1
|
Wang M, Deng R, Wang L, Li M, Zeng T, Na Y, Gu D. Association between 3D membranous urethral parameters and urinary continence recovery after RARP. Eur J Med Res 2024; 29:165. [PMID: 38475943 DOI: 10.1186/s40001-024-01758-y] [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: 08/11/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES To evaluate whether the urinary continence (UC) recovery after robotic-assisted radical prostatectomy (RARP) relates to the membranous urethral length (MUL) and the membranous urethral complex volume (MUV). MATERIALS AND METHODS 120 patients who underwent RARP were enrolled according to the different times of UC recovery and examined using prostate magnetic resonance imaging (MRI) before surgery. The membranous urethral (MU) parameters were measured using the three-Dimensional (3D) model reconstructed by holographic technology, such as total MUV (tMUV), exposed MUV (eMUV), full MUL (fMUL) and exposed MUL (eMUL). Statistical software SPSS 26.0 was used to analyze the data and compare the MU parameters and baseline data in different groups. RESULTS Patients with larger tMUV (p = 0.038), eMUV (p = 0.003), longer fMUL (p = 0.025), eMUL (p = 0.044) had better UC after removal of the catheter, and eMUV (OR = 1.002, 95%CI = 1.001-1.004, p = 0.004) was a predictor; the patients with younger age (p = 0.021), lower VPSS score (p = 0.004) and larger eMUV (p = 0.012) and longer eMUL (p = 0.049) had better UC recovery one month after RARP while eMUV (OR = 1.002, 95% CI = 1.000-1.003, p = 0.008) and VPSS score (OR = 0.886, 95% CI = 0.806-0.973, p = 0.011) were independent risk factors; The patients with younger age (p = 0.018), larger tMUV (p = 0.029), eMUV (p = 0.016) had better UC recovery three months after RARP. eMUV (OR = 1.002, 95% CI = 1.000-1.004, p = 0.042) and age (OR = 0.904, 95% CI = 0.818-0.998, p = 0.046) were independent risk factors. CONCLUSION This clinical study shows that patients with larger MUV and longer MUL can return to UC earlier after surgery. Among that, eMUV is a better predictor.
Collapse
Affiliation(s)
- Ming Wang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ruiqi Deng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lei Wang
- Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
| | - Mingzhao Li
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tao Zeng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanqun Na
- Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China.
| | - Di Gu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Matsuyama N, Naiki T, Hamamoto S, Sugiyama Y, Kubota Y, Hamakawa T, Etani T, Iwatsuki S, Taguchi K, Ota Y, Gonda M, Aoki M, Morikawa T, Kato T, Okada A, Yasui T. Postoperative Bladder Neck to Pubic Symphysis Ratio Predictive for De Novo Overactive Bladder after Robot-Assisted Radical Prostatectomy. Diagnostics (Basel) 2023; 13:3173. [PMID: 37891994 PMCID: PMC10606078 DOI: 10.3390/diagnostics13203173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The aim was to investigate the incidence and clinical predictive factors of de novo overactive bladder (OAB) after robot-assisted radical prostatectomy (RARP), including a Retzius-sparing (RS) approach, in the same period at a single institution. METHODS Of a total of 113 patients with localized prostate cancer, 81 received conventional RARP (CON-RARP) and 32 received RS-RARP at our institution. The basic characteristics data of patients and self-assessment questionnaires, including IPSS and OABSS, were obtained preoperatively and 1, 3, and 6 months after RARP. In addition, a retrospective biomarker analysis was also performed of predictive clinical parameters obtained from cystography that included a postoperative bladder neck to pubic symphysis (BNPS) ratio. RESULTS Patients' basic characteristics were similar between CON-RARP and RS-RARP groups. With respect to the surgical procedure, anastomosing time was found to be significantly longer for patients in the RS-RARP compared to the CON-RARP group (p < 0.01). Compared to the CON-RARP group, the RS-RARP group showed a significantly lower postoperative BNPS and aspect ratio (p < 0.001). The incidence of de novo OAB in patients of the CON-RARP group was greater than for those in the RS-RARP group (40.7% CON-RARP vs. 25.0% RS-RARP), though this was not significant. Regarding the emergence of de novo OAB, the following were revealed in univariate analysis to be independent prognostic factors: age > 64 years (hazards ratio [HR]: 4.32, 95% confidence interval [CI]: 1.51-12.3), postoperative BNPS ratio > 0.44 (HR: 8.7, 95% CI: 6.43-54.5), postoperative aspect ratio > 1.18 (HR: 3.36, 95% CI: 1.49-7.61). Additionally, multivariate analysis identified a sole significant prognostic factor: postoperative BNPS ratio > 0.44 (HR: 13.3, 95% CI: 4.33-41.1). CONCLUSION Our findings indicate that the postoperative BNPS ratio may be a practical predictive indicator of the emergence of de novo OAB after RARP.
