, Zurich, Switzerland
- Corresponding author. Luzerner Kantonsspital, Spitalstrasse 6000, 16 Luzern, Switzerland. Tel. +41 205 11 11; Fax: +41 205 11 11.
| |
Collapse
|
9
|
Gao Y, Yang Y, Li X, Wang T, Cheng Q, Jia Z, Niu SX, Zhang XY, Wang BJ, Zhang X. Vesicoprostatic muscle reconstruction: a step further for immediate and early urinary continence. World J Urol 2023:10.1007/s00345-023-04398-9. [PMID: 37093318 DOI: 10.1007/s00345-023-04398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVES The vesicoprostatic muscle (VPM) is a longitudinal smooth muscle that originates from the trigone of the bladder or the opening of the ureter and is involved in urination as part of the detrusor apron. We explored the effect of VPM reconstruction on immediate and early recovery of urinary continence in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). PATIENTS AND METHODS A total of 523 patients with localized prostate cancer were enrolled from June 2018 to June 2020. All patients were diagnosed in our department based on magnetic resonance imaging and pathological findings on prostate biopsy. After 1:1 propensity score matching, 105 patient pairs were matched. The study was approved by our institutional review board and all surgeries were performed by three experienced high-volume surgeons. Demographic data, total operation time, pathological outcomes, the urinary continence rates of the two groups at different times after RALP, and factors influencing postoperative urinary continence after RALP were recorded. Student's t test was used to compare continuous variables and the Pearson χ2 test to compare categorical variables. Logistic regression analysis was used to identify factors affecting immediate and early postoperative urinary control. RESULTS VPM reconstruction promoted immediate and early recovery of urinary continence (immediate continence, 66.67 vs. 40.00%, P = 0.000; 3-month continence, 80.95 vs. 64.76%, P = 0.008). CONCLUSIONS VPM reconstruction improved immediate and early urinary continence in patients who underwent RALP.
Collapse
Affiliation(s)
- Yu Gao
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yang Yang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, People's Republic of China
| | - Tao Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Qiang Cheng
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhuo Jia
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shao-Xi Niu
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiang-Yi Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bao-Jun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Urology, PLA Military General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Urology, PLA Military General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| |
Collapse
|
10
|
Robot assisted laparoscopic radical prostatectomy with maximal urethral length preservation technique preserves penile length. J Robot Surg 2023. [PMID: 36867324 DOI: 10.1007/s11701-023-01548-4] [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: 03/04/2023]
Abstract
Penile shortening is a recognized but neglected side effect of prostate cancer treatment. In this study we explore the effect of maximal urethral length preservation (MULP) technique on penile length preservation after robot assisted laparoscopic prostatectomy (RALP). In an IRB approved study, we prospectively evaluated the stretched flaccid penile length (SFPL) pre and post RALP in subjects with a diagnosis of prostate cancer. The multiparametric MRI (MP-MRI) was utilized for surgical planning if available preoperatively. Repeated measures t-test, linear regression and 2-way ANOVA analyses were performed. A total of 35 subjects underwent RALP. Mean age was 65.8 yr (SD: 5.9), preoperative SFPL was 15.57 cm (SD: 1.66) and postoperative SFPL was 15.41 cm (SD: 1.61) p = 0.68. No change in the postoperative SFPL was recorded among 27 subjects (77.1%) while 5 subjects (14.3%) had 0.5 cm shortening, and 3 subjects (8.6%) had 1 cm shortening. Pathologic stage, preoperative MP-MRI and body mass index (BMI) were significant predictors of postoperative SFPL on linear regression analysis, p = 0.001. Among 26 subjects with pathologic stage 2 disease, no statistical difference was seen in repeated measures t-test between pre and postoperative SFPL, 15.36 vs 15.3 cm, p = 0.08. All subjects were continent by 6 months postoperatively, with no complications. We demonstrate that incorporating MULP technique and preoperative MP-MRI preserves SFPL in subjects undergoing a RALP.
Collapse
|
11
|
Song QX, Li J, Shen K, Peng Z, Qiu X, Zhu H, Gu Y, Xu W, Wang J, Zhu Y, Pan J, Dong B, Xue W. The application of "S.I.S" technique improves long-term continence after robotic radical prostatectomy. Neurourol Urodyn 2023; 42:650-661. [PMID: 36705067 DOI: 10.1002/nau.25131] [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: 09/01/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
AIMS To propose a novel S.I.S technique during the robotic-assisted radical prostatectomy (RARP), encompassing pubourethral suspension, posterior wall intensification, and bladder neck stripping, and to present functional and oncological outcomes with a special focus on long-term continence. METHODS From January 1, 2018, to December 31, 2019, consecutive patients who underwent RARP were retrospectively investigated and separated into the S.I.S group and the conventional group. Preoperative patient characteristics, tumor status, and perioperative parameters were collected, followed by the assessment of self-reported status on continence, using an International Consultation on Incontinence Modular Questionnaire-urinary incontinence short form (ICIQ-UI-SF). Statistical comparisons were performed on variables between the two surgery groups, and multivariate logistic regression analysis was used to determine predictive factors for postoperative incontinence severity. RESULTS A total of 602 subjects were analyzed with a median follow-up of 24 months. There was no significant difference regarding baseline characteristics and perioperative parameters, except for a more advanced tumor stage in the S.I.S group. The application of the S.I.S technique did not jeopardize the positive surgical margin rate at the bladder neck or long-term tumor control. Notably, the patient-reported degree of incontinence was significantly reduced with the assistance of S.I.S technique, as evidenced by the diminished severe-to-very severe cases. On multivariate analysis, both preoperative body mass index and use of S.I.S modification were independent predictive factors for the long-term incontinence severity. CONCLUSIONS The application of S.I.S technique during RARP is feasible and superior compare with the conventional approach, with a significantly alleviated long-term incontinence severity, without compromising cancer control.
