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Lu H, Yu C, Yu X, Yang D, Yu S, Xia L, Lin Y, Yang B, Wu Y, Li G. Effects of Bony Pelvic and Prostate Dimensions on Surgical Difficulty of Robot-Assisted Radical Prostatectomy: An Original Study and Meta-analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15769-w. [PMID: 39080137 DOI: 10.1245/s10434-024-15769-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/25/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Due to the deep location of the prostate within the pelvic cavity, procedures of robot-assisted radical prostatectomy (RARP) might be challenged by the prostate size and the limited pelvic cavity space. This study aimed to investigate the roles of bony pelvic and prostate dimensions in RARP procedures by an original study coupled with a meta-analysis. METHODS In the original study, patients undergoing multiport RARP between 2021 and 2022 were consecutively assessed. The associations of anatomic features with operative time (OT), estimated blood loss (EBL), and positive surgical margin (PSM) were evaluated using linear and logistic regression analyses as well as restricted cubic spline (RCS) analysis. Based on machine-learning algorithms, this study established predictive models for surgical difficulty and interpreted the model using SHapley Additive exPlanation (SHAP). In the meta-analysis, three databases were searched for eligible studies. Quantitative syntheses were subsequently performed. RESULTS Overall, 219 patients were enrolled in the original study. Prostate volume (PV) and the prostate volume-to-pelvic cavity index (PCI) ratio (PV-to-PCI ratio) were significantly associated with longer OT (P < 0.05). In the RCS models, U-shaped associations were observed between the prostate anteroposterior diameter (PAD) and OT, and between the prostate height (PH) and EBL, and an L-shaped association was observed between the anteroposterior diameter of the pelvic inlet (API) and EBL. The XGBoost model was superior to the logistic regression model in predicting prolonged OT. The meta-analysis demonstrated that greater PV was significantly associated with longer OT (β = 0.20; 95% confidence interval [CI] 0.12-0.27; odds ratio [OR] = 1.05; 95% CI 1.00-1.11), and a smaller PV could increase the risk of PSM (OR = 0.82; 95% CI 0.77-0.88). CONCLUSIONS A large prostate within a narrow and deep pelvis might suggest increased surgical difficulty of RARP. The size of the pelvic inlet also had a great impact on RARP. For PAD and PH, there seemed to be an optimal range with the lowest surgical difficulty. Machine-learning models based on the XGBoost algorithm could be successfully applied to predict the surgical difficulty of RARP.
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Affiliation(s)
- Haohua Lu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenhao Yu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaojing Yu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dexin Yang
- Department of Toxicology of School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Liqun Xia
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yudong Lin
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bowen Yang
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yihua Wu
- Department of Toxicology of School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Porcaro AB, Bianchi A, Gallina S, Serafin E, Vidiri S, Veccia A, Rizzetto R, Ditonno F, Montanaro F, Baielli A, Artoni F, Marafioti Patuzzo G, Franceschini A, Brusa D, Princiotta A, Boldini M, Brunelli M, DE Marco V, Migliorini F, Cerruto MA, Antonelli A. High-volume surgeons decrease operating time in robot-assisted radical prostatectomy: results in 1229 patients. Minerva Urol Nephrol 2024; 76:312-319. [PMID: 38920011 DOI: 10.23736/s2724-6051.24.05617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND The aim is to evaluate factors impacting operating time (OT) during robot-assisted radical prostatectomy (RARP) with or without extended pelvic lymph node dissection (ePLND) for prostate cancer. METHODS Overall, 1289 patients underwent RARP from January 2013 to December 2021. ePLND was performed in 825 cases. Factors potentially associated with OT variations were assessed. Three low-volume (LVS) and two high-volume surgeons (HVS) performed the procedures. A linear regression model was computed to assess associations with OT variations. RESULTS When RARP was performed by HVS an OT decrease was observed independently by significant clinical (Body Mass Index [BMI]; prostate volume [PV]) and anatomical/perioperative features (prostate weight [PW]; intraoperative blood loss [BL]) both in clinical (change in OT: -42.979 minutes; 95% CI: -51.789; -34.169; P<0.0001) and anatomical/perioperative models (change in OT: -40.020 minutes; 95% CI: -48.494; -31.587; P<0.0001). A decreased OT was observed in clinical (change in OT: -27.656 minutes; 95% CI: -33.449; -21.864; P<0.0001) and anatomical/perioperative (change in OT: -24.935 minutes; 95% CI: -30.562; -19.308; P<0.0001) models also in case of RARP with ePLND performed by HVS, independently by BMI, PV, PSA as well as for PW, seminal vesicle invasion, positive surgical margins, and BL. CONCLUSIONS In a tertiary academic referral center, OT decreased when RARP was performed by HVS, independently of adverse clinical and anatomical/perioperative factors. Available OT loads can be planned to optimize waiting lists, teaching tasks, operative costs, and surgeon's volume.
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Affiliation(s)
- Antonio B Porcaro
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy -
| | - Alberto Bianchi
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Stefano Vidiri
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Alessandro Veccia
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Francesco Ditonno
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Francesca Montanaro
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Alberto Baielli
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Francesco Artoni
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | | | - Andrea Franceschini
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Davide Brusa
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | | | - Michele Boldini
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Vincenzo DE Marco
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
| | - Maria A Cerruto
- Department of Urology, A.O.U. Integrata, University of Verona, Verona, Italy
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Jaber AR, Moschovas MC, Saikali S, Gamal A, Perera R, Rogers T, Patel E, Sandri M, Tilki D, Patel V. Impact of Prostate Size on the Functional and Oncological Outcomes of Robot-assisted Radical Prostatectomy. Eur Urol Focus 2024; 10:263-270. [PMID: 38290859 DOI: 10.1016/j.euf.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Robot-assisted radical prostatectomy (RARP) is the main surgical approach for treatment of prostate cancer in the USA. Prostate size is always depicted as a factor affecting the outcomes of RARP as shown by many studies, but these studies are limited to a small number of patients. Our aim was to evaluate functional and oncologic outcomes of RARP across varying prostate size measured as prostate specimen weight. METHODS A cohort of 14 481 patients who underwent RARP in a single center was divided into four groups according to prostate specimen weight: group 1, <50 g; group 2, 50-100 g; group 3, 100-150 g; and group 4, >150 g. Perioperative and postoperative variables and pathological and functional outcomes were compared among the four groups. Cumulative incidence functions were plotted to visualize the distribution of event-time variables among the groups, and differences were evaluated using the log-rank test. KEY FINDINGS AND LIMITATIONS Patients with larger prostates (groups 3 and 4) were more likely to have higher prostate-specific antigen (PSA), lower biopsy grade group, and worse baseline urinary and sexual characteristics. Group 4 had lower rates of full nerve-sparing surgery (13.7% vs 38.3%) and lymph node dissection (51.3% vs 71.4%), more pT2 disease (69.8% vs 60.3%), less pT3 disease (30.2% vs 39.7%), and lower rates of positive surgical margins (12.8% vs 19.3%) and biochemical recurrence (5.9% vs 7.5%) than group 1. Finally, we observed differences in functional outcomes among the groups for greater prostate size, and patients in group 4 had worse rates of urinary continence (77.8% vs 89.5%) and recovery of sexual function (70.0% vs 84.1%) than group 1. Our study is limited by its retrospective design. CONCLUSIONS AND CLINICAL IMPLICATIONS The results demonstrate that in this large cohort of patients, greater prostate size affects multiple outcomes, including the rate of nerve-sparing surgery, potency and continence recovery, and oncological and pathological outcomes. These data will be valuable when counseling patients regarding possible RARP outcomes and the timeline for recovery. PATIENT SUMMARY Our study shows that prostate size can affect the outcomes of robot-assisted removal of the prostate for patients with prostate cancer. Larger prostate size can be associated with worse functional outcomes after surgery.
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Affiliation(s)
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Celebration, FL, USA; University of Central Florida, Orlando, FL, USA
| | - Shady Saikali
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Ahmed Gamal
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Roshane Perera
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Ela Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Marco Sandri
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA; University of Central Florida, Orlando, FL, USA
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Stankovic M, Wolff L. The Impact of Prostate Volume in Open Radical Prostatectomy: A Single Centre Experience. Clin Genitourin Cancer 2024; 22:7-13. [PMID: 37349164 DOI: 10.1016/j.clgc.2023.06.005] [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: 01/13/2023] [Revised: 03/24/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Even the most experienced surgeons experience technical difficulties and challenges when operating on very large prostates, regardless of surgical technique. Our goal was to determine whether preoperative prostate volume has an impact on functional and oncological outcomes after open radical prostatectomy. MATERIALS AND METHODS We reviewed the records of 909 patients who underwent open radical prostatectomy by a single surgeon at our institution. Variables were compared across quartile distributions of prostate volume as defined by preoperative transrectal ultrasound examination, including group A with prostate volume < 30ccm 3, group B with prostate volume ≥ 30ccm 3 and < 50ccm 3, group C with prostate volume ≥ 50ccm 3 and < 70ccm 3 and group D with prostate volume ≥ 70ccm3. Factors assessed in this analysis were patient age, preoperative prostate specific antigen (p-PSA), Gleason score, pathological stage, margin status, operative time, cystography leakage, early continence, biochemical recurrence (BCR)-free, and overall-survival (OS). The complication rates were classified using Clavien Dindo classification. RESULTS There were no statistically relevant differences between the groups considering preoperative factors such as age, p-PSA, Gleason score, and tumor stadium. Patients with a very large prostate had slightly higher percentage of anastomosis leakage, severe Clavien Dindo complication rates (≥ 3), longer operation time and severe early incontinence (IV°) rates, simultaneously having lower positive margin rates. Nevertheless, the early continence rates, BCR-free and OS were similar regardless of the prostate size. CONCLUSIONS open radical prostatectomy for patients with very large prostate is a viable therapy option with slightly higher urinary leakage-, early incontinence- and complication-rates that takes slightly more operation time. However, the functional and oncological outcomes are similar when compared to smaller prostates.
