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Westhofen T, Feyerabend E, Buchner A, Schlenker B, Becker A, Eismann L, Rodler S, Jokisch F, Stief CG, Kretschmer A. Impact of Preoperative LUTS on Health-related Quality of Life Following Radical Prostatectomy: A Propensity Score Matched Longitudinal Study. Urology 2024; 192:52-58. [PMID: 38679296 DOI: 10.1016/j.urology.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To assess the impact of preoperative lower urinary tract symptoms (LUTS) on long-term health-related quality of life (HRQOL) up to 10 years after radical prostatectomy (RP) for prostate cancer (PC). METHODS Within our prospective institutional database of 6487 patients treated with RP for PC (2008-2020), 2727 patients with preoperative LUTS (IPSS score of ≥8) were identified. A 1:1 propensity-score matched analysis of 3056 men (n = 1528 LUTS, n = 1528 no LUTS) was conducted. Primary endpoint was HRQOL (based on EORTC QLQ-C30 and PR25). Linear regression models tested the effect of preoperative LUTS on the net change in general HRQOL (P <.05). RESULTS Median follow-up was 48 months. Preoperative mean global health status (GHS) score (67.4 vs 75.7) was significantly lower in the LUTS cohort (P <.001). Post-RP the difference in general HRQOL between the LUTS cohort and the no-LUTS cohort became smaller (65.7 vs 67.8), however, remaining statistically significant (P = .037). In long-term follow-up, general HRQOL was comparable between both subcohorts (P-range 0.716-0.876). Multivariable linear regression analysis revealed increased preoperative IPSS as an independent predictor for increased perioperative improvement of IPSS (P <.001) CONCLUSION: For patients undergoing RP, preoperative LUTS were associated with a postoperative improvement of HRQOL outcomes. In long-term follow-up, HRQOL was comparable to patients without preoperative LUTS. Hence, RP is an efficient option to treat PC as well as LUTS in those patients.
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Affiliation(s)
- Thilo Westhofen
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Enya Feyerabend
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lennert Eismann
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Severin Rodler
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany; Janssen Global Research and Development, Los Angeles, CA
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Soputro NA, Olivares R. Editorial Comment on "Impact of Preoperative LUTS on Health-related Quality of Life Following Radical Prostatectomy: A Propensity Score Matched Longitudinal Study". Urology 2024; 192:59-60. [PMID: 38825086 DOI: 10.1016/j.urology.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Nicolas A Soputro
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Rubén Olivares
- Glickman Urologic & Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Qvigstad LF, Eri LM, Lien MD, Fosså SD, Aas K, Berge V. Reduction of lower urinary tract symptoms in prostate cancer patients treated with robot assisted laparoscopic prostatectomy. Scand J Urol 2024; 59:121-125. [PMID: 38888041 DOI: 10.2340/sju.v59.40070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024]
Abstract
PROBLEM The aim of this study was to evaluate the change in LUTS in patients treated with RALP and to assess factors that may predict an improvement of LUTS. MATERIALS AND METHOD In our institutional prospective research registry, 1935 patients operated in the period between 2009 and 2021 with complete baseline- and 12-month EPIC-26 questionnaire were eligible for the study. Also SF-12 data estimating general quality of life (QoL) were analyzed. A LUTS summary score was constructed from the two questions concerning voiding stream/residual and frequency, and transformed linearly to a 0-100 scale with higher scores representing less symptoms A change of 6 points or more were considered Meaningful Clinical Differences (MCD). Two summary scores were calculated from the SF-12 - a mental component score (MCS-12) and a physical component score (PCS-12). Multivariate regression was used to estimate covariates associated with postoperative MCD, MCS-12 and PCS-12. RESULTS Mean change of LUTS-score showed an increase of 10 points 12-months post-RALP. 52% of patients achieved MCD. In multivariate logistic regression, preoperative LUTS was statistically significant associated with MCD. Reduction of LUTS was associated improved mean score of MCS-12 and PCS-12. DISCUSSION AND CONCLUSION Along with information about risk for urinary incontinence after RALP, patients with LUTS at baseline must be informed that these symptoms may be reduced after RALP. In our study, this LUTS reduction was associated with better general QoL.
