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Wu X, Wong CHM, Gandaglia G, Chiu PKF. Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy. Curr Opin Urol 2023; 33:482-487. [PMID: 37646515 DOI: 10.1097/mou.0000000000001127] [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: 09/01/2023]
Abstract
PURPOSE OF REVIEW Urinary incontinence is common postoperative complication following robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (PCa). Despite the increasing adoption of RARP in the treatment of high-risk PCa (HRPC), concerns persist regarding the adequacy of reported continence outcomes in this subgroup. This review aims to illuminate the state of continence recovery in HRPC patients post-RARP. RECENT FINDINGS Urinary continence (UC) recovery rates in HRPC was reported to be lower than the intermediate/low-risk counterparts from 6 to 24 months post-RARP. Predictive models showed that age, obesity, race, disease status, and surgical approaches represent predictors of continence recovery. Special techniques like NeuroSAFE technique and Retzius-Sparing approach also play a role in reducing incontinence also in the high-risk scenario. SUMMARY RARP for HRPC appears to be associated with worse continence compared with other risk groups. A multimodality approach for prediction and prevention of incontinence after RARP is vital. Further research into this area is necessary to enhance continence recovery outcomes in HRPC patients undergoing RARP.
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Affiliation(s)
- Xiaobo Wu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chris Ho-Ming Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Watari S, Ichikawa T, Shiraishi H, Tokunaga M, Kubota R, Kusumi N, Tsushima T. Efficacy of urine loss ratio for prognosis of urinary continence after radical prostatectomy: A retrospective cohort study in a single Japanese institution. Investig Clin Urol 2023; 64:168-174. [PMID: 36882176 PMCID: PMC9995956 DOI: 10.4111/icu.20220380] [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: 11/25/2022] [Revised: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
PURPOSE The usefulness of the urine loss ratio in the early postoperative period for prognosis of long-term urinary continence after radical prostatectomy has not been fully determined. MATERIALS AND METHODS All patients who underwent radical prostatectomy for prostate cancer at our institution between November 2015 and March 2021 were retrospectively included. We investigated the rate of continence achievement 1 year after surgery, as well as the associated risk factors for reduced continence achievement, classified by every 10% of the urine loss ratio. RESULTS Of the 100 patients with available urine loss ratio data, 66 achieved urinary continence. Ninety-three percent of patients with urine loss ratios of ≤10%, 40%-75% of patients with urine loss ratios of 11%-80%, and 20%-36% of patients with urine loss ratios of >80%, achieved continence. The logistic regression analysis showed that the urine loss ratio severity, body mass index (BMI) of >25 kg/m², and smoking history were unfavorable to achieve urinary continence. A BMI of ≤25 kg/m² was favorable for urinary continence achievement, but only up to an 80% urine loss ratio. Nonsmokers achieved continence well, even with a urine loss ratio of >80%. CONCLUSIONS Classifying patients into three groups based on their urine loss ratios is potentially useful for urinary continence prognosis. Smoking and obesity were risk factors for continued urinary incontinence, although the prognostic accuracy was expected to improve when considering the severity of the urine loss ratio.
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Affiliation(s)
- Shogo Watari
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Takaharu Ichikawa
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan.
| | - Hiromasa Shiraishi
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Moto Tokunaga
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Risa Kubota
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Norihiro Kusumi
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Tomoyasu Tsushima
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan
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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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Deng W, Chen R, Zhu K, Cheng X, Xiong Y, Liu W, Zhang C, Li Y, Jiang H, Zhou X, Sun T, Chen L, Liu X, Wang G, Fu B. Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis. JOURNAL OF ONCOLOGY 2021; 2021:4375722. [PMID: 34970314 PMCID: PMC8714374 DOI: 10.1155/2021/4375722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). MATERIALS AND METHODS 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. RESULTS Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group (p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group (p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group (p = 0.192 and p = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up (p = 0.013 and p = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups (p = 0.228). CONCLUSIONS For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.