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Affiliation(s)
- Mladen Stankovic
- Department of Urology, Salem Hospital, Academic Hospital -University of Heidelberg, Heidelberg, Germany.
| | - Laura Wolff
- Department of Urology, Salem Hospital, Academic Hospital -University of Heidelberg, Heidelberg, Germany
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Latest Evidence on Post-Prostatectomy Urinary Incontinence. J Clin Med 2023; 12:jcm12031190. [PMID: 36769855 PMCID: PMC9917389 DOI: 10.3390/jcm12031190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
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Castellan P, Ferretti S, Litterio G, Marchioni M, Schips L. Management of Urinary Incontinence Following Radical Prostatectomy: Challenges and Solutions. Ther Clin Risk Manag 2023; 19:43-56. [PMID: 36686217 PMCID: PMC9851058 DOI: 10.2147/tcrm.s283305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Urinary incontinence is a common and debilitating problem in patients undergoing radical prostatectomy. Current methods developed to treat urinary incontinence include conservative treatments, such as lifestyle education, pelvic muscle floor training, pharmacotherapy, and surgical treatments, such as bulking agents use, artificial urinary sphincter implants, retrourethral transobturator slings, and adjustable male sling system. Pelvic floor muscle exercise is the most common management to improve the strength of striated muscles of the pelvic floor to try to recover the sphincter weakness. Antimuscarinic drugs, phosphodiesterase inhibitors, duloxetine, and a-adrenergic drugs have been proposed as medical treatments for urinary incontinence after radical prostatectomy. Development of new surgical techniques, new surgical tools and materials, such as male slings, has provided an improvement of outcomes after UI surgery. Such improvement is still ongoing, and the uptake of new devices might lead to even better outcomes after UI surgery.
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Affiliation(s)
| | - Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy,Correspondence: Simone Ferretti, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy, Tel +393278733805, Fax +390871357756, Email
| | - Giulio Litterio
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Luigi Schips
- Department of Urology, ASL02 Abruzzo, Chieti, Italy,Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
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Oncological and functional outcomes of high-risk and very high-risk prostate cancer patients after robot-assisted radical prostatectomy. PLoS One 2023; 18:e0282494. [PMID: 36867638 PMCID: PMC9983825 DOI: 10.1371/journal.pone.0282494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/15/2023] [Indexed: 03/04/2023] Open
Abstract
PURPOSE This study investigated the oncological and functional outcomes of robot-assisted radical prostatectomy (RaRP) in high-risk and very high-risk prostate cancer patients. MATERIALS AND METHODS One hundred localized prostate cancer patients receiving RaRP from August 2015 to December 2020 were retrospectively enrolled. According to NCCN risk classification, patients were classified into two groups, below high-risk group, and high-risk/very high-risk group, to analyze continence outcome within postoperative year one and biochemical recurrence-free survival. RESULTS The mean age of the cohort was 69.7 ± 7.4 years with a median follow-up of 26.4 (range 3.3-71.3) months. Among them, 53%, and 47% patients were below high-risk group, and high-risk/very high-risk group, respectively. The median biochemical recurrence-free survival of the entire cohort was 53.1 months. The high-risk/very high-risk group without adjuvant treatment had significantly worse biochemical recurrence-free survival than the high-risk/very high-risk group with adjuvant treatment (19.6 vs. 60.5 months, p = 0.029). Rates of postoperative stress urinary incontinence at 1 week, 1 month, and 12 months were 50.7%, 43.7%, and 8.5%, respectively. High-risk/very high-risk patients had significantly higher rates of stress urinary incontinence at postoperative week 1 (75.8% vs. 28.9%) and month 1 (63.6% vs. 26.3%) than the below high-risk group (both p < 0.01). Rates of stress urinary incontinence after RaRP did not differ between two groups from postoperative 3 months to 12 months. The factor of high-risk / very high-risk group was a predictor of immediate but not for long-term postoperative stress urinary incontinence. CONCLUSIONS High-risk and very high-risk prostate cancer patients receiving a combination of RaRP and adjuvant treatment had comparable biochemical recurrence-free survival to below high-risk prostate cancer patients. The high-risk/very high-risk factor impeded early but not long-term postoperative recovery of continence. RaRP can be considered a safe and feasible option for high-risk and very high-risk prostate cancer patients.
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Lee K, Shiota M, Takamatsu D, Ushijima M, Blas L, Okabe A, Kajioka S, Goto S, Kinoshita F, Matsumoto T, Monji K, Kashiwagi E, Inokuchi J, Oda Y, Eto M. Correlation between extended pelvic lymph node dissection and urinary incontinence at early phase after robot‐assisted radical prostatectomy. Int J Urol 2022; 30:340-346. [PMID: 36478611 DOI: 10.1111/iju.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the impact of extended pelvic lymph node dissection (ePLND) on urinary incontinence (UI) at early post-surgery robot-assisted radical prostatectomy (RARP). METHODS Patients who underwent RARP without cavernous nerve sparing were included between 2014 and 2019. Patient data were obtained prospectively. The associations between ePLND and postoperative urinary continence were defined as a maximum of one daily pad use. International prostate symptom score (IPSS) was examined. Expression of synaptophysin and tyrosine hydroxylase (TH) in perilymph node adipose tissue (PLA) was evaluated by immunohistochemistry. RESULTS In total, 186 and 163 patients underwent RARP with and without ePLND. Urinary continence rate at 1 month postoperatively among patients with ePLND was lower than those without ePLND (24.1% vs. 35.1%, p < 0.05), however, not significantly different at 3, 6, and 12 months after RARP (57.4 vs. 62.6%, 73.1 vs. 74.2%, and 83.0 vs. 81.2%, respectively). Total and voiding plus postvoiding IPSS scores at 1 month were higher in patients with ePLND than in those without ePLND (14.5 ± 0.5 vs. 13.6 ± 0.6, 7.0 ± 0.3 vs. 6.2 ± 0.4, respectively, p < 0.05). In univariate and multivariate analyses, larger prostate volume and ePLND were factors associated with an increased UI rate. Among patients who underwent ePLND, synaptophysin and TH-positive nerve fibers were detected in PLA. CONCLUSIONS Detection of synaptophysin and TH-immunopositive nerves suggested denervation of sympathetic and peripheral nerves caused by ePLND might be associated with a higher UI rate and poor urinary symptoms at an early stage after RARP.
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Affiliation(s)
- Ken Lee
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Dai Takamatsu
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
- Department of Anatomic Pathology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Miho Ushijima
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Leandro Blas
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Ayami Okabe
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Shunichi Kajioka
- Department of Pharmacy International University of Health and Welfare Fukuoka Japan
| | - Shunsuke Goto
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Fumio Kinoshita
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Keisuke Monji
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences Kyushu University Fukuoka Japan
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9
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Lamberg H, Shankar PR, Singh K, Caoili EM, George AK, Hackett C, Johnson A, Davenport MS. Preoperative Prostate MRI Predictors of Urinary Continence Following Radical Prostatectomy. Radiology 2022; 303:99-109. [PMID: 35040671 PMCID: PMC8962824 DOI: 10.1148/radiol.210500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/30/2021] [Accepted: 11/05/2021] [Indexed: 11/11/2022]
Abstract
Background Urinary continence after radical prostatectomy (RP) is an important determinant of patient quality of life. Anatomic measures at prostate MRI have been previously associated with continence outcomes, but their predictive ability and interrater agreement are unclear in comprehensive clinical models. Purpose To evaluate the predictive ability and interrater agreement of MRI-based anatomic measurements of post-RP continence when combined with clinical multivariable models. Materials and Methods In this retrospective cohort study, continence outcomes were evaluated in men who underwent RP from August 2015 to October 2019. Preoperative MRI-based anatomic measures were obtained retrospectively by four abdominal radiologists. Before participation, these radiologists completed measure-specific training. Logistic regression models were developed with clinical variables alone, MRI variables alone, and combined variables for predicting continence at 3, 6, and 12 months after RP; some patient data were missing at each time point. Interrater agreement of MRI variables was assessed by using intraclass correlation coefficients (ICCs). Results A total of 586 men were included (mean age ± standard deviation: 63 years ± 7). The proportion of patients with incontinence was 0.2% (one of 589) at baseline, 27% (145 of 529) at 3 months, 14% (63 of 465) at 6 months, and 9% (37 of 425) at 12 months. Longer coronal membranous urethra length (MUL) improved the odds of post-RP continence at all time points (odds ratio per 1 mm: 0.86 [95% CI: 0.80, 0.93], P < .001; 0.86 [95% CI: 0.78, 0.95], P = .003; and 0.79 [95% CI: 0.67, 0.91], P = .002, respectively) in models that incorporated both clinical and MRI predictors. No other MRI variables were predictive. Age and baseline urinary function score were the only other predictive clinical variables at every time point. Interrater agreement was moderate (ICC, 0.62) for MUL among readers with measure-specific prostate MRI training and poor among those without the training (ICC, 0.38). Conclusion Preoperative MRI-measured coronal membranous urethra length was an independent predictor of urinary continence after prostatectomy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Hannah Lamberg
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Prasad R. Shankar
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Karandeep Singh
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Elaine M. Caoili
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Arvin K. George
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Caitlin Hackett
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Anna Johnson
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
| | - Matthew S. Davenport
- From the Department of Radiology (H.L., P.R.S., E.M.C., C.H.,
M.S.D.), Michigan Radiology Quality Collaborative (P.R.S., M.S.D.), and
Department of Urology (K.S., A.K.G., A.J., M.S.D.), University of Michigan,
Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030; and
Department of Learning Health Sciences, University of Michigan Medical School,
Ann Arbor, Mich (K.S.)
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Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram. Cancers (Basel) 2022; 14:cancers14071644. [PMID: 35406416 PMCID: PMC8997126 DOI: 10.3390/cancers14071644] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Many men fear urinary leakage after radical surgery for prostate cancer and may even choose against operation for unrealistic fears of leakage. Many urologists are unaware of their own results, and some urologists who collect their results do so in different ways. We collected urinary leakage data from 680 men in a uniform and simple way at 6, 12, and 24 months after operation: no pads, 1–2 pads, or ≥3 pads required daily. We used many patient characteristics to identify the key factors that predict recovery of urinary control after operation: age, race, height and weight, and preoperative erectile function. Easy-to-use nomograms were constructed that should be tested by other urologists to make sure they perform equally well in their patients. Nomograms like these allow men and the urologists counseling them to share patient-specific information about the timeline for, and the chance of, recovery of urinary control after operation. Abstract Incontinence after robot-assisted radical prostatectomy (RARP) is feared by most patients with prostate cancer. Many risk factors for incontinence after RARP are known, but a paucity of data integrates them. Prospectively acquired data from 680 men who underwent RARP January 2008–December 2015 and met inclusion/exclusion criteria were queried retrospectively and then divided into model development (80%) and validation (20%) cohorts. The UCLA-PCI-Short Form-v2 Urinary Function questionnaire was used to categorize perfect continence (0 pads), social continence (1–2 pads), or incontinence (≥3 pads). The observed incontinence rates were 26% at 6 months, 7% at 12 months, and 3% at 24 months. Logistic regression was used for model development, with variables identified using a backward selection process. Variables found predictive included age, race, body mass index, and preoperative erectile function. Internal validation and calibration were performed using standard bootstrap methodology. Calibration plots and receiver operating curves were used to evaluate model performance. The initial model had 6-, 12-, and 24-month areas under the curves (AUCs) of 0.64, 0.66, and 0.80, respectively. The recalibrated model had 6-, 12-, and 24-month AUCs of 0.52, 0.52, and 0.76, respectively. The final model was superior to any single clinical variable for predicting the risk of incontinence after RARP.