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Affiliation(s)
| | - Lars Magne Eri
- Department of Urology, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - My Diep Lien
- Oslo Hospital Service, Research Support, Oslo University Hospital, Oslo, Norway
| | - Sophie Dorothea Fosså
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway; dDepartment of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kirsti Aas
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway; Akershus University Hospital, Lørenskog, Norway
| | - Viktor Berge
- Department of Urology, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Soda T, Otsuka H, Koike S, Okada T. Baseline factors and surgical procedures affecting changes in lower urinary tract symptoms after robot-assisted radical prostatectomy: the impact of nerve-sparing. Int Urol Nephrol 2024; 56:989-997. [PMID: 37907707 DOI: 10.1007/s11255-023-03859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To determine baseline factors and surgical procedures associated with clinically meaningful improvement or deterioration of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP). METHODS We retrospectively reviewed our RARP database and analyzed the changes in the International Prostate Symptom Score (IPSS) at baseline and 1, 3, 6, and 12 months postoperatively. Multivariable ordinal logistic regression analysis was performed to determine variables that predicted clinically meaningful improvement (∆IPSS ≤ -5) or deterioration (∆IPSS ≥ 5) in LUTS after RARP. RESULTS A total of 172 patients were eligible for analysis. Patients aged ≥ 70 reported a higher IPSS before and after RARP (all p < 0.05). Patients with a prostate volume of > 30 mL or body mass index of < 24 kg/m2 had worse preoperative LUTS; however, the difference disappeared after RARP. While patients with or without nerve-sparing (NS) had a similar preoperative LUTS burden, the NS group reported significantly lower IPSS than the non-NS group at all postoperative time points (p < 0.05). Twelve months after RARP, LUTS improved in 27% and worsened in 6% of patients in the NS group, compared with 20% and 24% of those in the non-NS group, respectively (p = 0.018). Preoperative IPSS (OR, 0.84; 95% CI, 0.79-0.89) and NS (OR, 0.39; 95% CI, 0.18-0.83) were independently associated with clinically meaningful changes of LUTS at 12 months after RARP. CONCLUSION Other than baseline LUTS severity, NS was the only independent factor associated with clinically meaningful changes in LUTS after RARP.
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Affiliation(s)
- Takeshi Soda
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Hikari Otsuka
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Shuhei Koike
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Takuya Okada
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan
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Tourinho-Barbosa R, Sanchez-Salas R, Sivaraman A, Borges RC, Candela L, Batista LT, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Cathelineau X, Korkes F. Urinary Symptoms Change and Quality of Life After Robotic Radical Prostatectomy: A Secondary Analysis of a Randomized Controlled Trial. Urology 2024; 185:73-79. [PMID: 38281669 DOI: 10.1016/j.urology.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/26/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To present the patient-reported quality of life (QoL) outcomes from a prospective, randomized controlled trial comparing the use of pelvic floor muscle training (PFMT) and duloxetine after robot-assisted radical prostatectomy (RARP). METHODS We identified 213 men with organ-confined disease having post-RARP urinary incontinence who were randomly assigned to received PFMT, duloxetine, combined PFMT-duloxetine and pelvic floor muscle home exercises. Urinary symptoms burden was measured by marked clinical important difference improvement (MCID) defined by using the International Prostate Symptom Score (IPSS) difference of - 8 points (ΔIPSS ≤-8). QoL was assessed according to Visual Analog Scale (VAS), King's Health Questionnaire (KQH), and International Index of Erectile Function (IIEF-5). Multivariable regression analyses aimed to predict MCID, burden of urinary symptoms (IPSS ≥8), and patients reporting to be satisfied (IPSS QoL ≤2) or comfortable (VAS ≤1) post-RARP. RESULTS Moderate to severe urinary symptoms decreased from 48% preoperatively to 40%, 34%, and 23% at 3, 6, and 12months post-RARP. After surgery, MCID improvement was observed in 19% of patients, and deterioration in 3.3%. Large prostate was the only factor associated to MCID (OR 1.03 [95%CI 1.01-1.05], P = .005). At 6months, patients reached the same degree of preoperative satisfaction. Neurovascular bundle preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR 12.8 [CI95% 1.47-111.7], P = .02 at 3months) and was also associated to higher median postoperative IIEF-5. CONCLUSION Despite urinary incontinence following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms within a year, which subsequently elevates QoL. Furthermore, nerve-sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL.
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Affiliation(s)
- Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil; Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada.