Collapse
Affiliation(s)
- Nayuka Matsuyama
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Taku Naiki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Shuzo Hamamoto
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Yosuke Sugiyama
- Department of Pharmacy, Nagoya City University Hospital, Nagoya 467-8601, Japan;
| | - Yasue Kubota
- Department of Clinical Physiology, Graduate School of Nursing, Nagoya City University, Nagoya 467-8601, Japan;
| | - Takashi Hamakawa
- Department of Urology, Nagoya City University West Medical Center, Nagoya 462-8508, Japan;
| | - Toshiki Etani
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Shoichiro Iwatsuki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Kazumi Taguchi
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Yuya Ota
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Masakazu Gonda
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Maria Aoki
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Toshiharu Morikawa
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Taiki Kato
- Department of Urology, Nagoya City University East Medical Center, Nagoya 464-8547, Japan;
| | - Atsushi Okada
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| | - Takahiro Yasui
- Department of Nephro-Urology, Graduate School of Medical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (N.M.); (S.H.); (T.E.); (S.I.); (K.T.); (Y.O.); (M.G.); (M.A.); (T.M.); (A.O.); (T.Y.)
| |
Collapse
|
3
|
Yu WR, Jiang YH, Jhang JF, Kuo HC. Use of Urinary Biomarkers in Discriminating Interstitial Cystitis/Bladder Pain Syndrome from Male Lower Urinary Tract Dysfunctions. Int J Mol Sci 2023; 24:12055. [PMID: 37569430 PMCID: PMC10419079 DOI: 10.3390/ijms241512055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
To analyze the urinary biomarkers in men with lower urinary-tract symptoms (LUTS) and identify interstitial cystitis/bladder pain syndrome (IC/BPS) from the other lower urinary-tract dysfunctions (LUTDs) by the levels of characteristic urinary biomarkers. In total, 198 men with LUTS were prospectively enrolled and urine samples were collected before intervention or medical treatment. Videourodynamic studies were routinely performed and the LUTDs were diagnosed as having bladder-outlet obstruction (BOO) such as bladder-neck dysfunction, benign prostatic obstruction, or poor relaxation of external sphincter (PRES); and bladder dysfunction such as detrusor overactivity (DO), hypersensitive bladder (HSB), and IC/BPS. Patients suspicious of IC/BPS were further confirmed by cystoscopic hydrodistention under anesthesia. The urine samples were investigated for 11 urinary inflammatory biomarkers including eotaxin, IL-6, IL-8, CXCL10, MCP-1, MIP-1β, RANTES, TNF-α, NGF, BDNF, and PGE2; and 3 oxidative stress biomarkers 8-OHdG, 8-isoprostane, and TAC. The urinary biomarker levels were analyzed between LUTD subgroups and IC/BPS patients. The results of this study revealed that among the patients, IC/BPS was diagnosed in 48, BOO in 66, DO in 25, HSB in 27, PRES in 15, and normal in 17. Patients with BOO had a higher detrusor pressure and BOO index than IC/BPS, whereas patients with IC/BPS, BOO, and DO had a smaller cystometric bladder capacity than the PRES and normal subgroups. Among the urinary biomarkers, patients with IC/BPS had significantly higher levels of eotaxin, MCP-1, TNF-α, 8-OHdG, and TAC than all other LUTD subgroups. By a combination of different characteristic urinary biomarkers, TNF-α, and eotaxin, either alone or in combination, had the highest sensitivity, specificity, positive predictive value, and negative predictive value to discriminate IC/BPS from patients of all other LUTD subgroups, BOO, DO, or HSB subgroups. Inflammatory biomarker MCP-1 and oxidative stress biomarkers 8-OHdG and TAC, although significantly higher in IC/BPS than normal and PRES subgroups, did not have a diagnostic value between male patients with IC/BPS and the BOO, DO, or HSB subgroups. The study concluded that using urinary TNF-α and eotaxin levels, either alone or in combination, can be used as biomarkers to discriminate patients with IC/BPS from the other LUTD subgroups in men with LUTS.
Collapse
Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung Yang Road, Hualien 970, Taiwan; (Y.-H.J.); (J.-F.J.)
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung Yang Road, Hualien 970, Taiwan; (Y.-H.J.); (J.-F.J.)
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung Yang Road, Hualien 970, Taiwan; (Y.-H.J.); (J.-F.J.)
| |
Collapse
|
4
|
Kasai T, Banno T, Nakamura K, Kouchi Y, Shigeta H, Suzuki F, Kaneda Y, Bhandari D, Murayama A, Takamatsu K, Kobayashi N, Sawano T, Nishikawa Y, Sato H, Ozaki A, Kurokawa T, Kanzaki N, Shimmura H. Duration and Influencing Factors of Postoperative Urinary Incontinence after Robot-Assisted Radical Prostatectomy in a Japanese Community Hospital: A Single-Center Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4085. [PMID: 36901096 PMCID: PMC10001515 DOI: 10.3390/ijerph20054085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Post-operative urinary incontinence (PUI) after robotic-assisted radical prostatectomy (RARP) is an important complication; PUI occurs immediately after postoperative urethral catheter removal, and, although approximately 90% of patients improve within one year after surgery, it can significantly worsen their quality of life. However, information is lacking on its nature in community hospital settings, particularly in Asian countries. The purposes of this study were to investigate the time required to recover from PUI after RARP and to identify its associated factors in a Japanese community hospital. METHODS Data were extracted from the medical records of 214 men with prostate cancer who underwent RARP from 2019 to 2021. We then calculated the number of days elapsed from the surgery to the initial outpatient visit confirming PUI recovery among the patients. We estimated the PUI recovery rate using the Kaplan-Meier product limit method and evaluated associated factors using the multivariable Cox proportional hazards model. RESULTS The PUI recovery rates were 5.7%, 23.4%, 64.6%, and 93.3% at 30, 90, 180, and 365 days following RARP, respectively. After an adjustment, those with preoperative urinary incontinence experienced significantly slower PUI recovery than their counterparts, while those with bilateral nerve sparing experienced recovery significantly sooner than those with no nerve sparing. CONCLUSION Most PUI improved within one year, but a proportion of those experiencing recovery before 90 days was smaller than previously reported.