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Salciccia S, Rosati D, Viscuso P, Canale V, Scarrone E, Frisenda M, Catuzzi R, Moriconi M, Asero V, Signore S, De Dominicis M, Emiliozzi P, Carbone A, Pastore AL, Fuschi A, Di Pierro GB, Gentilucci A, Cattarino S, Mariotti G, Busetto GM, Ferro M, De Berardinis E, Ricciuti GP, Panebianco V, Magliocca FM, Del Giudice F, Maggi M, Sciarra A. Influence of operative time and blood loss on surgical margins and functional outcomes for laparoscopic versus robotic-assisted radical prostatectomy: a prospective analysis. Cent European J Urol 2022; 74:503-515. [PMID: 35083069 PMCID: PMC8771133 DOI: 10.5173/ceju.2021.0177] [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: 07/03/2021] [Revised: 08/22/2021] [Accepted: 11/06/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The aim of this article was to analyze whether operative time and blood loss during radical prostatectomy (RP) can significantly influence surgical margins (SM) status and post-operative functional outcomes. Material and methods We prospectively analyzed prostate cancer (PC) patients undergoing RP, using robot-assisted (RARP) or laparoscopic (LRP) procedures. Blood loss was defined using the variation in hemoglobin (Hb, g/dl) values from the day before surgery and no later than 4 hours after surgery. Results From a whole population of 413 cases considered for RP, 67% underwent LRP and 33.0% RARP. Positive SM (SM+) were found in 33.9% of cases. Mean surgical operative time was 172.3 ±76 min (range 49–485), whereas blood loss was 2.3 ±1.2 g/dl (range 0.3–7.6). Operative time and blood loss at RP were not significantly correlated (r = -0.028275; p = 0.684). SM+ rates significantly (p = 0.002) varied by operative time; a higher SM+ rate was found in cases with an operative time <120 min (41.2%) and >240 min (53.4%). The risk of SM+ significantly increased 1.70 and 1.94 times in cases with an operative time <120 min and >240 min, respectively, independently to the surgical approach. The rate of erectile disfunction (ED) varied from 22.4% to 60.3% between <120 min and >240 min procedures (p = 0.001). According to blood loss, SM+ rates slightly but significantly (p = 0.032) varied; a higher rate of SM+ was found in cases with a Hb variation between 2–4 g/dl (35.9%). Conclusions Independently to the surgical approach, operative time, more than blood loss at RP, represents a significant variable able to influence SM status and post-operative ED.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Davide Rosati
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Pietro Viscuso
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Vittorio Canale
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Emiliano Scarrone
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Marco Frisenda
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Roberta Catuzzi
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Moriconi
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Vincenzo Asero
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Stefano Signore
- Department of Urology, S. Eugenio Hospital, ASL Rome 2, Rome, Italy
| | | | - Paolo Emiliozzi
- Department of Urology, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Carbone
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza Rome University, Polo Pontino, Latina, Italy
| | - Antonio Luigi Pastore
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza Rome University, Polo Pontino, Latina, Italy
| | - Andrea Fuschi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza Rome University, Polo Pontino, Latina, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | | | | | - Gianna Mariotti
- Department of Urology, University Sapienza Rome, Rome, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Gian Piero Ricciuti
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
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Kuo HC, Jiang YH. Changes of lower urinary tract function after robot-assisted radical prostatectomy: An urodynamic follow-up within 1 year. Tzu Chi Med J 2022. [DOI: 10.4103/tcmj.tcmj_96_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13236130. [PMID: 34885239 PMCID: PMC8656835 DOI: 10.3390/cancers13236130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Prostate size can vary widely among men regardless of whether they have prostate cancer or not. Many studies reported very conflicting results regarding the impact of prostate size on the outcome of radical prostatectomy. This is the first systematic review and meta-analysis on this topic to investigate the impact of prostate size on the operative, functional and oncological outcomes of radical prostatectomy. In general, a smaller prostate can be associated with fewer surgical complications, but with a higher chance of positive surgical margins. This can be useful when counseling patients before surgery. Abstract Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.
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14
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[Evaluating continence recovery time after robot-assisted radical prostatectomy]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021. [PMID: 34393231 PMCID: PMC8365051 DOI: 10.19723/j.issn.1671-167x.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate urinary continence recovery time and risk factors of urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RARP). METHODS From January 2019 to January 2021, a consecutive series of patients with localized prostate cancer (cT1-T3, cN0, cM0) were prospectively collected. RARP with total anatomical reconstruction was performed in all the cases by an experienced surgeon. Lymph node dissection was performed if the patient was in high-risk group according to the D'Amico risk classification. The primary endpoint was urinary continence recovery time after catheter removal. Postoperative and pathological variables were analyzed. Continence was rigo-rously analyzed 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal. Continence was evaluated by recording diaper pads used per day, and all the patients were instructed to perform the 24-hour pad weight test until full recovery of urinary continence. The patient was defined as continent if no more than one safety pad were needed per day, or no more than 20-gram urine leakage on the 24-hour pad weight test. Time from catheter removal to full recovery of urinary continence was recorded, and risk factors influencing continence recovery time evaluated. RESULTS In total, 166 patients were analyzed. The mean age of the enrolled patients was 66.2 years, and the median prostate specific antigen (PSA) was 8.51 μg/L. A total of 59 patients (35.5%) had bilateral lymphatic dissection, and 28 (16.9%) underwent neurovascular bundle (NVB) preservation surgery. Postoperative pathology results showed that stage pT1 in 1 case (0.6%), stage pT2 in 77 cases (46.4%), stage pT3 in 86 cases (51.8%), and positive margins in 28 patients (16.9%). Among patients who underwent lymph node dissection, lymph node metastasis was found in 7 cases (11.9%). Median continence recovery time was one week. The number of the continent patients at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 65 (39.2%), 32 (19.3%), 34 (20.5%), 24 (14.5%), and 9 (5.4%). Two patients remained incontinent 24 weeks after catheter removal. The continence rates after catheter removal at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 39.2%, 58.4%, 78.9%, 93.4%, and 98.8%, respectively. Univariate COX analysis revealed that diabetes appeared to influence continence recovery time (OR=1.589, 95%CI: 1.025-2.462, P=0.038). At the end of 48 hours, 4 weeks, 12 weeks, and 24 weeks after catheter removal, the mean OABSS score of the continent group was significantly lower than that of the incontinent group. CONCLUSION RARP showed promising results in the recovery of urinary continence. Diabetes was a risk factor influencing continence recovery time. Bladder overactive symptoms play an important role in the recovery of continence after RARP.
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Qian J, Fu Y, Wu X, Xu L, Zhang M, Zhang Q, Rosenberg JE, Xu L, Qiu X, Guo H. Impact of protruded median lobe on perioperative, urinary continence and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy. Transl Androl Urol 2021; 10:538-547. [PMID: 33718056 PMCID: PMC7947452 DOI: 10.21037/tau-20-1229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background To investigate the effect of protruded median lobe (PML) on the perioperative, oncological, and urinary continence (UC) outcomes among patients underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods 231 consecutive patients who had undergone RS-RARP were collected and analyzed. Patients were divided into three groups based on the PML degree: PML<5 mm (n=99); 5≤ PML <10 mm (n=91); PML ≥10 mm (n=41). The perioperative outcomes, short-term oncological, and UC outcomes were compared among the three groups. Those outcomes were also compared in patients with significant PML (>10 mm) who underwent the traditional or Retzius-sparing RARP. Results The median PML was significantly associated age (P<0.001) and prostate volume (P<0.001). Perioperative characteristics including console time, estimated blood loss (EBL), intraoperative transfusion rate, and complications were not statistically different among the three groups (P=0.647, 0.574, 0.231, 0.661, respectively). The rate of positive surgical margin (PSM) were not significantly different in the three groups (P=0.065). No significant difference regarding UC and biochemical recurrence (BCR) at 12-month follow-up was observed in the three groups (P>0.05). Comparison between the two approaches in men with significant PML showed better recovery of UC (HR =1.83, 95% CI: 1.117-3.01, log-rank P=0.002) and similar BCR (log-rank P=0.072) after RS-RARP. Conclusions RS-RARP is an oncologically and functionally equivalent approach for patients with PML. Compared with the traditional approach, RS-RARP offers benefits regarding UC for cases with significant PML.
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Affiliation(s)
- Jiajun Qian
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Yao Fu
- Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiao Wu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Liu Xu
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Mengjie Zhang
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Qing Zhang
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | | | - Linfeng Xu
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Xuefeng Qiu
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Affiliated Drum Tower hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Urology, Nanjing University, Nanjing, China
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16
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Faria EF, Maciel CVM, Berger A, Mitre A, Dauster B, Freitas CH, Fraga C, Chade D, Dall'Oglio M, Carvalho F, Campos F, Carvalhal GF, Lemos GC, Guimarães G, Zampolli H, Alves JR, Manzano JP, Fortes MA, Rocha MFH, Rubinstein M, Luz M, Romanelli P, Coelho R, Rocha R, Machado RD, Dos Reis RB, Zequi S, Guida R, Muglia V, Tobias-Machado M. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus. J Robot Surg 2021; 15:829-839. [PMID: 33426578 DOI: 10.1007/s11701-020-01186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.