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
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Kohada Y, Hieda K, Miyamoto S, Tasaka R, Asami A, Akiyama K, Sakamoto Y, Kirishima F, Saito K, Fukushima T, Takemoto K, Babasaki T, Kobatake K, Kitano H, Goto K, Ikeda K, Hayashi T, Hinata N. Retrospective evaluation of the improvement in the urinary status-related quality of life after robot-assisted radical prostatectomy. Int J Urol 2023; 30:1020-1027. [PMID: 37496371 DOI: 10.1111/iju.15251] [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: 12/16/2022] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES This study aimed to investigate the characteristics of patients who report improvement in quality of life (QOL) related to urinary status after undergoing robot-assisted radical prostatectomy (RARP) for localized prostate cancer. METHODS We retrospectively reviewed the patients who underwent RARP between May 2010 and May 2021 at our institution and were preoperatively unsatisfied with their urinary status. Patients were grouped as Group 1 (improved patients: "satisfied" with urinary status based on international prostate symptom score QOL [IPSS-QOL] = 0-2 at 12 months after RARP) and Group 2 (unimproved group: "unsatisfied"-IPSS-QOL 3-6). Additionally, the Expanded Prostate Cancer Index Composite (EPIC) urinary subdomains (urinary function, urinary bother [UB], urinary incontinence, and urinary irritation/obstruction [UIR]) and IPSS were evaluated preoperatively and till 12 months after RARP. RESULTS Of the 237 patients, 72 (30.4%) were Group 1, and 165 (69.6%) were Group 2. Only UB and UIR improved at 12 months after RARP in Group 1, while other EPIC urinary subdomains remained unimproved at 12 months in both groups. On the other hand, IPSS improved at 12 months in both groups. Univariate and multivariate analysis revealed that the nerve-sparing, preoperative low IPSS (<11 vs. ≥11), and low IPSS-QOL (3 vs. 4-6) were associated with improvement in urinary status-related QOL (p < 0.05). CONCLUSIONS Improvement in UB and UIR are important factors to ascertain improvement in urinary status-related QOL after RARP. Nerve-sparing and preoperative IPSS/IPSS-QOL values are useful predictors of this improvement.
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Affiliation(s)
- Yuki Kohada
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryo Tasaka
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Akihiro Asami
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kosuke Akiyama
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yuki Sakamoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Fumiaki Kirishima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kohei Saito
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Takafumi Fukushima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenshiro Takemoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Takashi Babasaki
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kohei Kobatake
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenichiro Ikeda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Kadono Y. Editorial Comment to Retrospective evaluation of the improvement in the urinary status-related quality of life after robot-assisted radical prostatectomy. Int J Urol 2023; 30:1027-1028. [PMID: 37563915 DOI: 10.1111/iju.15271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Yoshifumi Kadono
- Department of Nephrology and Urology, Japanese Red Cross Fukui Hospital, Fukui, Japan
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Nakai Y, Tanaka N, Inoue T, Onishi K, Morizawa Y, Hori S, Gotoh D, Miyake M, Torimoto K, Fujimoto K. Quality of life after non-nerve-sparing, robot-assisted radical prostatectomy. Asia Pac J Clin Oncol 2023. [PMID: 37850378 DOI: 10.1111/ajco.14031] [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: 06/16/2023] [Revised: 09/21/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To evaluate quality of life (QOL) after non-nerve-sparing, robot-assisted radical prostatectomy (RARP) and factors associated with worsened QOL. METHODS Patients who underwent non-nerve-sparing RARP (n = 115) were enrolled. The Expanded Prostate Cancer Index Composite and 8-item Short Form Health Survey were used to evaluate QOL at baseline and postoperative 1, 3, 6, 12, and 24 months. Preoperative factors were evaluated by multivariate analysis for worsened QOL. RESULTS Postoperative 24-month urinary QOL worsened in 68 of 115 (59%) patients. In multivariate analysis, membranous urethral length ≥10.8 mm [odds ratio (OR): .26, 95% confidence interval (CI): .07-.96] and intravesical prostatic protrusion ≥12 mm (OR: .14, 95% CI .06-.35) were significantly associated with maintaining postoperative 24-month urinary QOL. Significantly more patients with intravesical prostatic protrusion ≥12 mm than < 12 mm had improved urinary QOL. At postoperative 24 months, 43 of 115 (38%) patients had worsened sexual QOL. In multivariate analysis, higher Sexual Health Inventory for Men score (OR: 8.39, 95% CI 2.28-30.9), sexual activity (OR: 6.94, 95% CI: 2.27-21.2), and intercourse activity (OR: 6.81, 95% CI: 1.64-28.3) preoperatively were significantly associated with worsened postoperative 24-month sexual QOL. More patients with high preoperative intercourse activity (12/23,53%) had significantly worsened (p = .009) QOL regarding sexual bother than those who had no preoperative intercourse activity (21/92, 23%). CONCLUSION After non-nerve-sparing RARP, patients with long membranous urethral length and/or intravesical prostatic protrusion maintain urinary QOL. Patients with high intercourse activity presented with impairment of sexual QOL after non-nerve-sparing RARP.