Collapse
Affiliation(s)
- Tadashi Kasai
- Department of Rehabilitation, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Haruki Shigeta
- School of Medicine, Tohoku University, Sendai 980-8575, Japan
| | - Fumio Suzuki
- Department of Rehabilitation, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Yudai Kaneda
- School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Divya Bhandari
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
- Medical Governance Research Institute, Tokyo 108-0074, Japan
| | - Anju Murayama
- School of Medicine, Tohoku University, Sendai 980-8575, Japan
| | - Katumori Takamatsu
- Department of Rehabilitation, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Naomi Kobayashi
- Department of Rehabilitation, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan
| | - Hiroyuki Sato
- Department of Rehabilitation, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
- Medical Governance Research Institute, Tokyo 108-0074, Japan
| | - Tomohiro Kurokawa
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Norio Kanzaki
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
| |
Collapse
|
5
|
Haga N, Miyazaki T, Gunge N, Okabe Y, Matsuzaki H. Editorial Comment from Dr Haga et al. to Minimal residual membranous urethral length and membranous urethral length predict poor recovery from incontinence after robot-assisted radical prostatectomy and after open radical prostatectomy. Int J Urol 2022; 29:1523-1524. [PMID: 36102778 DOI: 10.1111/iju.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| |
Collapse
|
6
|
Yu WR, Chang WC, Kuo HC. Clinical presentation, videourodynamic characteristics, and treatment outcome in men with interstitial cystitis-like lower urinary tract symptoms. Int Urol Nephrol 2022; 54:2157-2165. [PMID: 35804206 DOI: 10.1007/s11255-022-03294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In men, lower urinary tract symptoms (LUTS) similar to interstitial cystitis/bladder pain syndrome (IC/BPS) are difficult to diagnose, and treatment outcomes are poor. This study investigated clinical characteristics and videourodynamic study (VUDS) parameters, pathophysiology, and treatment outcomes in men with IC-like LUTS. METHODS Men with frequency, urgency, dysuria, and bladder pain initially diagnosed as IC/BPS by ESSIC criteria were assessed to rule out other lower urinary tract diseases (LUTD) by voiding diary, digitorectal examination, urinalysis, VUDS, and cystoscopic hydrodistention. Subsequent treatments for LUTD and specific treatment for IC/BPS were based on VUDS and cystoscopic findings. Clinical VUDS characteristics and treatment outcomes were compared with those of women with IC/BPS. RESULTS Seventy consecutive men (median age 54.5 years) were enrolled. The median maximum bladder capacity under cystoscopic hydrodistention was 650 mL (IQR 495-763) and glomerulation grade was 2 (1.0-2.0). The patients had moderate anxiety and depression severity; 49% had improved treatment outcomes. On VUDS, 42 (60%) patients had variable LUTD, including detrusor overactivity (n = 14), bladder neck dysfunction (n = 15), dysfunctional voiding (n = 3), and poor relaxation of the external sphincter (n = 24); also, 22 (31.4%) had a previous bladder outlet procedure. The self-reported treatment outcome was significantly better for patients with vs. without LUTD (p = 0.014). CONCLUSIONS Men with IC-like LUTS diagnosed as IC/BPS may have bladder outlet dysfunction as well as bladder dysfunction, causing a hypersensitive and painful bladder. The IC-like symptoms in the patients with LUTD might, in part, originated from bladder outlet dysfunction rather than the bladder alone.
Collapse
Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Chuan Chang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien, Taiwan.