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Affiliation(s)
| | | | - André Berger
- Hospital Moinhos de Vento, Porto Alegre , RS, Brazil
| | - Anuar Mitre
- University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Daher Chade
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
| | | | | | - Franz Campos
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | - Murilo Luz
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
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17
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Trieu D, Ju IE, Chang SB, Mungovan SF, Patel MI. Surgeon case volume and continence recovery following radical prostatectomy: a systematic review. ANZ J Surg 2020; 91:521-529. [PMID: 33319438 DOI: 10.1111/ans.16491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/16/2020] [Accepted: 11/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common complication following radical prostatectomy (RP). Prolonged UI has a substantial impact on quality of life and psychosocial well-being. As the RP technique is complex, it is reasonable to propose that surgeon experience could affect post-operative continence recovery outcomes. This study aimed to systematically evaluate evidence regarding a surgeon's experience and continence recovery after RP. METHODS A comprehensive search of the literature was performed in April 2020 using the Medline, Embase, CINAHL and psychINFO electronic databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. All English language studies investigating UI following RP, stratified by surgeon experience, were included. Surgeon experience was defined as average annual case load or volume. RESULTS Thirteen studies published between 2003 and 2020 met the inclusion criteria and were included in our systematic review. Three prospective and 10 retrospective cohort studies included a total of 47 316 patients undergoing RP via open, laparoscopic or robotic-assisted procedures. Heterogeneity in the definition of surgeon experience and UI did not allow a meta-analysis. The majority of studies reported that surgeons with higher surgical volumes achieved better continence recovery rates at the early (6-week), 3-month, 6-month and later (≥12-month) time points. Most studies where a high surgical volume was defined as >50 cases/year demonstrated a significant difference in continence outcomes. CONCLUSION Better urinary continence recovery results can be expected by patients who undergo RP performed by a surgeon with greater experience. An annual surgical case load of >50 cases/year results in improved continence recovery outcomes following RP.
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Affiliation(s)
- Danny Trieu
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Irene E Ju
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Simon B Chang
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sean F Mungovan
- Westmead Private Physiotherapy Services, Westmead Private Hospital, Sydney, New South Wales, Australia.,The Clinical Research Institute, Sydney, New South Wales, Australia.,Department of Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Manish I Patel
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
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18
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Retrotrigonal muscular layer sling associated with total anatomical reconstruction in robot-assisted radical prostatectomy and early continence. World J Urol 2020; 39:2475-2481. [PMID: 33112984 DOI: 10.1007/s00345-020-03500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Urinary continence (UC) represents the main non-oncological goal in patients undergoing robotic-assisted radical prostatectomy (RARP). To evaluate the efficacy in early UC achievement, we described a new sling technique using the retrotrigonal muscular layer (TZ sling) combined with total anatomical reconstruction (TAR). PATIENTS AND METHODS We prospectively enrolled 407 consecutive prostate cancer (PC) patients undergoing RARP between May 2017 and January 2020. The first 250 patients underwent only TAR, while the following 157 patients TAR + TZ sling, by isolating and anchoring the retrotrigonal muscular layer to the pubic bone with 2 bilateral sutures. We defined UC as ≤ 1 pad/die, which was assessed after catheter removal at 1, 4 and 12wk using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. Sling-related operative time and post-operative complications were analyzed. RESULTS In the TAR group, the UC rates at the 1, 4 and 12wk were 58%, 66% and 86%; in the TAR + TZ sling group 72%, 76% and 88%, respectively. A statistically significant difference was observed in the two groups at 1wk (p = 0.0049) and 4wk (p = 0.035) favoring the TZ sling surgical strategy. This difference in UC rates was lost at 12wk (p ≥ 0.05). No statistically significant differences in operative time, acute urinary retentions and other complication rates were observed between the two groups (p = NS). CONCLUSIONS We have described a new, safe, feasible modification of RARP using a sling with the retrotrigonal muscular layer associated with TAR. We have demonstrated a statistically significant improvement in early UC rate in patients who are undergoing TAR and TZ sling compared to undergoing only TAR.
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Uchida T, Higure T, Kawakami M, Nakano M, Nakajima N, Kim H, Nitta M, Hasegawa M, Kawamura Y, Shoji S, Miyajima A. What factors affect the operative time of robot-assisted laparoscopic radical prostatectomy? Surg Endosc 2020; 35:4436-4443. [PMID: 32909210 DOI: 10.1007/s00464-020-07946-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) has gained prominence since the da Vinci surgical system was introduced in 2000. RARP has now become a standard procedure for treating cases with localized prostate cancer. However, no study has examined its surgical time by accurately measuring the pelvic visceral fat (PVF) volume. This study aimed to investigate the factors associated with prolonged console time and surgical difficulty by RARP surgeons. METHODS This study included 405 patients who underwent RARP between 2014 and 2019 at our institution. Given that the anatomical characteristics were considered to affect RARP, PVF and working space (WS) were estimated preoperatively by computed tomography using a 3D image analysis system. Univariate and multivariate logistic regression analyses were performed to identify the factors prolonging console time, such as body mass index (BMI), prostate volume, previous abdominal surgery, nerve-sparing procedure, PVF, and WS. We also investigated whether post-operative complications were associated with any of these factors. RESULTS Larger PVF (p = 0.028, odds ratio (OR) 1.43), smaller WS (p < 0.001, OR 2.48), and the nerve-sparing procedure (p = 0.037, OR 1.61) were statistically significant factors associated with prolonged console time. Furthermore, higher BMI (p = 0.013, OR 1.49) and smaller pelvic width (p < 0.001, OR 2.63) were the alternative and more practical factors associated with prolonged console time. The post-operative anastomotic leakage occurrence rate increased with the number of risk factors, while post-operative complications did not change even in high-risk cases. CONCLUSION PVF and WS are significant factors associated with prolonged console time in RARP cases. However, BMI can be as useful as PVF, since BMI significantly correlated with PVF. Additionally, pelvic width (PW) can be an alternative to WS, since PW correlated with WS. This study demonstrated that preoperative BMI and PW might predict the surgical risk and identify suitable RARP cases for novice surgeons.
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Affiliation(s)
- Takato Uchida
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Taro Higure
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Masayoshi Kawakami
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Mayura Nakano
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Nobuyuki Nakajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Hakushi Kim
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Masahiro Nitta
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Yoshiaki Kawamura
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan.
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Athermal versus ultrasonic nerve-sparing laparoscopic radical prostatectomy: a comparison of functional and oncological outcomes. World J Urol 2020; 39:1453-1462. [PMID: 32740806 DOI: 10.1007/s00345-020-03351-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Many urologists emphasize the concept of heat-related damage suggesting the avoidance of any energy to perform nerve-sparing radical prostatectomy. At our institution, both athermal and ultrasonic dissection have been used over the last years to perform a nerve-sparing laparoscopic radical prostatectomy (NSLRP). In this study, we compare functional and oncological outcomes of the two procedures. METHODS All charts from patients undergoing NSLRP between January 2009 and June 2015 were reviewed. The International Index of Erectile Function (IIEF-5) was recorded preoperatively and 3, 12 and 24 months after surgery; continence was recorded at 3 and 12 months; PSA was recorded at last follow-up. Uni- and multivariate analyses were performed to assess the association of variables with functional and oncological outcomes. RESULTS Ultrasonic NSLRP was used for 120 patients, while athermal NSLRP on 111. The impact of the cutting technique on erection recovery was different at 3 months, favoring athermal dissection (p = 0.002); however, significance was lost at 12 (p = 0.09) and 24 (p = 0.14) months. Continence recovery was comparable at 3 (p = 0.1) and 12 (p = 0.2) months; the rate of positive surgical margins and PSA recurrence were also similar (p = 0.2 and p = 0.06, respectively). At univariate analysis, age, Gleason sum, nerve-sparing laterality, and extension (intra- vs interfascial) were associated with overall erection recovery; only age and nerve-sparing laterality were independent predictors. Age and preoperative TRUS prostate volume were associated with continence recovery, both at uni- and multivariate analysis. CONCLUSIONS The use of an ultrasonic device compared to athermal dissection during NSLRP does not affect long-term potency, nor continence and early biochemical recurrence.
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21
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Zhang S, Liang C, Qian J, Liu Y, Lv Q, Li J, Li P, Shao P, Wang Z. The Impact of Three Different Bladder Neck Reconstruction Techniques on Urinary Continence after Laparoscopic Radical Prostatectomy. J Endourol 2020; 34:663-670. [PMID: 32228027 DOI: 10.1089/end.2020.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Shaobo Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Liang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Qian
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yiyang Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lv
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Shao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Laucirica O, Gomez E, Hajianfar R, Vilanova JC, Muniesa M. Complete puborectalis, puboperinealis muscle and urethral rhabdomyosphincter preservation in laparoscopic radical prostatectomy: Anatomical landmarks to achieve early urinary continence. Int J Urol 2020; 27:525-536. [PMID: 32301194 PMCID: PMC7384200 DOI: 10.1111/iju.14228] [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] [Received: 10/25/2019] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Abstract
Objectives To describe our surgical technique of “muscle‐sparing” laparoscopic radical prostatectomy and to review relevant anatomical landmarks during the procedure. Methods This was a prospective non‐controlled case series of 120 consecutive patients who underwent laparoscopic radical prostatectomy, always carried out by the same surgeon (OL). The median follow‐up period was 33 months. Dissection of the puboperinealis and puborectalis muscle consists of the precise dissection of the puborectalis and puboperinealis muscles from the periprostatic fascia. Rhabdomyo‐dissection consists of an approach that spares the external urethral sphincter from the ventral surface of the prostate and membranous urethra. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications and outcomes of urinary continence were assessed. A descriptive statistical analysis was carried out. Results Continence rates were 70.8%, 83.3% and 92.5%, at 0–2, 3–4 and 5–8 weeks after removal of the urethral catheter, respectively; 96.6% and 98.3% at 6 and 12 months after surgery. The positive surgical margin rate associated with rhabdomyo‐dissection was 8.3%. Conclusions Laparoscopic radical prostatectomy with dissection of the puboperinealis and puborectalis muscle, and rhabdomyo‐dissection is an oncologically safe procedure, associated with very early recovery urinary continence in most patients. It is a technique that can be applied in most cases, as long as there is no invasion of the ventral side of the prostate.