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Affiliation(s)
- Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Kashihara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Japan
| | - Takeshi Inoue
- Department of Urology, Nara Prefecture General Medical Center, Nara, Japan
| | - Kenta Onishi
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Japan
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9
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Gao Y, Yang Y, Li X, Wang T, Cheng Q, Jia Z, Niu SX, Zhang XY, Wang BJ, Zhang X. Vesicoprostatic muscle reconstruction: a step further for immediate and early urinary continence. World J Urol 2023:10.1007/s00345-023-04398-9. [PMID: 37093318 DOI: 10.1007/s00345-023-04398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVES The vesicoprostatic muscle (VPM) is a longitudinal smooth muscle that originates from the trigone of the bladder or the opening of the ureter and is involved in urination as part of the detrusor apron. We explored the effect of VPM reconstruction on immediate and early recovery of urinary continence in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP). PATIENTS AND METHODS A total of 523 patients with localized prostate cancer were enrolled from June 2018 to June 2020. All patients were diagnosed in our department based on magnetic resonance imaging and pathological findings on prostate biopsy. After 1:1 propensity score matching, 105 patient pairs were matched. The study was approved by our institutional review board and all surgeries were performed by three experienced high-volume surgeons. Demographic data, total operation time, pathological outcomes, the urinary continence rates of the two groups at different times after RALP, and factors influencing postoperative urinary continence after RALP were recorded. Student's t test was used to compare continuous variables and the Pearson χ2 test to compare categorical variables. Logistic regression analysis was used to identify factors affecting immediate and early postoperative urinary control. RESULTS VPM reconstruction promoted immediate and early recovery of urinary continence (immediate continence, 66.67 vs. 40.00%, P = 0.000; 3-month continence, 80.95 vs. 64.76%, P = 0.008). CONCLUSIONS VPM reconstruction improved immediate and early urinary continence in patients who underwent RALP.
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Affiliation(s)
- Yu Gao
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yang Yang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, People's Republic of China
| | - Tao Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
- Medical School of Chinese PLA, Beijing, People's Republic of China
| | - Qiang Cheng
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhuo Jia
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Shao-Xi Niu
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiang-Yi Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Bao-Jun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Urology, PLA Military General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA General Hospital, Beijing, People's Republic of China.
- Department of Urology, PLA Military General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
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10
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Jivanji D, Kaplan-Marans E, West M, Silver D, Silver M, Schulman A. Can men 75 and older safely receive a minimally invasive radical prostatectomy? J Robot Surg 2023:10.1007/s11701-023-01583-1. [PMID: 36952132 DOI: 10.1007/s11701-023-01583-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/18/2023] [Indexed: 03/24/2023]
Abstract
Men 75 and older presenting with localized prostate cancer have traditionally not been managed with surgery. Therefore, we compared the morbidity and operative outcomes of radical prostatectomy (RP) in men 75 and older to their younger counterparts. We utilized the American College of Surgeons National Surgical Quality Improvement Program database to gather subjects who received a minimally invasive RP (CPT: 55866) from 2016 to 2020. This cohort was then stratified by age to compare men 18-74 years old and men 75 and older. The preclinical profile, complications, and outcomes were analyzed. Chi-square and Mann-Whitney U test were used to analyze categorical and continuous variables, respectively. Of the 48,485 men identified, 2,009 (4.1%) were ≥ 75 years old. Within the 75 and older cohort, the median age was 76 (IQR: 75-78), the median BMI was 27.3 (IQR: 24.9-29.9), and 1,601 (79.7%) were Caucasian. Men 75 and older had higher rates of Clavien 3 (1.3% vs. 0.8%, p = 0.02) and Clavien 4 (7.8% vs. 5.0%, p < 0.001) complications. Reoperative rates (1.7% vs. 1.1%, p = 0.01), readmission rates (6.5% vs. 4.1%, p < 0.001), and mortality (0.4% vs. 0.1%, p < 0.001) were all higher in men 75 and older. Multivariate analysis shows older age to be a risk factor for readmission (OR 1.58, 95%CI 1.31-1.90). Complications and 30-day outcomes remain within an acceptable range to offer surgery in men 75 and older. Age alone should not disqualify men from receiving a RP, but appropriate patient selection and counseling are necessary.