Collapse
Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Li
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Shen
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zehong Peng
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xudong Qiu
- The Graduate School, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanjing Zhu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyuan Gu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenxin Xu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieying Wang
- Department of Clinical Center for Investigation, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahua Pan
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baijun Dong
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
12
|
Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center. J Clin Med 2023; 12:jcm12041358. [PMID: 36835893 PMCID: PMC9962972 DOI: 10.3390/jcm12041358] [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: 01/01/2023] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academic center. METHODS Data from patients undergoing RALP between January 2017 and March 2021 were prospectively collected. RALP was performed by three highly experienced surgeons following the principles of the Montsouris technique, with a bladder-neck-sparing intent and maximal preservation of the membranous urethra (if oncologically safe) without any anterior/posterior reconstruction. (Self-assessed urinary incontinence (UI) was defined as the need of one or more pads per die (excluding the need for a safety pad/die. Univariable and multivariable logistic regression analysis was used to assess the independent predictors of early incontinence among routinely collected patient- and tumor-related variables). RESULTS A total of 925 patients were included; of these, 353 underwent RALP (38.2%) without nerve-sparing intent. The median patient age and BMI were 68 years (IQR 63-72) and 26 (IQR 24.0-28.0), respectively. Overall, 159 patients (17.2%) reported early (30 d) incontinence. In multivariable analysis adjusting for patient- and tumor-related features, a non-nerve-sparing procedure (OR: 1.57 [95% CI: 1.03-2.59], p = 0.035) was independently associated with the risk of urinary incontinence in the short-term period, while the absence of cardiovascular diseases before surgery (OR: 0.46 [95% CI: 0.320.67], p ≤ 0.01) was a protective factor for this outcome. At a median follow-up of 17 months (IQR 10-24), 94.5% of patients reported to be continent. CONCLUSIONS In experienced hands, most patients fully recover urinary continence after RALP at mid-term follow-up. On the contrary, the proportion of patients who reported early incontinence in our series was modest but not negligible. The implementation of surgical techniques advocating anterior and/or posterior fascial reconstruction might improve the early continence rate in candidates for RALP.
Collapse
|
13
|
Gu Z, Zheng Z, Zhang W, Mao S, Wang S, Geng J, Yao X. The development and assessment of a predicting nomogram for the recovery of immediate urinary continence following laparoscopic radical prostatectomy. Front Surg 2023; 9:1071093. [PMID: 36684134 PMCID: PMC9852533 DOI: 10.3389/fsurg.2022.1071093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose This study aimed to develop a nomogram to predict the recovery of immediate urinary continence in laparoscopic radical prostatectomy (LRP) patients. Methods A prediction model was developed based on a dataset of 154 LRP patients. Immediate urinary continence was defined as free from using pads within 7 days after the removal of the urinary catheter. The least absolute shrinkage and selection operator regression (LASSO) model was applied to screen the features. Multivariate logistic regression analysis was used to establish prediction model integrating the features selected from the LASSO regression analysis. Receiver operating curve (ROC), calibration and decision curve analysis (DCA) were used to assess the model's discrimination, calibration and clinical utility. Results The identified features of the prediction model included age, body mass index (BMI) and three pelvic anatomic parameters measured by MRI: membranous urethral length (MUL), intravesical prostatic protrusion length (IPPL) and puborectalis muscle width (PMW). The nomogram showed good discrimination with an are under the curve(AUC) of 0.914 (95% CI, 0.865-0.959, p < 0.001). Moreover, good calibration was showed in the model. Lastly, DCA showed that the nomogram was clinically useful. Conclusion The developed novel nomogram that can predict the possibility for post-prostatectomy patients to recover immediate urinary continence could be used as a counseling tool to explain urinary incontinence to patients after LRP.
Collapse
Affiliation(s)
- Zhuoran Gu
- Department of Urology, Shanghai Tenth People’s Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Zongtai Zheng
- Department of Urology, Shanghai Tenth People’s Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Wentao Zhang
- Department of Urology, Shanghai Tenth People’s Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Shiyu Mao
- Department of Urology, Shanghai Tenth People’s Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China
| | - Shuai Wang
- Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiang Geng
- Department of Urology, Shanghai Tenth People’s Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China,Correspondence: Xudong Yao Jiang geng
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People’s Hospital; Institute of Urinary Oncology, Tongji University School of Medicine, Shanghai, China,Correspondence: Xudong Yao Jiang geng
| |
Collapse
|
14
|
Robot-assisted radical prostatectomy using a novel urethral reconstruction technique vs standard vesicourethral anastomosis. A retrospective cohort study. World J Urol 2023; 41:51-58. [PMID: 36434138 DOI: 10.1007/s00345-022-04208-8] [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: 07/10/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Urinary incontinence is a common postoperative complication of radical prostatectomy (RP). In order to improve postoperative urinary continence rate, we proposed a urethral reconstruction technique which can prevent functional urethra retracting and maintain urethral stability. This study aims to describe the novel technique of robotic-assisted radical prostatectomy (RARP) and compare it with standard vesicourethral anastomosis (VUA) in the early postoperative urinary continence. METHODS Based on the anatomy study, we proposed our novel urethral reconstruction technique. The technique is a continuous suture of the outer urethral rhabdosphincter and the levator ani muscle, the medial dorsal raphe and Denonvilliers fascia. A retrospective, single-center cohort of 75 patients undergoing RARP between August 2020 and February 2022 was analyzed, including 38 patients in the study group undergoing the novel urethral reconstruction technique and 37 patients in the control group undergoing the standard VUA. RESULTS The two groups were comparable in all baseline characteristics. The continence rates in the study group were significantly higher than that in the control group at the day catheter was removed, 1st month and 3rd month after the catheter removal (71.1% vs 37.8%, p = 0.004; 76.3% vs 43.2%, p = 0.003; and 94.7% vs 78.4%, p = 0.037; respectively). No significant difference was observed in operation time (p = 0.241). Meantime, no increase in complications rate was observed in the study group. CONCLUSIONS Our novel urethral reconstruction technique contributes to the early urinary continence after RARP effectively and safely.
Collapse
|
15
|
Nakanishi Y, Matsumoto S, Okubo N, Tanabe K, Kataoka M, Yajima S, Masuda H. Significance of postoperative membranous urethral length and position of vesicourethral anastomosis for short-term continence recovery following robot-assisted laparoscopic radical prostatectomy. BMC Urol 2022; 22:145. [PMID: 36071427 PMCID: PMC9450420 DOI: 10.1186/s12894-022-01097-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). METHODS Clinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. RESULTS Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (< 25 kg/m2) (p = 0.040), longer preoperative MUL (≥ 9.5 mm) (p = 0.013), longer postoperative MUL (≥ 9 mm) (p < 0.001), higher PVUA (< 14.5 mm) (p = 0.019) and shorter operating time (< 170 min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90-7.40, p < 0.001) and higher PVUA (OR 2.02, 95% CI 1.07-3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into 3 groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% versus 68.2% versus 85.0% (p < 0.001) at 3 months. CONCLUSIONS PVUA and postoperative MUL were significant factors for short-term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.