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Affiliation(s)
- Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Ru Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Department of Urology, The First Hospital of Putian City, Putian, Fujian Province, China
| | - Ke Zhu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Xiaofeng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Yunqiang Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Weipeng Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Yulei Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Hao Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Ting Sun
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Gongxian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Yongwai Street 17, Nanchang, Jiangxi Province, China
- Jiangxi Institute of Urology, Yongwai Street 17, Nanchang, Jiangxi Province, China
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Hoeh B, Preisser F, Wenzel M, Humke C, Wittler C, Hohenhorst JL, Volckmann-Wilde M, Köllermann J, Steuber T, Graefen M, Tilki D, Karakiewicz PI, Becker A, Kluth LA, Chun FKH, Mandel P. Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy. Curr Oncol 2021; 28:4738-4747. [PMID: 34898569 PMCID: PMC8628712 DOI: 10.3390/curroncol28060399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/07/2021] [Accepted: 11/13/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. METHODS Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of <1, 1-10, 11-50, and >50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. RESULTS From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine <1 g, 1-10 g, 11-50 g, and >50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03; for urine loss 1-10 g vs. 11-50 g vs. >50 g, Ref: <1 g; all p < 0.05). CONCLUSIONS Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H3T 1C5, Canada; (J.L.H.); (P.I.K.)
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
- Correspondence: ; Tel.: +49-(0)69-6301-83147; Fax: +49-(0)69-6301-83140
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Jan L. Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H3T 1C5, Canada; (J.L.H.); (P.I.K.)
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
| | - Maja Volckmann-Wilde
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
- Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H3T 1C5, Canada; (J.L.H.); (P.I.K.)
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
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Chung JW, Kim SW, Kang HW, Ha YS, Choi SH, Lee JN, Kim BS, Kim HT, Kim TH, Yoon GS, Kwon TG, Chung SK, Yoo ES. Efficacy of modified radical prostatectomy technique for recovery of urinary incontinence in high-grade prostate cancer. MINERVA UROL NEFROL 2020; 72:605-614. [PMID: 32298065 DOI: 10.23736/s0393-2249.20.03633-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study was conducted to evaluate predictive factors of urinary continence recovery after radical prostatectomy (RP) for high-grade prostate cancer (PCa). METHODS A total of 241 patients with high-grade (Gleason Score 8 or 9) PCa who underwent RP in a single Korean center between January 2011 and May 2018 were retrospectively reviewed. Urinary continence was defined as no pads use. Urinary continence was evaluated at 1, 3, 6, and 12 months after RP. Univariate and multivariate analyses were performed to determine the predictive factors of urinary continence recovery after RP. RESULTS The mean age was 67.6±6.4 years, and the mean PSA was 18.7±21.1 ng/dL. A total of 197 (81.7%) patients underwent nerve-sparing RP, and 198 patients (82.2%) were continent 1 year after RP. Multivariate analysis showed that the age (odds ratio [OR]=1.091 [1.015-1.172], P=0.018), Body Mass Index (BMI) (OR=1.227 [1.057-1.424], P=0.007), and modified surgical technique (OR=0.109 [0.044-0.267], P<0.001) were independent factors for predicting urinary continence recovery after RP. CONCLUSIONS Younger age, low BMI, and modified surgery were independent predictors of urinary continence recovery after RP in patients with high-grade PCa. These findings may help surgeons to give pre- and postoperative advice to patients with high-grade PCa about urinary continence recovery after RP.
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Affiliation(s)
- Jae W Chung
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Sang W Kim
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Ho W Kang
- Department of Urology, College of Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, South Korea
| | - Yun S Ha
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Seock H Choi
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Jun N Lee
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Bum S Kim
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Hyun T Kim
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Tae H Kim
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Ghil S Yoon
- Department of Pathology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Tae G Kwon
- Department of Urology, School of Medicine, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea.,Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, South Korea
| | - Sung K Chung
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
| | - Eun S Yoo
- Department of Urology, School of Medicine, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea -
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