| |
Collapse
|
7
|
Tutolo M, Rosiello G, Stabile G, Tasso G, Oreggia D, De Wever L, De Ridder D, Pellegrino A, Esposito A, De Cobelli F, Salonia A, Briganti A, Montorsi F, Everaerts W, Van der Aa F. The key role of levator ani thickness for early urinary continence recovery in patients undergoing robot-assisted radical prostatectomy: A multi-institutional study. Neurourol Urodyn 2022; 41:1563-1572. [PMID: 35781824 DOI: 10.1002/nau.25001] [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: 11/27/2021] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urinary continence (UC) recovery dramatically affects quality of life after robot-assisted radical prostatectomy (RARP). Membranous urethral length (MUL) has been the most studied anatomical variable associated with UC recovery. OBJECTIVE To investigate whether levator ani thickness (LAT), assessed with multi-parametric magnetic resonance imaging (mpMRI), correlates with UC recovery after RARP. DESIGN, SETTING, AND PARTICIPANTS The study included 209 patients treated with RARP by expert surgeons with extensive robotic experience from 2017 to 2019. All patients had complete, clinical, mpMRI, pathological, and postoperative data including pelvic floor muscle training (PFMT) protocols. INTERVENTION After a radiologist-specific training, two urologists independently examined the files, blinded to clinical and pathological findings as well as to postoperative continence status. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS On mpMRI, LAT, bladder neck (BN) shape, MUL, and apex overlapping (AO) were measured. UC recovery was defined as use of 0 or 1 safety pad at follow-up. Multivariable models were used to assess the association between variables and UC recovery. RESULTS AND LIMITATIONS Overall, 173 (82.8%) patients were continent after a median follow-up of 23 months (interquartile range [IQR]: 17-28). Of these, 98 (46.9%) recovered within 3 months after surgery, 42 (20.1%) from 3 to 6 months, and 33 (15.8%) from 6 months onwards. A significant higher rate of patients with LAT > 10 mm (88.1 vs.75.8%; p = 0.03) experienced UC recovery, compared to those with LAT < 10 mm. This difference was observed in the first 3 months after surgery. At multivariable analysis, LAT (odds ratio [OR]: 1.18, 95% confidence interval [CI]: 1.02-1.37; p = 0.02), Preoperative ICIQ score (OR: 0.91, 95% CI: 0.82-0.98, p = 0.03) and PFMT (OR: 1.98, 95% CI: 1.01-3.93; p = 0.04) independently predict higher UC recovery within 3 months, after accounting for age, BMI, preoperative PSA, D'Amico risk group, MUL, BN shape and AO. CONCLUSIONS LAT greater than 1 cm was associated with greater UC recovery. Specifically, LAT greater than 1 cm seems to be associated with higher UC rate at 3 months after RARP, compared to those with LAT < 1 cm. PATIENT SUMMARY Magnetic resonance features can help in predicting the risk of incontinence after robot-assisted radical prostatectomy and should be taken into account when counseling patients before surgery.
Collapse
Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Rosiello
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Stabile
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Tasso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Davide Oreggia
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Liesbeth De Wever
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Antony Pellegrino
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy
| | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Haga N, Gunge N, Matsuzaki H, Okabe Y, Miyazaki T. Editorial Comment to Myosteatosis as a novel predictor of urinary incontinence after robot-assisted radical prostatectomy. Int J Urol 2021; 29:40-41. [PMID: 34664318 DOI: 10.1111/iju.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| |
Collapse
|
9
|
Ito T, Watanabe K, Matsushita Y, Watanabe H, Tamura K, Motoyama D, Sugiyama T, Otsuka A, Miyake H. Impact of Bladder Neck Angle Measured by Postoperative Magnetic Resonance Imaging on Midterm Recovery of Urinary Continence in Prostate Cancer Patients Undergoing Robot-Assisted Radical Prostatectomy. J Endourol 2021; 35:1610-1615. [PMID: 34078137 DOI: 10.1089/end.2021.0071] [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: 11/13/2022] Open
Abstract
Introduction: MRI has helped clarify the relationship between pelvic anatomical structures and functional outcomes after robot-assisted radical prostatectomy (RARP). The objective of this study was to assess the impact of the bladder neck angle (BNA) measured by postoperative MRI on midterm recovery of urinary continence (UC) in patients undergoing RARP. Patients and Methods: This study retrospectively included 200 consecutive patients with prostate cancer who were treated by RARP and received MRI 3 months after RARP. Based on postoperative MRI, the BNA was measured as the angle between the anterior and posterior bladder walls. The midterm recovery of UC was defined as the use of either no pad or an occasional security pad at 6 months after RARP. Results: One hundred forty-four of the 200 patients (72.0%) achieved midterm recovery of UC and the median BNA was 70°. There were no significant differences in several parameters, including age, body mass index, total prostate volume, preservation of the neurovascular bundle, and postoperative membranous urethral length (MUL), between patients with BNA ≥70° and <70°. Of these parameters, only the BNA and postoperative MUL were independently associated with the midterm recovery of UC. The optimal cutoff points of the BNA and MUL (65° and 9 mm, respectively) were calculated by the receiver operating characteristics curve, and a scoring model for the prediction of midterm recovery of UC was developed according to the logistic regression analysis. This scoring model was demonstrated to be satisfactorily calibrated (p for Hosmer-Lemeshow test = 0.49) and provide good discrimination (area under the curve: 0.723; p < 0.001). Conclusions: These findings suggest that midterm recovery of UC after RARP is favorably affected by the large BNA and long postoperative MUL, and our scoring model can be used as a reliable tool for predicting the midterm continence status after RARP.