Collapse
Affiliation(s)
- Yasukazu Nakanishi
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
| | - Shunya Matsumoto
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Naoya Okubo
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Kenji Tanabe
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Madoka Kataoka
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Rosenberg JE, Jung JH, Lee H, Lee S, Bakker CJ, Dahm P. Posterior musculofascial reconstruction in robot-assisted laparoscopic prostatectomy for the treatment of clinically localised prostate cancer: a Cochrane Review. BJU Int 2022; 130:6-17. [PMID: 34825456 DOI: 10.1111/bju.15657] [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: 11/26/2022]
Abstract
OBJECTIVES To assess the effects of posterior musculofascial reconstruction robot-assisted laparoscopic prostatectomy (PR-RALP) compared to no PR during standard RALP (S-RALP) for the treatment of clinically localised prostate cancer. PATIENTS AND METHODS We performed a systematic search with no restrictions including randomised controlled trials (RCTs) comparing variations of PR-RALP vs S-RALP for clinically localised prostate cancer. The quality of evidence was assessed on outcome basis according to Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Our search identified 13 records of eight unique RCTs, of which six were published studies, and two were abstract proceedings. There were 1085 randomised patients, of whom 963 completed the trials. All patients had either cT1c or cT2 or cT3a disease. RESULTS A PR-RALP may improve urinary continence 1 week after catheter removal compared to no PR (risk ratio [RR] 1.25, 95% confidence interval [CI] 0.90-1.73; I2 = 42%, five studies, 498 patients, low certainty of evidence [CoE]). A PR-RALP may have little to no effect on urinary continence 3 months after surgery compared to no PR (RR 0.98, 95% CI 0.84-1.14; I2 = 67%, six studies, 842 patients, low CoE). A PR-RALP probably results in little to no difference in serious adverse events compared to no PR (RR 0.75, 95% CI 0.29-1.92; I2 = 0%, six studies, 835 patients, moderate CoE). CONCLUSIONS This review found evidence that PR-RALP may improve early continence 1 week after catheter removal but not thereafter. Meanwhile, adverse event rates are probably not impacted and positive surgical margin rates are likely similar. There was no difference in our subgroup analysis for all outcomes with anterior reconstruction technique when combined with PR vs only PR.
Collapse
Affiliation(s)
- Joel E Rosenberg
- University of California San Diego, University of California, San Diego, CA, USA
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hunju Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Solam Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Caitlin J Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
18
|
Mantica G, Cocci A, Vetterlein MW, Verla W, Campos-Juanatey F, Castiglione F, Rosenbaum CM, Waterloos M, Adamowicz J, Frankiewicz M, Kluth LA. Urethral fixation to improve urinary continence recovery after radical cystectomy with ileal neobladder: the EAU YAU Reconstructive Working Party point of view. Minerva Urol Nephrol 2022; 74:365-367. [PMID: 35607784 DOI: 10.23736/s2724-6051.22.04950-3] [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]
Affiliation(s)
- Guglielmo Mantica
- Department of Urology, IRCCS San Martino Polyclinic, University of Genoa, Genoa, Italy -
| | - Andrea Cocci
- Department of urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wesley Verla
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Felix Campos-Juanatey
- Unit of Andrology and Reconstructive Urology, Marques de Valdecilla University Hospital, IDIVAL, Santander, Spain
| | - Fabio Castiglione
- Department of Urology, University College London Hospital, London, UK
| | | | - Marjan Waterloos
- Department of Urology, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Jan Adamowicz
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | | |
Collapse
|
19
|
Pedraza AM, Wagaskar V, Parekh S, Tewari A. Technical advances in nerve-sparing and continence preservation. Curr Opin Urol 2022; 32:204-210. [PMID: 34954705 DOI: 10.1097/mou.0000000000000958] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Urinary incontinence and erectile dysfunction are common after radical prostatectomy. These side effects greatly impact patients' quality of life. Therefore, surgical techniques and technology tools are constantly being developed to optimize trifecta outcomes. Here we focus on advances in nerve-sparing (NS) and continence preservation. RECENT FINDINGS New surgical techniques dedicated to preservation rather than reconstruction have been developed to improve urinary continence (UC) and NS. On the other hand, intraoperative assessment of prostatic and periprostatic structures has shown promising outcomes toward NS whereas avoiding omission of extracapsular extension (ECE). Likewise, neural regeneration strategies are under research to improve return of erectile function and UC. SUMMARY Superb outcomes after Robot-Assisted Radical Prostatectomy require a proper balance between NS and risk of ECE. Detailed anatomic knowledge together with an accurate surgical planning are cornerstone for tailoring the approach in each case.
Collapse
Affiliation(s)
- Adriana M Pedraza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | | |
Collapse
|
20
|
Shin D, Ahn J, Kwon HJ, Hur KJ, Moon HW, Park YH, Cho HJ, Ha US, Hong SH, Lee JY, Kim SW, Bae WJ. Impact of preoperative factors on recovery of continence after artificial urinary sphincter implantation in postprostatectomy incontinence. Prostate Int 2021; 9:176-180. [PMID: 35059353 PMCID: PMC8740127 DOI: 10.1016/j.prnil.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this study was to determine the influence of preoperative factors on the recovery of continence after artificial urinary sphincter (AUS) implantation in postprostatectomy incontinence. Materials and methods Seventy-two patients who underwent AUS implantation between April 2006 and March 2020 were analyzed. The clinical features and preoperative urodynamic parameters were correlated with the postoperative continence rate using linear and logistic regression analysis. The recovery of continence was defined by the patient requiring no use of a protective urine pad during the 24 hours. Results Of the 72 patients, 57 (79.2%) recovered continence (dry group), while 15 (20.8%) were wearing more than 1 pad per day (wet group) on the last follow-up visit. In the clinical characteristics, only the interval between radical prostatectomy and AUS (in months) showed a statistically significant difference (35.4 ± 26.2 in the dry group, 22.7 ± 12.2 in the wet group, p = 0.009). Other preoperative clinical features such as the underlying disease, surgical methods, size of prostate, tumor stage, and radio nor hormonal therapy did not present statistically significant differences. Of the preoperative urodynamic parameters, only the abdominal leak point pressure (ALPP) showed statistical significance when related to surgical outcomes by 88.6 ± 33.6 in the dry group and 66.1 ± 29.6 in wet the group (P = 0.024). The number of patients for whom ALPP was higher than 80 cm H2O was 61.4% in the dry group and 20% in the wet group (95% confidence interval: 1.612-25.11). Other preoperative UDS features including detrusor underactivity, maximum urethral closure pressure, and others were not statistically significant. Conclusions The interval between RP and AUS, as well as the preoperative ALPP, can be possible predictive factors for the surgical outcomes of AUS implantation. In addition, an ALPP of >80 cm H2O has a high degree of predictability for success of AUS surgical outcomes in post-RP incontinence.