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Affiliation(s)
- Oscar Laucirica
- Department of Urology, Moises Broggi Hospital, Barcelona, Spain
| | - Esther Gomez
- Department of Urology, Moises Broggi Hospital, Barcelona, Spain
| | - Ramin Hajianfar
- Department of Urology, Moises Broggi Hospital, Barcelona, Spain
| | - Joan C Vilanova
- Department of Radiology, Clinica Girona, Institute of Diagnostic Imaging, University of Girona, Girona, Spain
| | - Marta Muniesa
- Department of Urology, Moises Broggi Hospital, Barcelona, Spain
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23
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Karabulut I, Yilmazel FK, Yilmaz AH, Celik EC, Ceylan O, Ozkaya F, Adanur S, Polat O. Effect of Reconstructive Techniques on Continence in Robot-Assisted Laparoscopic Prostatectomy: Novel Combination of Long Urethral Stump and Anterior Suspension Suture. Eurasian J Med 2020; 52:57-60. [PMID: 32158316 DOI: 10.5152/eurasianjmed.2020.19234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effects of the novel combination of a long urethral stump and anterior suspension suture in patients who underwent Robot-Assisted Laparoscopic Prostatectomy (RALP) for localized prostate cancer. Materials and Methods Of the 40 participating patients, 20 did not undergo any reconstructive technique, whereas the remaining 20 patients underwent reconstructive technique that included the combination of long urethral stump and anterior suspension suture. Body mass index (BMI) (kg/m2), age, preoperative prostate-specific antigen (PSA) levels, prostate volume, Gleason score, D'Amico risk class, clinical stage, operation type and the application of either perioperative or postoperative reconstructive techniques, and the duration of catheterization were the parameters investigated. Continence rate was measured in the 3rd, 6th, and 12th month after the removal of the catheter. Both techniques were compared statistically. Results The control and reconstructive groups each comprised 20 patients. Between the groups, no statistically significant differences were observed in age, BMI, American Society of Anesthesiologists class, risk group, prostate weight, perioperative PSA, duration of surgery, duration of hospitalization, surgical margins, and the total amount of bleeding (p>0.05). Continence rate was significantly higher in the reconstructive group in the 3rd and 6th months compared with the control group (p<0.05). Conclusion The combination of anterior suspension suture and long urethral stump contributed to early improvement in the continence rates.
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Affiliation(s)
- Ibrahim Karabulut
- Department of Urology, Health Sciences University Training and Research Hospital, Erzurum, Turkey
| | - Fatih Kursat Yilmazel
- Department of Urology, Health Sciences University Training and Research Hospital, Erzurum, Turkey
| | | | - Erkan Cem Celik
- Deparment of Anesthesiolgy and Reanimation, Health Sciences University Training and Research Hospital, Erzurum, Turkey
| | - Onur Ceylan
- Deparment of Pathology, Atatürk University, School of Medicine, Erzurum, Turkey
| | - Fatih Ozkaya
- Deparment of Urology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Senol Adanur
- Deparment of Urology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Ozkan Polat
- Deparment of Urology, Atatürk University School of Medicine, Erzurum, Turkey
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24
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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).
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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
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25
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Huben NB, Hussein AA, May PR, Whittum M, Krasowski C, Ahmed YE, Jing Z, Khan H, Kim HL, Schwaab T, Underwood W, Kauffman EC, Mohler JL, Guru KA. Development of a Patient-Based Model for Estimating Operative Times for Robot-Assisted Radical Prostatectomy. J Endourol 2019; 32:730-736. [PMID: 29631438 DOI: 10.1089/end.2018.0249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To develop a methodology for predicting operative times for robot-assisted radical prostatectomy (RARP) using preoperative patient, disease, procedural, and surgeon variables to facilitate operating room (OR) scheduling. METHODS The model included preoperative metrics: body mass index (BMI), American Society of Anesthesiologists score, clinical stage, National Comprehensive Cancer Network risk, prostate weight, nerve-sparing status, extent and laterality of lymph node dissection, and operating surgeon (six surgeons were included in the study). A binary decision tree was fit using a conditional inference tree method to predict operative times. The variables most associated with operative time were determined using permutation tests. Data were split at the value of the variable that results in the largest difference in mean for surgical time across the split. This process was repeated recursively on the resultant data. RESULTS A total of 1709 RARPs were included. The variable most strongly associated with operative time was the surgeon (surgeons 2 and 4-102 minutes shorter than surgeons 1, 3, 5, and 6, p < 0.001). Among surgeons 2 and 4, BMI had the strongest association with surgical time (p < 0.001). Among patients operated by surgeons 1, 3, 5, and 6, RARP time was again most strongly associated with the surgeon performing RARP. Surgeons 1, 3, and 6 were on average 76 minutes faster than surgeon 5 (p < 0.001). The regression tree output in the form of box plots showed operative time median and ranges according to patient, disease, procedural, and surgeon metrics. CONCLUSION We developed a methodology that can predict operative times for RARP based on patient, disease and surgeon variables. This methodology can be utilized for quality control, facilitate OR scheduling, and maximize OR efficiency.
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Affiliation(s)
- Neil B Huben
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.,2 Alabama College of Osteopathic Medicine , Dothan, Alabama
| | - Ahmed A Hussein
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York.,3 Department of Urology, Cairo University , Cairo, Egypt
| | - Paul R May
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Michelle Whittum
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Collin Krasowski
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Youssef E Ahmed
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Zhe Jing
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Hijab Khan
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Hyung L Kim
- 4 Department of Urology, Cedar Sinai Medical Center , Los Angeles, California
| | - Thomas Schwaab
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Willie Underwood
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Eric C Kauffman
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - James L Mohler
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
| | - Khurshid A Guru
- 1 Department of Urology, Roswell Park Cancer Institute , Buffalo, New York
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Rajih E, Meskawi M, Alenizi AM, Zorn KC, Alnazari M, Zanaty M, Alhathal N, El-Hakim A. Perioperative predictors for post-prostatectomy urinary incontinence in prostate cancer patients following robotic-assisted radical prostatectomy: Long-term results of a Canadian prospective cohort. Can Urol Assoc J 2019; 13:E125-E131. [PMID: 30332593 PMCID: PMC6520054 DOI: 10.5489/cuaj.5356] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to report the impact of perioperative factors that have not been well-studied on continence recovery following robotic-assisted radical prostatectomy (RARP). METHODS We analyzed data of 322 men with localized prostate cancer who underwent RARP between October 2006 and May 2015 in a single Canadian centre. All patients were assessed at one, three, six, 12, and 24 months after surgery. We evaluated risk factors for post-prostatectomy urinary incontinence from a prospectively collected database in multivariate Cox regression analysis. The primary endpoint was continence, defined as 0 pad usage per day. RESULTS 0-pad continence rates were 126/322 (39%), 187/321 (58%), 222/312 (71%), 238/294 (80%), and 233/257 (91%) at one, three, six, 12, and 24 months, respectively. Bladder neck preservation (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.5-0.99; p=0.04), and prostate size (HR 0.99; 95% CI 0.98-0.99; p=0.02) were independent predictors of continence recovery after RARP. Smoking at time of surgery predicted delayed continence recovery on multivariate analysis (HR 1.42; 95% CI 1.01-1.99; p=0.04). Neurovascular bundles preservation was associated with continence recovery after 24 months. No statistically significant correlation was found with other variables, such as age, body mass index, Charlson comorbidity index, preoperative oncological baseline parameters, presence of median lobe, or thermal energy use. CONCLUSIONS Our results confirmed known predictors of postprostatectomy incontinence (PPI), namely bladder neck resection and large prostate volume. Noteworthy, cigarette smoking at the time of RARP was found to be a possible independent risk factor for PPI. This study is hypothesis-generating.
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Affiliation(s)
- Emad Rajih
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Malek Meskawi
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Abdullah M Alenizi
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Mansour Alnazari
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Marc Zanaty
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Naif Alhathal
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Assaad El-Hakim
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
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Cakmak S, Canda AE, Ener K, Atmaca AF, Altinova S, Balbay MD. Does Type 2 Diabetes Mellitus Have an Impact on Postoperative Early, Mid-Term and Late-Term Urinary Continence After Robot-Assisted Radical Prostatectomy? J Endourol 2019; 33:201-206. [PMID: 30648427 DOI: 10.1089/end.2018.0822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We evaluated the effect of diabetes mellitus (DM) on urinary continence after robotic radical prostatectomy (RARP). PATIENTS AND METHODS Overall, 99 patients with DM and 213 patients without DM who underwent RARP with at least 2-year follow-up were included. The preoperative prostate biopsy Gleason scores and clinical stages of the groups were similar. The patients who were dry or used one safety pad per day were regarded as continent. Early (0-3 months), mid-term (4-12 months), and late-term (>12 months) continence rates were evaluated. RESULTS In diabetic and nondiabetic groups, mean age was 63.3 ± 6.5 and 61.3 ± 6.8 years, respectively (p = 0.015). On the day of the removal of the urethral catheter, 61.6% (n = 61) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At third-month follow-up, 80.8% (n = 80) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At sixth-month follow-up, 89.9% (n = 89) of the diabetic patients and 99.1% (n = 211) of the nondiabetic patients were continent (p = 0.000). At first-year follow-up, 93.9% (n = 93) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.001). At 18th-month follow-up, 96.0% (n = 95) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.013). At second-year follow-up, 98.0% (n = 97) of the diabetic patients and 100% (n = 213) of the nondiabetic patients were continent (p = 0.115). Multivariate analysis showed that age and body mass index had no impact on urinary continence (p > 0.05). Presence of diabetes (p = 0.008) and duration (≥5 years) of diabetes (p = 0.004) were independent factors that had a significant negative impact on urinary continence. CONCLUSIONS Diabetes seems to be a significant disadvantage in gaining urinary continence compared with nondiabetic patients particularly in the first 18 months after RARP. Diabetic patients should be informed about possible late recovery of postoperative urinary continence compared with nondiabetic patients after RARP.
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Affiliation(s)
- Serdar Cakmak
- 1 Urology Clinics, Ordu State Hospital, Ordu, Turkey
| | | | - Kemal Ener
- 3 Department of Urology, University of Health Sciences Affiliated with Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ali Fuat Atmaca
- 4 Department of Urology, School of Medicine Affiliated with Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Serkan Altinova
- 5 Department of Urology, School of Medicine, Liv Hospital, Istinye University, Ankara, Turkey
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28
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Kim MS, Jang WS, Chung DY, Koh DH, Lee JS, Goh HJ, Choi YD. Effect of prostate gland weight on the surgical and oncological outcomes of extraperitoneal robot-assisted radical prostatectomy. BMC Urol 2019; 19:1. [PMID: 30606182 PMCID: PMC6318996 DOI: 10.1186/s12894-018-0434-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/20/2018] [Indexed: 12/21/2022] Open
Abstract
Background Robot-assisted radical prostatectomy (RARP) is performed by urologists as one of the surgical procedures for treating prostate cancer. Numerous studies have been published with regard to the impact of prostate weight on performing RARP but were limited by the insufficient number of patients and use of the transperitoneal approach. This study aimed to determine the effect of prostate gland weight on the surgical and short-term oncological outcomes of RARP using the extraperitoneal approach. Methods In total, 1168 patients who underwent extraperitoneal RARP (EP-RARP) performed by a single surgeon at Yonsei University Severance Hospital between May 2009 and May 2016 were included in the study. The patients were divided into 4 groups according to the prostate weight measured by transrectal ultrasonography preoperatively. Intraoperative and postoperative outcomes were analyzed retrospectively. One-way analysis of variance and the chi-square test were used in the statistical analyses. Results Age, the Gleason score, clinical stage, and pathological stage were significantly different. Patients with a larger prostate size had a longer console time and higher estimated blood loss (P < 0.05). There were no significant differences between the 4 groups in length of hospital stay, duration of catheterization, blood transfusion, body mass index, prostate-specific antigen (PSA) level, history of abdominal surgery, intraoperative complications, positive surgical margin, incidence of lymphocele, and PSA recurrence after 1 year. Conclusions The console time and estimated blood loss were significantly increased with a larger prostate size. However, there were no significant differences in the oncologic outcome and intraoperative complications, suggesting that EP-RARP requires meticulous bleeding control in patients with a prostate weighing > 75 g, and if appropriate management is implemented for blood loss intraoperatively, EP-RARP can be performed regardless of the prostate size.