Collapse
Affiliation(s)
- Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
10
|
Colarieti A, Thiruchelvam N, Barrett T. Evaluation of image-based prognostic parameters of post-prostatectomy urinary incontinence: A literature review. Int J Urol 2021; 28:890-897. [PMID: 34101272 DOI: 10.1111/iju.14609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/04/2021] [Indexed: 12/18/2022]
Abstract
Prostate cancer is the second most common male cancer, and radical prostatectomy is a highly effective treatment for intermediate and high-risk disease. However, post-prostatectomy urinary incontinence remains a major functional side-effect in patients undergoing radical prostatectomy. Despite recent improvements in preoperative imaging quality and surgical techniques, it remains challenging to predict or prevent occurrence of this complication. The aim of this research was to review the current published literature on pre- and postoperative imaging evaluation of the prostate and pelvic structures, to identify added value in the prediction of post-prostatectomy urinary incontinence. A computerized bibliographic search of the PubMed library was carried out to identify imaging-based articles evaluating the pelvic floor and surrounding structures pre- and/or postradical prostatectomy to predict post-prostatectomy urinary incontinence. A total of 32 articles were included. Of these, 29 papers assessed the importance of magnetic resonance imaging evaluation, with a total of 16 parameters evaluated. The most common parameters were intravesical protrusion, the membranous urethral length, prostatic volume and periurethral fibrosis. Preoperative membranous urethral length and its preservation after surgery showed the strongest correlation with urinary incontinence. Three studies evaluated ultrasound, with all carried out postoperatively. This technique benefits from a dynamic evaluation, and the results are promising for proximal urethral hypermobility and the degree of bladder neck funneling on the Valsalva maneuver. Several imaging studies evaluated the predictors of post-prostatectomy urinary incontinence, with preoperative membranous urethral length offering the most promise. However, the current literature is limited by the single-center nature of studies, and the heterogeneity in patient populations and methodologies used.
Collapse
Affiliation(s)
- Anna Colarieti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nikesh Thiruchelvam
- Department of, Urology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tristan Barrett
- Department of, Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| |
Collapse
|
11
|
Muñoz-Calahorro C, García-Sánchez C, Barrero-Candau R, García-Ramos JB, Rodríguez-Pérez AJ, Medina-López RA. Anatomical predictors of long-term urinary incontinence after robot-assisted laparoscopic prostatectomy: A systematic review. Neurourol Urodyn 2021; 40:1089-1097. [PMID: 33851426 DOI: 10.1002/nau.24652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
AIMS There is scarce evidence of anatomical risk factors that might affect long-term post-prostatectomy incontinence (PPI) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). This systematic review aims to identify anatomical measurements in preoperative magnetic resonance imaging (MRI) that might be associated with increased risk of urinary incontinence (UI) 1 year after RALP. METHODS A comprehensive search on Pubmed and Scopus databases up to November 2020 was performed. Eight articles met the inclusion criteria and were finally selected. RESULTS The selected studies included 1146 patients. Seven articles focused on membranous urethral length (MUL); all of them related MUL to long-term PPI in univariate analysis and five of them in multivariate analysis. Four studies presented MUL difference to measure the magnitude of the effect. Average MUL (mm) was 15.9 (SD, 2.6), 16.1 (95% confidence interval [CI]: 13.9-18.9), 12.1 (95% CI 9.7-14.9) and 14.5 in continent patients and 13.9 (SD, 2.9), 10 (95% CI: 8.7-12.1), 10.3 (95% CI: 8.7-12.4) and 9.3 in incontinent patients, with statistically significant differences in all cases. Five studies presented the odds ratio as a result; although there was substantial heterogeneity in the methods used to obtain it, there was consistency in finding an inverse association between MUL and PPI. Other measurements including prostatic-urethral angle, membranous urethral thickness, intraprostatic urethral length and intravesical prostatic protrusion have been reported in few studies, and no association with long-term PPI was found. Levator ani muscle thickness was related to long-term PPI in one article. CONCLUSION Greater MUL on preoperative MRI is associated with lower risk of UI 1 year after RALP.
Collapse
|
12
|
Ota Y, Hamamoto S, Matsuyama N, Hamakawa T, Iwatsuki S, Etani T, Taguchi K, Naiki T, Ando R, Nakane A, Okada A, Kawai N, Kubota Y, Yasui T. Pelvic Anatomical Features After Retzius-Sparing Robot-Assisted Radical Prostatectomy Intended for Early Recovery of Urinary Symptoms. J Endourol 2020; 35:296-304. [PMID: 32935558 DOI: 10.1089/end.2020.0463] [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] [Indexed: 01/19/2023] Open
Abstract
Purpose: To elucidate factors contributing to early urinary continence recovery after retzius-sparing robot-assisted radical prostatectomy (RS-RARP) by evaluating postoperative pelvic anatomical features between RS-RARP and conventional RARP (CON-RARP). Materials and Methods: We retrospectively examined 50 men who underwent RS-RARP (n = 25; the RS-RARP group) and CON-RARP (n = 25; the CON-RARP group) between October 2017 and June 2018. Perioperative outcomes and postoperative urinary continence were assessed in both groups. Anatomical features including the bladder neck-to-pubic symphysis ratio (determined from cystograms) and membranous urethral length (MUL) (determined from magnetic resonance imaging) were evaluated. Result: The daily urinary incontinence rate at discharge was significantly lower in the RS-RARP group than in the CON-RARP group (0.046 [range: 0.014-0.160] vs 0.357 [range: 0.139-0.616], p < 0.001). Postoperative urinary continence at 1, 3, 6, and 12 months was 80%, 92%, 96%, and 96% in the RS-RARP group and 24%, 40%, 68%, and 84% in the CON-RARP group, respectively (p < 0.001). The urgency scores in the international prostate symptom score (IPSS) questionnaire at 1 and 3 months were significantly lower in the RS-RARP than in the CON-RARP group (p = 0.028 and 0.033, respectively). The quality of life (QOL) indices were more significantly improved in the RS-RARP group than in the CON-RARP group 1 month (p = 0.027) and 3 months (p = 0.045) postoperatively. Receiver operating characteristic analysis revealed that a postoperative MUL of 12.1 mm (area under the curve: 0.852) was the optimal cutoff value predictive of continence recovery after 1 month. Multivariate analysis demonstrated that RS-RARP (odds ratio [OR]: 23.6; p < 0.001) and prostate volume (OR: 0.926; p = 0.049) were the independent factors of a longer MUL. Conclusions: RS-RARP results in an early continence recovery and a better urgency score in the IPSS by suppressing the descent of the bladder and maintaining a long MUL. RS-RARP may contribute to a better QOL recovery after RARP.