Collapse
Affiliation(s)
- Dongho Shin
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joonho Ahn
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeok Jae Kwon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Jae Hur
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyong Woo Moon
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Hyun Park
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - U-syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Korea
- Corresponding author. Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
| |
Collapse
|
21
|
Elliott PA, Hsiang S, Narayanan R, Bierylo J, Chang SC, Twardowski P, Wilson TG. Cryopreserved placental tissue allograft accelerates time to continence following robot-assisted radical prostatectomy. J Robot Surg 2021; 15:877-883. [PMID: 33426577 DOI: 10.1007/s11701-020-01187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Intra-operatively placed cryopreserved placental tissue allograft (CPTA) has shown promise in expediting the recovery urinary continence (UC) following robot-assisted radical prostatectomy (RARP). In this retrospective review of a prospectively maintained single-surgeon, single-institution RARP database, we compare three groups of patients: historical controls (C; N = 183 men) that received no allograft versus two different CPTA products (total CPTA N = 162 [A1 N = 81; A2 N = 81]). The CPTA product was intra-operatively placed as an onlay over the area of the neurovascular bundles during RARP. CPTA cases had significantly faster median time to UC (A1 = 1.4 months; A2 = 1.45 months) versus controls (1.64 months), p = 0.01. On multivariable analysis, use of A1 (HR 1.55, 95% CI [1.14-2.09], p = 0.005) and use of A2 (HR 1.53, CI [1.11-2.11], p = 0.01) were significantly associated with quicker return of UC. Older age (HR 0.97, CI [0.96-0.99], p = 0.001) and non-organ-confined clinical stage (HR 0.51, CI [0.26-1.0] p = 0.05), were significantly associated with slower return of UC. In a propensity score-matched analysis of 77 CPTA patients with sufficient follow-up versus controls, there was significantly less biochemical recurrence (BCR; p = 0.01). Our study indicates that CPTA use appears to accelerate time to UC in age- and performance status-matched men undergoing RARP without increased risk of BCR.
Collapse
|
22
|
Vis AN, Bergh RCN, Poel HG, Mottrie A, Stricker PD, Graefen M, Patel V, Rocco B, Lissenberg‐Witte B, Leeuwen PJ. Selection of patients for nerve sparing surgery in robot‐assisted radical prostatectomy. BJUI COMPASS 2021; 3:6-18. [PMID: 35475150 PMCID: PMC8988739 DOI: 10.1002/bco2.115] [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: 07/30/2021] [Revised: 09/13/2021] [Accepted: 09/18/2021] [Indexed: 11/09/2022] Open
Abstract
Context Robot‐assisted radical prostatectomy (RARP) has become the standard surgical procedure for localized prostate‐cancer (PCa). Nerve‐sparing surgery (NSS) during RARP has been associated with improved erectile function and continence rates after surgery. However, it remains unclear what are the most appropriate indications for NSS. Objective The objective of this study is to systematically review the available parameters for selection of patients for NSS. The weight of different clinical variables, multiparametric magnetic‐resonance‐imaging (mpMRI) findings, and the impact of multiparametric‐nomograms in the decision‐making process on (side‐specific) NSS were assessed. Evidence acquisition This systematic review searched relevant databases and included studies performed from January 2000 until December 2020 and recruited a total of 15 840 PCa patients. Studies were assessed that defined criteria for (side‐specific) NSS and associated them with oncological safety and/or functional outcomes. Risk of bias assessment was performed. Evidence synthesis Nineteen articles were eligible for full‐text review. NSS is primarily recommended in men with adequate erectile function, and with low‐risk of extracapsular extension (ECE) on the side‐of NSS. Separate clinical and radiological variables have low accuracy for predicting ECE, whereas nomograms optimize the risk‐stratification and decision‐making process to perform or to refrain from NSS when oncological safety (organ‐confined disease, PSM rates) and functional outcomes (erectile function and continence rates) were assessed. Conclusions Consensus exists that patients who are at high risk of ECE should refrain from NSS. Several multiparametric preoperative nomograms were developed to predict ECE with increased accuracy compared with single clinical, pathological, or radiological variables, but controversy exists on risk thresholds and decision rules on a conservative versus a less‐conservative surgical approach. An individual clinical judgment on the possibilities of NSS set against the risks of ECE is warranted. Patient summary NSS is aimed at sparing the nerves responsible for erection. NSS may lead to unfavorable tumor control if the risk of capsule penetration is high. Nomograms predicting extraprostatic tumor‐growth are probably most helpful.