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Affiliation(s)
- Min Seok Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Won Sik Jang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Doo Yong Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong Hoon Koh
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jong Soo Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyeok Jun Goh
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Murakami T, Otsubo S, Namitome R, Shiota M, Inokuchi J, Takeuchi A, Kashiwagi E, Tatsugami K, Eto M. Clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy. Mol Clin Oncol 2018; 9:575-581. [PMID: 30279989 DOI: 10.3892/mco.2018.1718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/12/2018] [Indexed: 11/06/2022] Open
Abstract
The present study investigated clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy (RARP). The study included 625 Japanese cases treated with RARP between 2009 and 2017. The association between clinical factors (age, overweight status, prostate volume, clinical T-stage, nerve sparing, lympho-node dissection, and the number of experienced cases) and perioperative outcomes (operation time, estimated blood loss, catheterization duration, and perioperative complication) were analyzed. Results revealed that overweight status, prostate volume, lymph-node dissection, and the number of experienced cases were associated with operation time. For estimated blood loss, the identified risk factors were overweight status, prostate volume, nerve sparing, lymph-node dissection, and the number of experienced cases. Lymph-node dissection and the number of experienced cases were also associated with catheterization duration. Additionally, only lymph-node dissection was associated with increased perioperative complication. Taken together, the present study identified several clinical factors affecting perioperative outcomes in RARP. This information may help surgeons to estimate perioperative outcomes as well as to inform patients.
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Affiliation(s)
- Tomohiko Murakami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Satoshi Otsubo
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ryo Namitome
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masaki Shiota
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ario Takeuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Eiji Kashiwagi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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de Carvalho PA, Barbosa JABA, Guglielmetti GB, Cordeiro MD, Rocco B, Nahas WC, Patel V, Coelho RF. Retrograde Release of the Neurovascular Bundle with Preservation of Dorsal Venous Complex During Robot-assisted Radical Prostatectomy: Optimizing Functional Outcomes. Eur Urol 2018; 77:628-635. [PMID: 30041833 DOI: 10.1016/j.eururo.2018.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP which preserves the nerves and vascular structures anterior to the prostate aiming to optimize functional outcomes. OBJECTIVE To present oncological and functional results of a modified technique for RARP. DESIGN, SETTING, AND PARTICIPANTS Prospective, noncontrolled case series including 128 consecutive patients undergoing RARP performed by a single surgeon (R.F.C). SURGICAL PROCEDURE RARP with retrograde release of the neurovascular bundle and preservation of dorsal venous complex. MEASUREMENTS Potency was defined as a Sexual Health Inventory for Men score of ≥17; continence was defined as use of no pads. Oncological results analyzed were positive surgical margins (PSM) rates and biochemical recurrence (BCR)-free survival. BCR was defined as prostate-specific antigen >0.2ng/ml. Complications were graded according to the Clavien-Dindo classification. RESULTS AND LIMITATIONS Median patient age was 63.5 yr. Median skin-to-skin time was 78min. Median length of hospital stay was 1 d, with seven patients (5.5%) hospitalized for more than 24h. Median intraoperative bleeding was 200ml and two patients required postoperative blood transfusion (1.6%). Four patients (3.1%) had grade ≥3 complications. Biochemical recurrence (BCR) occurred in nine of 128 patients (7%) and median time to BCR was 6 mo. Overall PSM rate was 13.3% (17 of 128 patients). PSM rate was 9% among patients with pT2 disease (8/89) and 27% in patients with pT3 (9/38). Continence was reached immediately in 85.9% of the patients and 98.4% were continent at1 yr. At 1 mo postoperatively, 60 patients were potent (53%), while 98 patients among 113 (86%) were potent 1 yr after surgery. A limitation of this study is that it was a noncomparative study. CONCLUSIONS Retrograde release of the neurovascular bundle with preservation of dorsal venous complex during RARP is safe and associated with excellent oncological and functional outcomes. Future comparative studies are needed. PATIENT SUMMARY Robot-assisted radical prostatectomy (RARP) presents consistent oncological outcomes for prostate cancer; yet continence and potency results are not uniform. We present a technical modification for RARP aiming to preserve the nerves and vascular structures anterior to the prostate. We evaluated 128 consecutive patients with clinically localized or locally advanced prostate cancer undergoing RARP with our modified technique of retrograde release of the neurovascular bundles with dorsal vein sparing. We have shown that this technique is safe, effective and associated with early recovery of continence and sexual function after surgery.
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Affiliation(s)
- Paulo Afonso de Carvalho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - João A B A Barbosa
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Giuliano B Guglielmetti
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | - Maurício Dener Cordeiro
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - William C Nahas
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil
| | | | - Rafael Ferreira Coelho
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer de Estado de São Paulo, São Paulo, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Hospital Nove de Julho, São Paulo, Brazil.
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Kitamura K, China T, Kanayama M, Nagata M, Isotani S, Wakumoto Y, Muto S, Ide H, Horie S. Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy. Prostate Int 2018; 7:54-59. [PMID: 31384606 PMCID: PMC6664308 DOI: 10.1016/j.prnil.2018.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction To determine the clinical predictive factors affecting the recovery from postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP). Materials and methods We consecutively analyzed 320 patients who underwent RARP between January 2012 and March 2015. The restoration of urinary continence was defined as follows: the use of no pads/no leakage of urine or the use of a safety pad. Preoperative covariates were statistically assessed by multivariate logistic regression analysis to investigate their predict factor to recovery of urinary incontinence. Therefore, in this study, we sought to identify predictors of early urinary continence status in a single-center retrospective study of consecutive patients who underwent RARP. Results Continence rates at 1, 3, 6, and 12 months after the catheter was removed were 44%, 71%, 83%, and 93%, respectively. Age, body mass index, and prostate volume had no significant association with urinary continence recovery. In contrast to this, longer preoperative membranous urethral length (MUL) was significantly associated with earlier postoperative continence recovery. Multivariate analysis demonstrated that longer preoperative MUL is significantly associated with continence recovery at 1 month (P = 0.0235). Conclusion Approximately 70% of patients achieved urinary continence within 3 months after RARP. Multivariate analysis showed that age, body mass index, and prostate volume had no significant association with urinary continence recovery. Preoperative MUL assessed by magnetic resonance imaging was an independent predictor of early recovery from urinary incontinence after RARP.
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Affiliation(s)
- Kosuke Kitamura
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Mayuko Kanayama
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masayosi Nagata
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Wakumoto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Department of Advanced Informatics for Genetic Disease, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, Bai X, Wu D. Robot-Assisted Radical Prostatectomy Is More Beneficial for Prostate Cancer Patients: A System Review and Meta-Analysis. Med Sci Monit 2018; 24:272-287. [PMID: 29332100 PMCID: PMC5776881 DOI: 10.12659/msm.907092] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Robot-assisted radical prostatectomy (RARP) is increasingly used worldwide, but comparisons of perioperative, functional, and oncologic outcomes among RARP, laparoscopic radical prostatectomy (LRP), and open radical prostatectomy (ORP) remain inconsistent. Material/Methods Systematic literature searches were conducted using EMBASE, PubMed, the Cochrane Library, CNKI, and Science Direct/Elsevier up to April 2017. A meta-analysis was conducted using Review Manager and Stata software. Results We included 33 studies. Meta-analysis revealed that blood loss, transfusion rate, and positive surgical margin (PSM) rate were significantly lower following RARP compared with LRP (SMD (95% confidence interval [CI]) 0.31 [0.01, 0.61]; combined ORs (95% CI) 5.32 [1.29, 21.98]; 1.27 [1.10, 1.46]) and ORP (SMD (95% CI) 0.75 [0.30, 1.21]; and combined ORs (95% CI) 3.44 [1.21, 9.79]); positive surgical margin (PSM) rates were significantly lower following RARP compared with LRP (combined ORs (95% CI) 1.27 [1.10, 1.46]), but not ORP. Operation time was also shorter for RARP than for LRP. The rates of nerve-sparing, recovery of complete urinary continence, and recovery of erectile function were significantly higher following RARP compared with LRP (combined ORs (95% CI) 0.55 [0.31, 0.95]; 0.66 [0.55, 0.78]; 0.46 [0.30, 0.71]) and ORP (combined ORs (95% CI) 0.36 [0.21, 0.63]; 0.33 [0.15, 0.74]; 0.65 [0.37, 1.14]). Conclusions This meta-analysis demonstrates that RARP results in better overall outcomes than LRP and ORP in terms of blood loss, transfusion rate, nerve sparing, urinary continence and erectile dysfunction recovery, and suggests that RARP offers better results than LRP and ORP in treatment of prostate cancer. However, studies with larger sample sizes and long-term results are needed.
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Affiliation(s)
- Yuefeng Du
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Qingzhi Long
- Department of Urology, Department of Urology, Xi'an, Shaanxi, China (mainland)
| | - Bin Guan
- Department of Urology, Department of Urology, Xi'an, Shaanxi, China (mainland)
| | - Lijun Mu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Juanhua Tian
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yumei Jiang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xiaojing Bai
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Dapeng Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Yu YD, Lee M, Hong SK, Byun SS, Lee SE, Lee S. Impact of Variations in Prostatic Apex Shape on Apical Margin Positive Rate After Radical Prostatectomy: Robot-Assisted Laparoscopic Radical Prostatectomy vs Open Radical Prostatectomy. J Endourol 2018; 32:46-53. [DOI: 10.1089/end.2017.0693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Young Dong Yu
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Minseung Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Bellangino M, Verrill C, Leslie T, Bell RW, Hamdy FC, Lamb AD. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy. Curr Urol Rep 2017; 18:99. [PMID: 29116405 PMCID: PMC5676800 DOI: 10.1007/s11934-017-0745-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. EVIDENCE ACQUISITION We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. EVIDENCE SYNTHESIS Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could include modification of intended approach to bladder neck dissection when anterior base lesions are identified on pre-operative MRI.