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Affiliation(s)
- Dhaval Jivanji
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.
| | - Elie Kaplan-Marans
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Michael West
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - David Silver
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
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Cooper CA, Sloan MJ, Singh A, Fantus RJ, Raheem OA. A Historical and Contemporary Review of Questionnaires Used in the Management of Post-Radical Prostatectomy Patients. Sex Med Rev 2022; 10:681-690. [PMID: 37051967 DOI: 10.1016/j.sxmr.2022.04.003] [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: 03/15/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Patients undergoing radical prostatectomy (RP) face obstacles to recovery spanning the domains of erectile and sexual function; urinary function; and health-related quality of life (HRQoL). Numerous patient-directed questionnaires exist that serve to assist in the care of these men. AIM To describe patient-directed questionnaires of historical and contemporary relevance involving the evaluation and treatment of men after radical prostatectomy. METHODS A comprehensive review of peer-reviewed publications on the topic was performed. Using PubMed, the search terms used were: "radical prostatectomy; erectile function; lower urinary tract symptoms; sexual dysfunction; urinary incontinence; and health-related quality of life. MAIN OUTCOME MEASURE We aimed to summarize questionnaires and survey devices of historical and contemporary importance for the care of men after RP. RESULTS Many questionnaires have been developed specifically for, or conscripted for use in, the care of men after RP. Some of the oldest questionnaires relating to sexual function, urinary function, and general and cancer-specific QoL are important and still utilized in the routine clinical care of post-RP patients. However, recent devices that may offer clinicians a more comprehensive understanding to aid in the evaluation and care of these men. CONCLUSIONS Post-RP patients face numerous challenges that require a thoughtful approach, one that is broad enough to identify a variety of potential physical and emotional disturbances, yet granular enough to identify appropriate areas for intervention. While there is not a "best" questionnaire for this population, having an appropriate understanding of the current available instruments and what information they provide may help clinicians more thoroughly assess and treat these men. Castillo O, Chen IK, Amini E, et al. Male Sexual Health Related Complications Among Combat Veterans. Sex Med Rev 2022;XX:XXX-XXX.
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Affiliation(s)
- Caleb A Cooper
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Matthew J Sloan
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Richard J Fantus
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA; Section of Urology, Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Omer A Raheem
- Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
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Karagiotis T, Witt JH, Jankowski T, Mendrek M, Wagner C, Schuette A, Liakos N, Rachubinski P, Urbanova K, Oelke M, Kachanov M, Leyh-Bannurah SR. Two-year quality of life after robot-assisted radical prostatectomy according to pentafecta criteria and cancer of the prostate risk assessment (CAPRA-S). Sci Rep 2022; 12:244. [PMID: 34997130 PMCID: PMC8742105 DOI: 10.1038/s41598-021-04289-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/13/2021] [Indexed: 01/25/2023] Open
Abstract
The quality of life (QoL) of men with optimal outcomes after robot-assisted radical prostatectomy (RARP) is largely unexplored. Thus we assessed meaningful changes of QoL measured with the EORTC QLQ-C30 24 months after RARP according to postsurgical Cancer of the Prostate Risk Assessment score (CAPRA-S) and pentafecta criteria. 2871 prostate cancer (PCa) patients with completed EORTC QLQ-C30 were stratified according to CAPRA-S, pentafecta (erectile function recovery, urinary continence recovery, biochemical-recurrence-free survival (BFS), negative surgical margins) and 90-day Clavien–Dindo-complications (CDC) ≤ 3a. Multivariable logistic regression analyses (LRM) aimed to predict improvement of EORTC QoL. Mean preoperative QoL values did not significantly differ between CAPRA-S low- (LR) vs. high-risk (HR, 75.7 vs. 75.2; p = 0.7) and pentafecta vs. non-pentafecta groups (75.6 vs. 75.2; p = 0.6). After RARP, stable QoL rates for CAPRA-S LR vs. HR and pentafecta were 30, 26 and 30%, respectively. Corresponding improved QoL rates were 44, 32 and 47%. In LRM, CAPRA-S and pentafecta criteria were independent predictors of improved QoL. We conclude that most favourable combined outcomes after RARP might confer stable or even improved QoL but up to one third of patients might experience deterioration. This warrants further investigation how to capture the underlying cause and to address and potentially solve these perceived negative effects despite successful RARP.
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Affiliation(s)
- Theodoros Karagiotis
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Jorn H Witt
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany.
| | - Thomas Jankowski
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Mikolaj Mendrek
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Andreas Schuette
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Pawel Rachubinski
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Katarina Urbanova
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Matthias Oelke
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
| | - Mykyta Kachanov
- Martini-Klinik Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Urooncology, St. Antonius-Hospital, Gronau, Germany
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