Collapse
Affiliation(s)
- André N. Vis
- Department of Urology Amsterdam UMC, Location VUmc Amsterdam The Netherlands
- Prostate Cancer Network Netherlands
| | | | - Henk G. Poel
- Prostate Cancer Network Netherlands
- Department of Urology NKI/AVL Amsterdam The Netherlands
| | | | | | - Marcus Graefen
- Martini‐Klinik University Hospital Hamburg‐Eppendorf Hamburg Germany
| | - Vipul Patel
- Global Robotics Institute Florida Hospital Celebration Health Orlando Florida USA
| | - Bernardo Rocco
- Department of Urology University of Modena and Reggio Emilia Modena Italy
| | - Birgit Lissenberg‐Witte
- Department of Epidemiology and Data Science Amsterdam UMC, Location VUmc Amsterdam The Netherlands
| | - Pim J. Leeuwen
- Prostate Cancer Network Netherlands
- Department of Urology NKI/AVL Amsterdam The Netherlands
| |
Collapse
|
23
|
Rosenberg JE, Jung JH, Lee H, Lee S, Bakker CJ, Dahm P. Posterior musculofascial reconstruction in robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer. Cochrane Database Syst Rev 2021; 8:CD013677. [PMID: 34365635 PMCID: PMC9746600 DOI: 10.1002/14651858.cd013677.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Delayed recovery of urinary continence is a major adverse effect of robotic-assisted laparoscopic prostatectomy (RALP) in men undergoing prostate cancer treatment. To address this issue, a number of surgical techniques have been designed to reconstruct the posterior aspect of the rhabdosphincter, which is responsible for urinary continence after removal of the prostate; however, it is unclear how well they work. OBJECTIVES: To assess the effects of posterior musculofascial reconstruction RALP compared to no posterior reconstruction during RALP for the treatment of clinically localized prostate cancer. SEARCH METHODS We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings, up to 12 March 2021. We applied no restrictions on publication language or status. SELECTION CRITERIA We included randomized controlled trials (RCTs) in which participants were randomized to undergo variations of posterior musculofascial reconstruction RALP versus no posterior reconstruction during RALP for clinically localized prostate cancer. DATA COLLECTION AND ANALYSIS Two review authors independently classified studies and abstracted data from the included studies. Primary outcomes were: urinary continence recovery within one week after catheter removal, at three months after surgery, and serious adverse events. Secondary outcomes were: urinary continence recovery at six and twelve months after surgery, potency recovery twelve months after surgery, positive surgical margins (PSM), and biochemical recurrence-free survival (BCRFS). We performed statistical analyses using a random-effects model. We rated the certainty of evidence (CoE) according to the GRADE approach. MAIN RESULTS Our search identified 13 records of eight unique RCTs, of which six were published studies and two were abstract proceedings. We included 1085 randomized participants, of whom 963 completed the trials (88.8%). All participants had either cT1c or cT2 or cT3a disease, with a mean prostate-specific antigen level of 8.15 ng/mL. Primary outcomes Posterior reconstruction RALP (PR-RALP) may improve urinary continence one week after catheter removal compared to no posterior reconstruction during RALP (risk ratio (RR) 1.25, 95% confidence interval (CI) 0.90 to 1.73; I2 = 42%; studies = 5, participants = 498; low CoE) although the CI also includes the possibility of no effect. Assuming 335 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 84 more men per 1000 (33 fewer to 244 more) reporting urinary continence recovery. Posterior reconstruction may have little to no effect on urinary continence three months after surgery compared to no posterior reconstruction during RALP (RR 0.98, 95% CI 0.84 to 1.14; I2 = 67%; studies = 6, participants = 842; low CoE). Assuming 701 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 14 fewer men per 1000 (112 fewer to 98 more) reporting urinary continence after three months. PR-RALP probably results in little to no difference in serious adverse events compared to no posterior reconstruction during RALP (RR 0.75, 95% CI 0.29 to 1.92; I2 = 0%; studies = 6, participants = 835; moderate CoE). Assuming 25 per 1000 men undergoing standard RALP experience a serious adverse event at this time point, this corresponds to six fewer men per 1000 (17 fewer to 23 more) reporting serious adverse events. Secondary outcomes PR-RALP may result in little to no difference in recovery of continence 12 months after surgery compared to no posterior reconstruction during RALP (RR 1.02, 95% CI 0.98 to 1.07; I2 = 25%; studies = 3, participants = 602; low CoE). Assuming 918 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 18 more men per 1000 (18 fewer to 64 more) reporting urinary continence recovery. We are very uncertain about the effects of PR-RALP on recovery of potency 12 months after surgery compared to no posterior reconstruction during RALP (RR 1.02, 95% CI 0.82 to 1.26; I2 = 3%; studies = 2, participants = 308; very low CoE). Assuming 433 per 1000 men undergoing standard RALP are potent at this time point, this corresponds to nine more men per 1000 (78 fewer to 113 more) reporting potency recovery. PR-RALP may result in little to no difference in positive surgical margins compared to no posterior reconstruction during RALP (RR 1.24, 95% CI 0.65 to 2.33; I2 = 50%; studies = 3, participants = 517; low CoE). Assuming 130 per 1000 men undergoing standard RALP have a positive surgical margin, this corresponds to 31 more men per 1000 (46 fewer to 173 more) reporting positive surgical margins. PR-RALP may result in little to no difference in biochemical recurrence compared to no posterior reconstruction during RALP (RR 1.36, 95% CI 0.74 to 2.52; I2 = 0%; studies = 2, participants = 468; low CoE). Assuming 70 per 1000 men undergoing standard RALP have experienced biochemical recurrence at this time point, this corresponds to 25 more men per 1000 (18 fewer to 107 more) reporting biochemical recurrence. AUTHORS' CONCLUSIONS: This review found evidence that PR-RALP may improve early continence one week after catheter removal but not thereafter. Meanwhile, adverse event rates are probably not impacted and surgical margins rates are likely similar. This review was unable to determine if or how these findings may be impacted by the person's age, nerve-sparing status, or clinical stage. Study limitations, imprecision, and inconsistency lowered the certainty of evidence for the outcomes assessed.
Collapse
Affiliation(s)
- Joel E Rosenberg
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea, South
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea, South
| | - Hunju Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Solam Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Caitlin J Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, Minnesota, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
24
|
Collette ERP, Klaver SO, Lissenberg-Witte BI, van den Ouden D, van Moorselaar RJA, Vis AN. Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience. J Robot Surg 2021. [PMID: 32930971 DOI: 10.1007/s11701-020-01145-9)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The prediction of post-prostatectomy incontinence (PPI) after robot-assisted radical prostatectomy (RARP) depends on multiple clinical, anatomical and surgical factors. There are only few risk formulas, tables or nomograms predicting PPI that may assist clinicians and their patients in adequate risk counseling on postoperative side-effects. Prospective data collection of 1814 patients who underwent RARP between 2009 and 2017 was done. Pre-operative parameters were age, body mass index (BMI), prostate volume, the American Society of Anesthesiologists (ASA) score, severity of Lower Urinary Tract Symptoms (LUTS), type of planned nerve-sparing surgery and surgical experience. The continence status was reported using Patient Reported Outcome Measurements (PROMs) using the validated pad-use questionnaire EPIC26. Continence was defined as either the use of zero pads or one safety pad. Multivariable logistic regression analysis was performed to identify predictors of PPI within one year after RARP. An online prediction tool was developed and validated. The median follow-up was 36 months (range 12-108). The response rate was high at 85.2%. A total of 85% (1537/1814) of patients was continent on follow-up. One-year continence rate was 80.1% (95% CI 78.3-81.9%) (1453/1814) and increased to 87.4% (95% CI 85.4-89.4%) after 5 years. On multivariable analysis, severity of LUTS (OR = 0.56 p = 0.004), higher age (OR = 0.73 p = 0.049), extend of nerve-sparing surgery (OR = 0.60 p = 0.001) and surgeon experience (OR = 1.48 p = 0.025) were significant independent predictors for PPI. The online prediction model performed well in predicting continence status with poor discrimination and good calibration. An intuitive online tool was developed to predict PPI after RARP that may assist clinicians and their patients in counseling of treatment.