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Affiliation(s)
- Mariangela Bellangino
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Department of Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Leslie
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard W. Bell
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Freddie C. Hamdy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D. Lamb
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Yamada Y, Fujimura T, Fukuhara H, Sugihara T, Nakagawa T, Kume H, Igawa Y, Homma Y. Predictors of Early Continence after Robot-assisted Radical Prostatectomy. Low Urin Tract Symptoms 2017; 10:287-291. [PMID: 28699263 DOI: 10.1111/luts.12181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/03/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our objective was to investigate predictors of early continence outcome after robot-assisted radical prostatectomy (RARP). METHODS Clinical records were prospectively collected in 272 patients who underwent RARP. Clinical parameters, continence rates, and time to achieve continence were investigated and analyzed. Recovery of continence was defined as achieving complete continence (pad-free). RESULTS In the univariate analysis, young age (≤67 years) and low pT stage (≤pT2) were significantly associated with continence achieved within 2 weeks after RARP (P = 0.0343 and P = 0.0406, respectively). Low prostate weight was the only factor associated with recovery of continence within 1 month (P = 0.0461). Multivariate analysis revealed that young age (≤67 years) and low pT stage (≤pT2) were statistically significant predictors of continence within 2 weeks after RARP (P = 0.040 and P = 0.015, respectively). CONCLUSION Young age and low pT stage were independent predictors of early continence.
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Affiliation(s)
- Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Simple vs six-branches autologous suburethral sling during robot-assisted radical prostatectomy to improve early urinary continence recovery: prospective randomized study. J Robot Surg 2017; 11:415-421. [PMID: 28078523 DOI: 10.1007/s11701-017-0672-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
We have recently described the use of a retropubic suburethral autologous sling created and placed during robotic radical prostatectomy (RARP). In this study, we assess the effectiveness of newly designed six-branches compared to two-branches suburethral autologous sling in improving early urinary continence (UC) recovery. 120 patients submitted to RARP were prospectively randomized according to the intraoperative positioning of six-branches (group 1, n = 60) or two-branches autologous sling (group 2, n = 60) obtained by different configuration of a same tract of vas deferens removed. Early UC recovery was assessed at 5 (catheter removal), 10 and 30 days postoperatively through the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. UC was defined as the non-use of pad. Chi square test and Wilcoxon test were used to investigate UC recovery between the two groups. Moreover, post-voiding residual was evaluated in each patient at the same time. At catheter removal, UC rate was in groups 1 and 2, 60 and 35% (p = 0.02); at 10 days 70 and 46% (p = 0.03); at 30 days 87 and 70% (p = 0.04), respectively. One patient in group 1 experienced acute urinary retention at the time of catheter removal and was treated uneventfully with a further 7-day catheterization. These preliminary data indicate that newly designed six-branches suburethral autologous sling is able to increase the rate of early UC recovery compared to the two-arms sling previously described by us.
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WASHINO S, HIRAI M, SAITO K, KOBAYASHI Y, ARAI Y, MIYAGAWA T. Impact of Androgen Deprivation Therapy on Volume Reduction and Lower Urinary Tract Symptoms in Patients with Prostate Cancer. Low Urin Tract Symptoms 2016; 10:57-63. [DOI: 10.1111/luts.12142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/22/2016] [Accepted: 05/09/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Satoshi WASHINO
- Department of Urology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Masaru HIRAI
- Department of Urology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Kimitoshi SAITO
- Department of Urology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Yutaka KOBAYASHI
- Department of Urology, Saitama Medical Center; Jichi Medical University; Saitama Japan
| | - Yoshiaki ARAI
- Department of Urology; Nishiohmiya Hospital; Saitama Japan
| | - Tomoaki MIYAGAWA
- Department of Urology, Saitama Medical Center; Jichi Medical University; Saitama Japan
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Santok GD, Abdel Raheem A, Kim LHC, Chang K, Lum TGH, Chung BH, Choi YD, Rha KH. Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size. BJU Int 2016; 119:135-141. [DOI: 10.1111/bju.13632] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Glen D.R Santok
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Ali Abdel Raheem
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
- Department of Urology; Tanta University Medical School; Tanta Egypt
| | - Lawrence H. C. Kim
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Kidon Chang
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Trenton G. H. Lum
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Byung H. Chung
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young D. Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Koon H. Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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Adding a newly trained surgeon into a high-volume robotic prostatectomy group: are outcomes compromised? J Robot Surg 2016; 11:69-74. [PMID: 27350553 DOI: 10.1007/s11701-016-0615-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
This study evaluates whether a new staff surgeon early in the learning curve can be integrated into a high-volume robotic practice with an established robotic team and mentorship without compromising robot-assisted radical prostatectomy (RARP) outcomes of the practice. We analyzed outcomes of 3064 patients who underwent RARP from 2007 to 2012 at a high-volume tertiary center by a robotic practice comprising three experienced robotic surgeons (2846 patients) and a newly hired surgeon (218 patients) immediately out of training (residency and oncology fellowship with 2 years of RARP exposure). The new surgeon performed RARP with intraoperative mentorship by the senior surgeons during the first year. Complications, biochemical recurrence (BCR), positive surgical margins rate (PSM), operating time (OR time), estimated blood loss (EBL) for the new and senior surgeons were compared. Multivariable linear, logistic and exact logistic regression adjusting for disease and patient characteristics were performed. On regression analyses, case number was the most significant predictor of decrease in probability of major complications (p = 0.025) and BCR (p = 0.004) for the new surgeon. Increasing case number was not associated with decrease in minor complications, PSM, OR time, or EBL (p > 0.05). Inclusion of the new surgeon's outcomes did not adversely impact outcomes of the practice. In conclusion, a new surgeon joining a high-volume robotic prostatectomy program with an established robotic team and mentorship can progress through the learning curve without compromising overall outcomes of the practice. Our results may be relevant for programs hiring newly trained staff to join an established robotic practice.
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Porpiglia F, Bertolo R, Manfredi M, De Luca S, Checcucci E, Morra I, Passera R, Fiori C. Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Implications on Early Recovery of Urinary Continence. Eur Urol 2016; 69:485-95. [DOI: 10.1016/j.eururo.2015.08.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/04/2015] [Indexed: 11/25/2022]
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41
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Cestari A, Ferrari M, Ghezzi M, Sangalli M, Zanoni M, Fabbri F, Sozzi F, Lolli C, Dell'Acqua V, Rigatti P. Retropubic Intracorporeal Placement of a Suburethral Autologous Sling During Robot-Assisted Radical Prostatectomy to Improve Early Urinary Continence Recovery: Preliminary Data. J Endourol 2015; 29:1379-85. [DOI: 10.1089/end.2015.0292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Cestari
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Matteo Ferrari
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Massimo Ghezzi
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Mattia Sangalli
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Matteo Zanoni
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Fabio Fabbri
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Francesco Sozzi
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Carolina Lolli
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Vincenzo Dell'Acqua
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
| | - Patrizio Rigatti
- Department of Urology, Advanced Urotechnology Center, Scientific Institute “Istituto Auxologico Italiano,” Milan, Italy
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42
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B�tow Z, Schunk S, Janssen M, Gr�ber S, Saar M, Kamradt J, Siemer S, St�ckle M, Ohlmann CH. Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy. Urol Int 2015; 95:465-71. [DOI: 10.1159/000440666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022]
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43
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Hirasawa Y, Ohno Y, Nakashima J, Shimodaira K, Hashimoto T, Gondo T, Ohori M, Tachibana M, Yoshioka K. Impact of a preoperatively estimated prostate volume using transrectal ultrasonography on surgical and oncological outcomes in a single surgeon’s experience with robot-assisted radical prostatectomy. Surg Endosc 2015; 30:3702-8. [DOI: 10.1007/s00464-015-4664-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
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44
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Kadono Y, Ueno S, Kadomoto S, Iwamoto H, Takezawa Y, Nakashima K, Nohara T, Izumi K, Mizokami A, Gabata T, Namiki M. Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: Nerve-sparing technique contributes to the reduction of postprostatectomy incontinence. Neurourol Urodyn 2015; 35:1034-1039. [PMID: 26352154 DOI: 10.1002/nau.22877] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/21/2015] [Indexed: 11/05/2022]
Abstract
AIMS To examine which preoperative factors, including urodynamic evaluations, and operative procedures could predict continence status after robot-assisted radical prostatectomy (RARP) in this study. MATERIALS AND METHODS Univariate and multivariate logistic regression analyses of preoperative factors such as age, body mass index, prostate-specific antigen level before biopsy, prostate size before surgery, membranous urethral length measured using magnetic resonance imaging (MRI), bladder compliance and maximum urethral closure pressure (MUCP) measured by urodynamic study (UDS), and nerve-sparing (NS) status predicting 24-hr pad test >2 g/day at 1 year after RARP were examined in 111 patients enrolled in this study. RESULTS The number of patients with incontinence at 1 year after RARP was 39 (35.1%). The only predictive factor for urinary continence was NS grades. To investigate the contribution of NS to urinary continence, 84 patients underwent UDS three times; before, immediately after, and 1 year after RARP. Chronological UDS revealed that recovery patterns of storage and voiding functions were the same among non-NS, unilateral-NS, and bilateral-NS groups, and that higher degrees of NS contributed to lesser decreases in MUCP and longer functional urethral length (FUL) after RARP. CONCLUSION Preoperative factors, including the results of UDS, could not predict continence 1 year after RARP. The NS procedure contributed to continence status. NS favorably affected MUCP and FUL; however, it did not affect bladder function after RARP. Neurourol. Urodynam. 35:1034-1039, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
| | - Satoru Ueno
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yuta Takezawa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazufumi Nakashima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Mikio Namiki
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Turan T, Boylu U, Başataç C, Gümüş E. Predictive preoperative factors for positive surgical margins in robotic radical prostatectomy in low-risk prostate cancer. Turk J Urol 2015; 39:69-73. [PMID: 26328083 DOI: 10.5152/tud.2013.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Positive surgical margins after radical prostatectomy for localized prostate cancer is a powerful predictor of PSA recurrence. Clinical stage, Gleason score and preoperative PSA are predictive factors for positive surgical margin after radical prostatectomy. In this study, we aimed to identify preoperative factors affecting surgical margin positivity in low-risk prostate cancer after robotic radical prostatectomy (RARP). MATERIAL AND METHODS Between 2008 and 2011 (<cT2b, PSA <10, Gleason <7), data from 112 patients with low-risk (<cT2b, PSA <10, Gleason <7), prostate cancer who had undergone RARP were examined prospectively. The effects of PSA, body mass index, surgery time after biopsy, percentage of positive cores, tumor length and prostate weight on positive surgical margin were evaluated. For statistical analyses, Mann-Whitney U, Pearson chi-square and logistic regression tests were used. RESULTS It was observed that mean age and body mass index had no effect on positive surgical margins (p=0.2 and 0.6). According to univariate analysis, it was found that an elapsed time of less than six weeks from biopsy to surgery (p=0.07), tumor percentage of more than 5% in a biopsy specimen (p=0.003), a positive core percentage of more than 20% (p=0.045) and a prostate volume below 50 cc (p=0.037) increased the rate of positive surgical margins. Based on multivariate analysis, PSA levels above 5 ng/mL (OR: 8.006, p=0.012) and an elapsed time of less than 6 weeks between biopsy and surgery (OR: 10.814, p=0.029) increased the risk of positive surgical margins. CONCLUSION In low-risk prostate cancer, a waiting time of less than six weeks between biopsy and surgery and PSA levels above 5 ng/mL are predictive of high surgical margin positivity after robotic radical prostatectomy.