Collapse
Affiliation(s)
- Yuya Ota
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Nayuka Matsuyama
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takashi Hamakawa
- Department of Urology, Nagoya East Medical Center, Nagoya, Aichi, Japan
| | - Shoichiro Iwatsuki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Toshiki Etani
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Akihiro Nakane
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yasue Kubota
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.,Department of Clinical Physiology, Nagoya City University Graduate School of Nursing, Nagoya, Aichi, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| |
Collapse
|
13
|
Kurimura Y, Haga N, Yanagida T, Tanji R, Onagi A, Honda R, Matsuoka K, Hoshi S, Hata J, Onoda M, Sato Y, Akaihata H, Kataoka M, Ogawa S, Ishibashi K, Matsubara A, Kojima Y. The preoperative pad test as a predictor of urinary incontinence and quality of life after robot-assisted radical prostatectomy: a prospective, observational, clinical study. Int Urol Nephrol 2019; 52:67-76. [PMID: 31571159 DOI: 10.1007/s11255-019-02301-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess whether the preoperative 1-h pad test could predict postoperative urinary incontinence and quality of life after robot-assisted radical prostatectomy. METHODS A total of 329 patients who underwent robot-assisted radical prostatectomy between 2013 and 2016 were prospectively enrolled in this study. These patients were divided into the preoperative urinary continence group and the preoperative urinary incontinence group according to the 1-h pad test. The time to achieve urinary continence, lower urinary tract function evaluated by uroflowmetry and post-voided residual urine volume, and quality of life evaluated by King's Health Questionnaire and International Consultation on Incontinence Questionnaire-Short Form were compared between these two groups. RESULTS There were 190 patients (58%) in the preoperative urinary continence group (1-h pad test ≤ 2 g) and 139 patients (42%) in the preoperative urinary incontinence group (1-h pad test > 2 g). In the preoperative urinary continence/incontinence groups, 83%/76% of patients achieved continence within 12 months, respectively, and urinary incontinence remained significantly longer in the preoperative incontinence group than in the preoperative continence group (P = 0.042). Although there were no significant differences in all quality of life items between the two groups before surgery, several items were significantly higher in the preoperative urinary continence group. CONCLUSION Achievement of urinary continence and improvement of urinary quality of life are delayed in patients with preoperative urinary incontinence assessed by the 1-h pad test. The preoperative 1-h pad test could be a useful predictor of prolonged urinary incontinence and poor quality of life after robot-assisted radical prostatectomy.
Collapse
Affiliation(s)
- Yoshimasa Kurimura
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan. .,Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
| | - Nobuhiro Haga
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tomohiko Yanagida
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ryo Tanji
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akifumi Onagi
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Ruriko Honda
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Hoshi
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsutaka Onoda
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kei Ishibashi
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| |
Collapse
|
14
|
Onoda M, Haga N, Kurimura Y, Tanji R, Onagi A, Honda R, Matsuoka K, Hoshi S, Koguchi T, Hata J, Sato Y, Akaihata H, Kataoka M, Ogawa S, Obara W, Kojima Y. Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study. Neurourol Urodyn 2019; 38:2200-2208. [DOI: 10.1002/nau.24117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/02/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Mitsutaka Onoda
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
- Department of UrologyIwate Medical University School of Medicine Morioka Japan
| | - Nobuhiro Haga
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Yoshimasa Kurimura
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Ryo Tanji
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Akifumi Onagi
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Ruriko Honda
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Kanako Matsuoka
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Seiji Hoshi
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Tomoyuki Koguchi
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Junya Hata
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Yuichi Sato
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Hidenori Akaihata
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Masao Kataoka
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Soichiro Ogawa
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| | - Wataru Obara
- Department of UrologyIwate Medical University School of Medicine Morioka Japan
| | - Yoshiyuki Kojima
- Department of UrologyFukushima Medical University School of Medicine Fukushima Japan
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW Post-prostatectomy overactive bladder (OAB) is a common and challenging condition to manage. The aim of the present report was to review the recent evidences regarding OAB symptoms that develop in men after prostatectomy and how to manage them. RECENT FINDINGS The prevalence of OAB after radical prostatectomy may range from 15.2 to 37.8%. Recent studies have highlighted the role of the urethrogenic mechanism (facilitation of the urethrovesical reflex due to stress urinary incontinence (SUI)) in the genesis of post-prostatectomy OAB in a significant proportion of patients. Several other pathophysiological factors such as iatrogenic decentralization of the bladder, defunctionalized bladder due to severe SUI, detrusor underactivity, or bladder outlet obstruction might be involved. The evaluation should aim to identify the underlying mechanism to tailor the treatment, which could range from SUI surgery, to fixing a urethral stricture, improving bladder emptying or using the conventional spectrum of OAB therapies. There is a paucity of data for OAB therapies specific to post-prostatectomy patients, with the exception of solifenacin, tolterodine, and botulinum toxin. There is currently no data on how preoperative management or surgical technique may prevent post-prostatectomy OAB.