Collapse
Affiliation(s)
- Eelco R P Collette
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands. .,Department of Urology, Amsterdam UMC, VU University Medical Center, room 4F27, De Boelelaan 1117, Postbus 7057, Amsterdam, 1081HV, The Netherlands.
| | - Sjoerd O Klaver
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Reindert J A van Moorselaar
- Department of Urology, Amsterdam UMC, VU University Medical Center, room 4F27, De Boelelaan 1117, Postbus 7057, Amsterdam, 1081HV, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam UMC, VU University Medical Center, room 4F27, De Boelelaan 1117, Postbus 7057, Amsterdam, 1081HV, The Netherlands
| |
Collapse
|
25
|
Deng W, Jiang H, Liu X, Chen L, Liu W, Zhang C, Zhou X, Fu B, Wang G. Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis. Front Oncol 2021; 11:687010. [PMID: 34079768 PMCID: PMC8165391 DOI: 10.3389/fonc.2021.687010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To estimate the safety and efficiency of transvesical Retzius-sparing robot-assisted radical prostatectomy (T-RARP) compared with standard robot-assisted radical prostatectomy (S-RARP) for localized prostate cancer (PCa). Materials and Methods 174 patients bearing localized PCa and undergoing T-RARP or S-RARP between October 2017 and January 2020 were retrospectively enrolled in our analysis. All potential baseline confounders were strictly restrained with propensity-score matching (PM) method (1: 1). Within the matched setting, the perioperative and functional outcomes were compared between the T-RARP and S-RARP groups, while the oncological results and functional recovery of the two arms were presented with Kaplan-Meier curves. Results Finally, 114 and 60 eligible patients harbouring localized PCa were identified in the S-RARP and T-RARP group, respectively. No significant differences between the two groups were found in all baseline characteristics after PM. Within the matched cohort, no case was converted to open surgery in either group. The T-RARP group was significantly related to a higher mean operative time (p = 0.001) and shorter median hospital stay length (p < 0.001). There were not significant differences in the median estimated blood loss and specimen Gleason score between the two arms. The proportions of transfusion, pT3a disease, postoperative complication, and positive surgical margin in the T-RARP group were also comparable to that in the S-RARP group. The mean prostate-specific antigen and median erectile functional scores did not differ significantly between the two groups at postoperative 3 months and last follow-up. T-RARP vs. S-RARP had significantly improved urinary continence (UC) rates at the removal of catheter (p < 0.001) and postoperative 3 months (p < 0.001), but the significant difference between the two groups in UC recovery disappeared at last follow-up (p = 0.119). No significant difference in biochemical recurrence-free survival was observed following the two surgeries (p = 0.727). Conclusions T-RARP by experienced hands was feasible for selected patients with clinically localized PCa, yielding significantly improved early return to UC and similar erectile functional preservation without compromising oncological control when compared with the standard approach.
Collapse
Affiliation(s)
- Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Hao Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, China.,Jiangxi Institute of Urology, Nanchang City, China
| |
Collapse
|
26
|
Basourakos SP, Ramaswamy A, Yu M, Margolis DJ, Hu JC. Racial Variation in Membranous Urethral Length and Postprostatectomy Urinary Function. EUR UROL SUPPL 2021; 27:61-64. [PMID: 33982018 PMCID: PMC8112615 DOI: 10.1016/j.euros.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
Urinary incontinence remains a significant post-prostatectomy sequalae. While many patient and technical factors have been found to contribute to post-prostatectomy incontinence, the impact of anatomical differences by races has not been studied . Shorter preoperative membranous urethral length (MUL) on prostate MRI has been associated with higher risk of post-prostatectomy incontinence. We compared MUL in Asian and non-Asian men and their post-prostatectomy urinary function using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). We found that MUL was significantly shorter for Asian vs. non-Asian men (7.9mm, 95% confidence interval [CI] 7.5-8.3 vs. 10.9mm, 95%CI 10.2-11.7 - mean difference 3.0mm, 95%CI for mean difference 2.15-3.87; p<0.01) and that Asian men had significantly worse EPIC-CP urinary score ≥12 months post-prostatectomy (3.82; 95%CI 2.47-5.17 vs. 1.95; 95%CI 1.11-2.79 - mean difference: 1.87; 95% CI for mean difference is 0.32-3.42; p=0.022). Confirmatory studies are needed to explore racial differences in MUL and its effect on post-prostatectomy urinary incontinence.
Collapse
Affiliation(s)
- Spyridon P. Basourakos
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ashwin Ramaswamy
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Miko Yu
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Daniel J. Margolis
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jim C. Hu
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
27
|
Deng W, Zhang C, Jiang H, Li Y, Zhu K, Liu X, Chen L, Liu W, Guo J, Zhou X, Fu B, Wang G. Transvesical Versus Posterior Approach to Retzius-Sparing Robot-Assisted Radical Prostatectomy: A Retrospective Comparison With a 12-Month Follow-Up. Front Oncol 2021; 11:641887. [PMID: 33937043 PMCID: PMC8082308 DOI: 10.3389/fonc.2021.641887] [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: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 12/16/2022] Open
Abstract
Objectives To assess the perioperative, functional, and oncological outcomes of transvesical robot-assisted radical prostatectomy (T-RARP) and posterior robot-assisted radical prostatectomy (P-RARP) for localized prostate cancer. Materials and Methods We analyzed the data of 96 patients who underwent T-RARP or P-RARP for localized prostate cancer between January 2017 and June 2019 in a retrospective fashion. Results No significant differences in the baseline characteristics existed between the T-RARP and P-RARP arms. Both interventions were successfully performed without open conversion in either group. T-RARP was associated with a slightly more operative time (135.3 vs. 127.3 min) and estimated blood loss (105.2 vs. 94.2 mL) than P-RARP, but the differences were not significant (both p > 0.05). The likelihood of transfusion, ≤Grade II, and >Grade II postoperative complications, pT3a disease and positive surgical margins in the T-RARP group was comparable with that in the P-RARP group. No significant differences were noted between these two arms in terms of UC at the removal of catheter and nocturia (p = 0.750 and p = 0.684, respectively), and all included patients recovered UC at 3 months postoperatively. The median International Index of Erectile Function-5 score in both groups remains comparable before and after RARP. The patients in the T-RARP and P-RARP groups had a similar biochemical recurrence-free survival (p = 0.387). Conclusions Both T-RARP and P-RARP by experienced hands are feasible for well-selected patients with prostate cancer, obtaining similar outcomes in terms of perioperative results, UC and erectile function, and oncological control within short-term follow-up.