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Affiliation(s)
- Turgay Turan
- Department of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Uğur Boylu
- Department of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Cem Başataç
- Department of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Eyüp Gümüş
- Department of Urology, Ümraniye Teaching Hospital, İstanbul, Turkey
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Mandel P, Weinhold P, Michl U, Huland H, Graefen M, Tilki D. Impact of prostate volume on oncologic, perioperative, and functional outcomes after radical prostatectomy. Prostate 2015; 75:1436-46. [PMID: 26074139 DOI: 10.1002/pros.23023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/30/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of prostate volume (PV) on oncologic, perioperative and functional outcomes after radical prostatectomy (RP) remains controversial, as recent studies present inconsistent results. We studied the influence of PV on outcomes in a large single center dataset and summarized the existing literature. METHODS 5,477 patients who underwent RP between January 2008 and December 2011 were analyzed. The impact of PV on biochemical recurrence (BCR) and metastasis-free survival (MFS) was assessed using Kaplan-Meier curves and multivariate Cox proportional hazard model. Uni- and multivariate logistic regressions were used to estimate the impact of PV on surgical margin (SM), 1-week, 3-months and 12-months continence and 3-months and 12-months potency. Finally, the impact of PV on intraoperative blood loss was analyzed using uni- and multivariate linear regressions. RESULTS Median follow-up was 36.1 months. Overall, 16.5% of patients recurred during the follow-up period. The mean preoperative PV was 43.3 ml. One-week, 3-months and 12-months continence rates were 55.6%, 69.3%, and 87.4% for patients with PV ≥ 70 compared to 64.4%, 78.3%, and 92.1% for patients with PV < 30, respectively. Three-months and 12-months potency rates were 37.1% and 54.8% for men with large glands (≥70) and 56.3% and 65.0% for men with PV < 30. In multivariate analysis, continence at 1 week, 3 months and 12 months was significantly worse in patients with glands ≥70 ml, while potency was not influenced by PV in multivariate analysis. There was a higher mean blood loss (P < 0.001) in patients with larger glands. In univariate analysis, higher PV was significantly associated with lower BCR (P = 0.019), but not with metastasis free survival (P = 0.112). CONCLUSIONS PV significantly influences BCR-free survival only in univariate analysis. Especially early (1-week and 3-months) postoperative continence is negatively affected by higher PV in multivariate analysis, while PV did not influence potency after adjusting for further covariates in a specialized high-volume institution.
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Affiliation(s)
- Philipp Mandel
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital Munich-Gro, ß, hadern, Munich, Germany
| | - Uwe Michl
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Ou YC, Yang CK, Chang KS, Wang J, Hung SW, Tung MC, Tewari AK, Patel VR. The surgical learning curve for robotic-assisted laparoscopic radical prostatectomy: experience of a single surgeon with 500 cases in Taiwan, China. Asian J Androl 2015; 16:728-34. [PMID: 24830691 PMCID: PMC4215670 DOI: 10.4103/1008-682x.128515] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To analyze the learning curve for cancer control from an initial 250 cases (Group I) and subsequent 250 cases (Group II) of robotic-assisted laparoscopic radical prostatectomy (RALP) performed by a single surgeon. Five hundred consecutive patients with clinically localized prostate cancer received RALP and were evaluated. Surgical parameters and perioperative complications were compared between the groups. Positive surgical margin (PSM) and biochemical recurrence (BCR) were assessed as cancer control outcomes. Patients in Group II had significantly more advanced prostate cancer than those in Group I (22.2% vs 14.2%, respectively, with Gleason score 8–10, P= 0.033; 12.8% vs 5.6%, respectively, with clinical stage T3, P= 0.017). The incidence of PSM in pT3 was decreased significantly from 49% in Group I to 32.6% in Group II. A meaningful trend was noted for a decreasing PSM rate with each consecutive group of 50 cases, including pT3 and high-risk patients. Neurovascular bundle (NVB) preservation was significantly influenced by the PSM in high-risk patients (84.1% in the preservation group vs 43.9% in the nonpreservation group). The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively. In conclusion, the incidence of PSM in pT3 was decreased significantly after 250 cases. There was a trend in the surgical learning curve for decreasing PSM with each group of 50 cases. NVB preservation during RALP for the high-risk group is not suggested due to increasing PSM.
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Affiliation(s)
- Yen-Chuan Ou
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan, China,
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Tuliao PH, Koo KC, Komninos C, Chang CH, Choi YD, Chung BH, Hong SJ, Rha KH. Number of positive preoperative biopsy cores is a predictor of positive surgical margins (PSM) in small prostates after robot-assisted radical prostatectomy (RARP). BJU Int 2015; 116:897-904. [PMID: 25098818 DOI: 10.1111/bju.12888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the impact of prostate size on positive surgical margin (PSM) rates after robot-assisted radical prostatectomy (RARP) and the preoperative factors associated with PSM. PATIENTS AND METHODS In all, 1229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had transurethral resection of the prostate, neoadjuvant therapy, clinically advanced cancer, and the first 200 performed cases (to reduce the effect of learning curve). Included were 815 patients who were then divided into three prostate size groups: <31 g (group 1), 31-45 g (group 2), >45 g (group 3). Multivariate analysis determined predictors of PSM and biochemical recurrence (BCR). RESULTS Console time and blood loss increased with increasing prostate size. There were more high-grade tumours in group 1 (group 1 vs group 2 and group 3, 33.9% vs 25.1% and 25.6%, P = 0.003 and P = 0.005). PSM rates were higher in prostates of <45 g with preoperative PSA levels of >20 ng/dL, Gleason score ≥7, T3 tumour, and ≥3 positive biopsy cores. In group 1, preoperative stage T3 [odds ratio (OR) 3.94, P = 0.020] and ≥3 positive biopsy cores (OR 2.52, P = 0.043) were predictive of PSM, while a PSA level of >20 ng/dL predicted the occurrence of BCR (OR 5.34, P = 0.021). No preoperative factors predicted PSM or BCR for groups 2 and 3. CONCLUSION A preoperative biopsy with ≥3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA level of >20 ng/dL is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer postoperative follow-up.
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Affiliation(s)
- Patrick H Tuliao
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyo C Koo
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christos Komninos
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chien H Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young D Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung H Chung
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung J Hong
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Koon H Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kumar A, Samavedi S, Bates AS, Coelho RF, Rocco B, Palmer K, Patel VR. Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors. BJU Int 2015; 116:764-70. [PMID: 25726729 DOI: 10.1111/bju.13106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyse the continence outcomes of robot-assisted radical prostatectomy (RARP) in suboptimal patients that have challenging continence recovery factors such as enlarged prostates, elderly patients, higher body mass index (BMI), salvage prostatectomy, and bladder neck procedures before RARP. PATIENTS AND METHODS From January 2008 through November 2012, 4,023 patients underwent RARP by a single surgeon at our institution. Retrospective analysis of prospectively collected data identified 3,362 men who had minimum of 1-year follow-up. This cohort of patients was stratified into six groups: Group I, aged ≥70 years (451 patients); Group II, BMI ≥35 kg/m(2) (197); Group III, prior bladder neck procedures (103); Group IV, prostate weight ≥80 g (280); and Group V, salvage prostatectomy (41). Group VI consisted of patients (2 447) with none of these risk factors. Continence outcomes at follow-up were analysed for all groups. RESULTS The continence rate at 1 year and mean (sd) time to continence in different groups were: for patients aged ≥70 years, 85.6% and 3.2 (4.5) months; BMI of ≥35 kg/m(2) , 87.8% and 3.1 (4.5) months; prior bladder neck treatment, 82.4% and 3.4 (4.7) months; prostate weight of ≥80 g, 85.8% and 3.3 (4.4) months; salvage procedures, 51.3% and 6.6 (8.3) months; and in Group VI (none of the risk factors), 95.1% and 2.4 (3.2) months. The continence rate was significantly higher in group VI compared with the salvage group (group V) at the different follow-up intervals (P < 0.001). When compared with the other groups (I-IV), the continence rate, although higher, was not statistically significant at the different intervals in group VI (no risk). The mean time to continence was significantly lower in group VI compared with the other groups (I-V; P < 0.001). CONCLUSIONS This study has shown that selected risk factors adversely affect the time to return of continence after RARP, yet aside from salvage patients, there was no statistically significant difference demonstrated between the adverse-risk groups included. Patients undergoing salvage RP had significantly lower continence rates at the various intervals compared with the other groups. Patients with the risk factors identified should be counselled concerning expectations for achieving urinary continence.
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Affiliation(s)
- Anup Kumar
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Srinivas Samavedi
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Anthony S Bates
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Rafael F Coelho
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Bernardo Rocco
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Kenneth Palmer
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Vipul R Patel
- Department of Urology, University of Central Florida College of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
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50
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Independent predictors of prolonged operative time during robotic-assisted radical prostatectomy. J Robot Surg 2015; 9:117-23. [DOI: 10.1007/s11701-015-0497-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/16/2015] [Indexed: 12/20/2022]
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