Collapse
|
16
|
Zhang F, Liao L. Artificial urinary sphincter implantation: an important component of complex surgery for urinary tract reconstruction in patients with refractory urinary incontinence. BMC Urol 2018; 18:3. [PMID: 29310634 PMCID: PMC5759840 DOI: 10.1186/s12894-018-0314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 01/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background We review our outcomes and experience of artificial urinary sphincter implantation for patients with refractory urinary incontinence from different causes. Methods Between April 2002 and May 2017, a total of 32 patients (median age, 40.8 years) with urinary incontinence had undergone artificial urinary sphincter placement during urinary tract reconstruction. Eighteen patients (56.3%) were urethral injuries associated urinary incontinence, 9 (28.1%) had neurogenic urinary incontinence and 5 (15.6%) were post-prostatectomy incontinence. Necessary surgeries were conducted before artificial urinary sphincter placement as staged procedures, including urethral strictures incision, sphincterotomy, and augmentation cystoplasty. Results The mean follow-up time was 39 months. At the latest visit, 25 patients (78.1%) maintained the original artificial urinary sphincter. Four patients (12.5%) had artificial urinary sphincter revisions. Explantations were performed in three patients. Twenty-four patients were socially continent, leading to the overall success rate as 75%. The complication rate was 28.1%; including infections (n = 4), erosions (n = 4), and mechanical failure (n = 1). The impact of urinary incontinence on the quality of life measured by the visual analogue scale dropped from 7.0 ± 1.2 to 2.2 ± 1.5 (P <0.001). Conclusions The primary sources for artificial urinary sphincter implantation in our center are unique, and the procedure is an effective treatment as a part of urinary tract reconstruction in complicated urinary incontinence cases with complex etiology.
Collapse
Affiliation(s)
- Fan Zhang
- Department of Urology, China Rehabilitation Research Center, Beijing, 100068, China.,Department of Urology, Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Beijing, 100068, China. .,Department of Urology, Capital Medical University, Beijing, China.
| |
Collapse
|
17
|
Complete bladder neck preservation promotes long-term post-prostatectomy continence without compromising midterm oncological outcome: analysis of a randomised controlled cohort. World J Urol 2017; 36:349-355. [PMID: 29214353 DOI: 10.1007/s00345-017-2134-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The only RCT available on complete bladder neck preservation (cBNP) during radical prostatectomy reported superior continence and QoL outcomes in the first 12 months after cBNP. We provide the first data on long-term urinary continence, QoL and biochemical recurrence (BCR) after complete bladder neck preservation in a randomised controlled cohort. METHODS After approval by IRB, 199 men recruited for the randomised, controlled single-blind Heidelberger cBNP Study had prostatectomy performed with (cBNP) or without (noBNP) complete bladder neck preservation. Only men with renewed consent for this follow-up were evaluated for continence, QoL outcomes and BCR by ICIQ-SF self-assessment questionnaire, Pad-use/day and PSA levels. Students-t test, Pearson´s Chi-square, Fishers exact test and multiple logistic regression analyses were applied. RESULTS Mean follow-up was approx. 4 years. There were no significant differences in baseline characteristics between responders/non-responders or between study groups. We noted significantly higher continence rates (p = 0.004), less pad-use (p < 0.001), reduced frequency (p = 0.023) and amount (p = 0.009) of urine loss, and higher QoL outcomes (p = 0.012) after cBNP. A younger age positively influenced continence (OR = 0.91), but the multivariate analysis found cBNP to be the only independent predictor of continence (p = 0.008; OR = 8.1). pT stage was the only predictor for positive surgical margins (PSM; p < 0.001). There was no significant difference in pT stage (p = 0.23) or BCR (p = 0.63) between study groups and also no significant correlation between BCR and presence (p = 0.26) or localisation (p = 0.11) of PSM, nerve sparing (p = 0.70), surgeon (p = 0.41), preoperative PSA (p = 0.53) or pT stage (p = 0.17). No cancer-related death was noted. CONCLUSIONS Results of this first follow-up on a prospective randomised controlled cohort demonstrate that cBNP is associated with significantly higher continence and QoL outcomes without compromising cancer control making cBNP a novel objective during radical prostatectomy.