Collapse
Affiliation(s)
- Wen Deng
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Cheng Zhang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hao Jiang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Yulei Li
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ke Zhu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Xiaoqiang Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weipeng Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Ju Guo
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| | - Gongxian Wang
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, China.,Jiangxi Institute of Urology, Nanchang, China
| |
Collapse
|
28
|
Liu Y, Zhao Q, Yang F, Wang M, Xing N. "Sandwich" Technique of Total Urethral Reconstruction in the Laparoscopic Radical Prostatectomy: A Prospective Study. Cancer Manag Res 2021; 13:2341-2347. [PMID: 33732026 PMCID: PMC7959195 DOI: 10.2147/cmar.s299367] [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: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the “Sandwich” urethra reconstruction technique on continence at the early stage after LRP. Methods During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the “Sandwich” technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated. Results There is no statistical difference in patients’ basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49±4.72 minutes in Group A and 20.16±5.75 minutes in Group B (P<0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (P<0.001). Maximum flow rates before and after the “Sandwich” procedure for 12 months were 13.2±2.8 m/s and 15.4±3.6 m/s, respectively (P=0.034). In addition, residual volumes before and after the “Sandwich” procedure for 12 months were 15 (0–20) mL and 0 (0–12.5) mL, respectively (P=0.107). Conclusion Our prospective study confirms that the “Sandwich” technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.
Collapse
Affiliation(s)
- Yong Liu
- Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China.,Department of Urology, Weihai Municipal Hospital, Weihai, 264200, People's Republic of China
| | - Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Mingshuai Wang
- Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China
| | - Nianzeng Xing
- Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China.,Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| |
Collapse
|
29
|
Effect of prostatic apex shape (Lee types) and urethral sphincter length in preoperative MRI on very early continence rates after radical prostatectomy. Int Urol Nephrol 2021; 53:1297-1303. [PMID: 33606155 PMCID: PMC8192356 DOI: 10.1007/s11255-021-02809-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/08/2021] [Indexed: 11/04/2022]
Abstract
Purpose To test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients. Methods In 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test. Results Of 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test. Conclusion Patients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.
Collapse
|
30
|
Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020; 9:3036-3048. [PMID: 33457277 PMCID: PMC7807332 DOI: 10.21037/tau.2020.03.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients’ quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
Collapse
Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
31
|
Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020. [PMID: 33457277 DOI: 10.21037/tau.2020.03.36)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients' quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
Collapse
Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
32
|
Hu JC, Ehdaie B, Sandhu J, Sjoberg DD, Carlsson SV, Tzeng M, Vickers AJ. Asian-American Race and Urinary Continence After Radical Prostatectomy. EUR UROL SUPPL 2020; 22:51-53. [PMID: 34337477 PMCID: PMC8317909 DOI: 10.1016/j.euros.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA.,New York Presbyterian Hospital, New York, NY, USA
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaspreet Sandhu
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid V Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael Tzeng
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
33
|
Beulens AJW, Brinkman WM, Umari P, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, van der Poel HG, Bangma C, Wagner C. Identifying the relationship between postoperative urinary continence and residual urethra stump measurements in robot assisted radical prostatectomy patients. Int J Med Robot 2020; 17:e2196. [PMID: 33113236 DOI: 10.1002/rcs.2196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the feasibility of urethral stump length and width measurements in recorded videos of robot assisted radical prostatectomy procedures using the Kinovea software and to assess if these measurements could be used as predictors of postoperative urinary continence. METHODS Fifty-three patients were selected from an institutional database of 1400 cases and included in the study. All videos were analysed using the computer software 'Kinovea'. All measurements were performed using the inserted bladder catheter as a reference point. RESULTS The reference point (bladder catheter) was available in 33 out of 53 patients. The median surgical urethral length (SUL) was significantly higher in the continent group (1050 vs. 1294 mm, p = 0.018). The urethral width measurements did not show a difference between the groups. In order to validate the Kinovea software as an accurate tool for the measurement of the urethral stump length and width results were correlated with the magnetic resonance imaging measurements of the urethra. CONCLUSIONS The results of this study showed a significantly longer median SUL incontinent patients.
Collapse
Affiliation(s)
- Alexander J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paolo Umari
- University of Eastern Piedmont, Novara, Italy
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ad J M Hendrikx
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Urologist, Not Practicing
| | - Jean Paul van Basten
- Prosper Prostate Cancer Center, Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chris Bangma
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Collette ERP, Klaver SO, Lissenberg-Witte BI, van den Ouden D, van Moorselaar RJA, Vis AN. Patient reported outcome measures concerning urinary incontinence after robot assisted radical prostatectomy: development and validation of an online prediction model using clinical parameters, lower urinary tract symptoms and surgical experience. J Robot Surg 2020; 15:593-602. [PMID: 32930971 PMCID: PMC8295126 DOI: 10.1007/s11701-020-01145-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
The prediction of post-prostatectomy incontinence (PPI) after robot-assisted radical prostatectomy (RARP) depends on multiple clinical, anatomical and surgical factors. There are only few risk formulas, tables or nomograms predicting PPI that may assist clinicians and their patients in adequate risk counseling on postoperative side-effects. Prospective data collection of 1814 patients who underwent RARP between 2009 and 2017 was done. Pre-operative parameters were age, body mass index (BMI), prostate volume, the American Society of Anesthesiologists (ASA) score, severity of Lower Urinary Tract Symptoms (LUTS), type of planned nerve-sparing surgery and surgical experience. The continence status was reported using Patient Reported Outcome Measurements (PROMs) using the validated pad-use questionnaire EPIC26. Continence was defined as either the use of zero pads or one safety pad. Multivariable logistic regression analysis was performed to identify predictors of PPI within one year after RARP. An online prediction tool was developed and validated. The median follow-up was 36 months (range 12–108). The response rate was high at 85.2%. A total of 85% (1537/1814) of patients was continent on follow-up. One-year continence rate was 80.1% (95% CI 78.3–81.9%) (1453/1814) and increased to 87.4% (95% CI 85.4–89.4%) after 5 years. On multivariable analysis, severity of LUTS (OR = 0.56 p = 0.004), higher age (OR = 0.73 p = 0.049), extend of nerve-sparing surgery (OR = 0.60 p = 0.001) and surgeon experience (OR = 1.48 p = 0.025) were significant independent predictors for PPI. The online prediction model performed well in predicting continence status with poor discrimination and good calibration. An intuitive online tool was developed to predict PPI after RARP that may assist clinicians and their patients in counseling of treatment.