Collapse
|
18
|
Haga N, Takinami R, Tanji R, Onagi A, Matsuoka K, Koguchi T, Akaihata H, Hata J, Ogawa S, Kataoka M, Sato Y, Ishibashi K, Aikawa K, Kojima Y. Comprehensive approach for post-prostatectomy incontinence in the era of robot-assisted radical prostatectomy. Fukushima J Med Sci 2017; 63:46-56. [PMID: 28747618 DOI: 10.5387/fms.2017-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Robot-assisted radical prostatectomy (RARP) has enabled steady and stable surgical procedures due to both meticulous maneuvers and magnified, clear, 3-dimensional vision. Therefore, better surgical outcomes have been expected with RARP than with other surgical modalities. However, even in the RARP era, post-prostatectomy incontinence has a relatively high incidence as a bothersome complication. To overcome post-prostatectomy incontinence, it goes without saying that meticulous surgical procedures and creative surgical procedures, i.e., "Preservation", "Reconstruction", and "Reinforcement" of the anatomical structures of the pelvis, are most important. In addition, medication and appropriate pad usage might sometimes be helpful for patients with post-prostatectomy incontinence. However, patients who have 1) BMI > 26 kg/m2, 2) prostate volume > 70 mL, 3) eGFR < 60 mL/min, or a 4) Charlson comorbidity index > 2 have a tendency to develop post-prostatectomy incontinence despite undergoing the same surgical procedures. It is important for patients who have a high risk for post-prostatectomy incontinence to be given information about delayed recovery of post-prostatectomy incontinence. Thus, not only the surgical procedures, but also a comprehensive approach, as mentioned above, are important for post-prostatectomy incontinence.
Collapse
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukushima Medical University School of Medicine
| | - Ruriko Takinami
- Department of Urology, Fukushima Medical University School of Medicine
| | - Ryo Tanji
- Department of Urology, Fukushima Medical University School of Medicine
| | - Akifumi Onagi
- Department of Urology, Fukushima Medical University School of Medicine
| | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University School of Medicine
| | - Tomoyuki Koguchi
- Department of Urology, Fukushima Medical University School of Medicine
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine
| | - Kei Ishibashi
- Department of Urology, Fukushima Medical University School of Medicine
| | - Ken Aikawa
- Department of Urology, Fukushima Medical University School of Medicine
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine
| |
Collapse
|
19
|
Haga N, Hata J, Matsuoka K, Koguchi T, Akaihata H, Kataoka M, Sato Y, Ogawa S, Ishibashi K, Kojima Y. The impact of nerve-sparing robot-assisted radical prostatectomy on lower urinary tract function: Prospective assessment of patient-reported outcomes and frequency volume charts. Neurourol Urodyn 2017; 37:322-330. [PMID: 28452451 DOI: 10.1002/nau.23297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/23/2017] [Indexed: 11/11/2022]
Abstract
AIMS To elucidate the effects of a nerve-sparing (NS) procedure on lower urinary tract symptoms (LUTS) and urinary function after robot-assisted radical prostatectomy (RARP), the associations between the NS procedure and LUTS and urinary function were investigated. METHODS The participants in this study were 200 consecutive patients who underwent RARP. These patients were categorized into unilateral and bilateral NS groups and the non-NS group. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, frequency-volume chart, uroflowmetry, 1-h pad test, and the 5-item International Index of Erectile Function (IIEF-5) questionnaire were evaluated before and after RARP. RESULTS The total IPSS score was significantly lower in the unilateral (P = 0.03) and bilateral NS groups (P = 0.03) than in the non-NS group after RARP. Diurnal maximum voided volume (MVV) values were significantly greater in the bilateral NS group than in the non-NS group after RARP (P = 0.002). Nocturnal frequency was significantly decreased in the unilateral NS group than in the non-NS group after RARP (3 months P = 0.01, 12 months P = 0.01). Erectile function was significantly better in both the unilateral NS group (P < 0.0001) and the bilateral NS group (P = 0.02) than in the non-NS group 12 months after RARP. CONCLUSIONS The NS procedure in RARP has the possibility to improve not only erectile function, but also LUTS, owing to both the increase of MVV and the decrease of nocturia. Therefore, the NS procedure is also recommended from the viewpoint of early improvement of LUTS and lower urinary tract dysfunction after RARP.
Collapse
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Hata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kanako Matsuoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tomoyuki Koguchi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masao Kataoka
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kei Ishibashi
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshiyuki Kojima
- Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
20
|
Song W, Kim CK, Park BK, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy. Can Urol Assoc J 2017; 11:E93-E99. [PMID: 28360954 DOI: 10.5489/cuaj.4035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP). METHODS Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months. RESULTS Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01-1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16-9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17-7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85-19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24-13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL. CONCLUSIONS Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.
Collapse
Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kwan Park
- Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Haga N. Author's Response to Akin et al. J Endourol 2016; 30:360. [PMID: 26859712 DOI: 10.1089/end.2016.29008.nha] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukushima Medical University School of Medicine , Fukushima, Japan
| |
Collapse
|
22
|
MRI factors to predict urinary incontinence after retropubic/laparoscopic radical prostatectomy. Int Urol Nephrol 2015; 47:1343-9. [DOI: 10.1007/s11255-015-1019-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 05/23/2015] [Indexed: 12/12/2022]
|