Collapse
Affiliation(s)
- Eelco R P Collette
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands.
- Department of Urology, Amsterdam UMC, VU University Medical Center, room 4F27, De Boelelaan 1117, Postbus 7057, Amsterdam, 1081HV, The Netherlands.
| | - Sjoerd O Klaver
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Reindert J A van Moorselaar
- Department of Urology, Amsterdam UMC, VU University Medical Center, room 4F27, De Boelelaan 1117, Postbus 7057, Amsterdam, 1081HV, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam UMC, VU University Medical Center, room 4F27, De Boelelaan 1117, Postbus 7057, Amsterdam, 1081HV, The Netherlands
| |
Collapse
|
35
|
Contemporary Techniques of Prostate Dissection for Robot-assisted Prostatectomy. Eur Urol 2020; 78:583-591. [PMID: 32747200 DOI: 10.1016/j.eururo.2020.07.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the years, several techniques for performing robot-assisted prostatectomy have been implemented in an effort to achieve optimal oncological and functional outcomes. OBJECTIVE To provide an evidence-based description and video-based illustration of currently available dissection techniques for robotic prostatectomy. DESIGN, SETTING, AND PARTICIPANTS A literature search was performed to retrieve articles describing different surgical approaches and techniques for robot-assisted radical prostatectomy (RARP) and to analyze data supporting their use. Video material was provided by experts in the field to illustrate these approaches and techniques. SURGICAL PROCEDURE Multiple surgical approaches are available: extraperitoneal, transvesical, transperitoneal posterior, transperitoneal anterior, Retzius sparing, and transperineal. Surgical techniques for prostatic dissection sensu strictu are the following: omission of the endopelvic fascia dissection, bladder neck preservation, incremental nerve sparing by means of an antegrade or retrograde approach, and preservation of the puboprostatic ligaments and dorsal venous complex. Recently, techniques for total or partial prostatectomy have been described. MEASUREMENTS Different surgical approaches and techniques for robotic prostatectomy have been analyzed. RESULTS AND LIMITATIONS Two randomized controlled trials evaluating the extraperitoneal versus the transperitoneal approach have demonstrated similar results. Level I evidence on the Retzius-sparing approach demonstrated earlier return to continence than the traditional anterior approach. The question whether Retzius-sparing RARP is associated with a higher rate of positive surgical margins is still open due to the intrinsic bias in terms of surgical expertise in the available comparative studies. This technique also offers an advantage in patients who have received kidney transplantation. Retrospective evidence suggests that the more the anatomical dissection (eg., more periprostatic tissue is preserved), the better the functional outcome in terms of continence. Yet, two randomized controlled trials evaluating the different techniques of dissection have so far been produced. Partial prostatectomies should not be offered outside clinical trials. CONCLUSIONS Several techniques and approaches are available for prostate dissection during RARP. While the Retzius-sparing approach seems to provide earlier return to continence than the traditional anterior transperitoneal approach, no technique has been proved to be superior to other(s) in terms of long-term outcomes in randomized studies. PATIENT SUMMARY We have summarized available approaches for the surgical treatment of prostate cancer. Specifically, we described the different techniques that can be adopted for the surgical removal of the prostate using robotic technology.
Collapse
|
36
|
Kang SG, Shim JS, Onol F, Bhat KRS, Patel VR. Lessons learned from 12,000 robotic radical prostatectomies: Is the journey as important as the outcome? Investig Clin Urol 2020; 61:1-10. [PMID: 31942457 PMCID: PMC6946819 DOI: 10.4111/icu.2020.61.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/19/2019] [Indexed: 01/15/2023] Open
Abstract
Robotic radical prostatectomy (RARP) is a standardized treatment for localized prostate cancer, which provides better functional outcomes and similar oncological outcomes compared to open approaches. Here, we share our experience of 12,000 RARPs by describing the outcomes of the procedure in terms of positive surgical margin (PSM), continence, and potency as well as by presenting our detailed surgical technique with recent modifications. On cancer control, the PSM rates were 5.8% and 26.1% in T2 and T3, respectively. On the premise of not compromising oncologic outcomes, a tailored approach to individual patients is essential. Even if an extracapsular extension is suspected, neurovascular bundle (NVB) tailoring can be applied using an anatomical landmark to preserve maximal nerve tissue with a negative margin. We developed a nomogram as a useful tool for deciding the degree of tailoring. For improvements of functional outcomes, we used athermal retrograde early release with a toggling technique, wherein the nerve dissection from the bottom helps with blood loss and allows for smooth NVB releasing. Additionally, we recently performed a new minimal apical dissection/lateral prostatic fascia preservation technique. As a result, our 1-week continence rate was 37% and the 6-week rate was 77.6%. In addition, the potency rates in our study were 69%, 82%, and 92% at 3 months, 6 months, and 1 year, respectively (preoperative Sexual Health Inventory for Men scores >21 & bilateral full nerve spared).
Collapse
Affiliation(s)
- Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Fikret Onol
- Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida School of Medicine, Orlando, FL, USA
| | - K R Seetharam Bhat
- Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Vipul R Patel
- Global Robotics Institute, Florida Hospital Celebration Health, University of Central Florida School of Medicine, Orlando, FL, USA
| |
Collapse
|
37
|
Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8122068. [PMID: 31771310 PMCID: PMC6947283 DOI: 10.3390/jcm8122068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3–4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52–5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10–3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13–9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72–1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21–1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.
Collapse
|