1
|
Kataoka M, Yokoyama M, Waseda Y, Ito M, Kobayashi M, Fujiwara M, Nakamura Y, Ishikawa Y, Fukuda S, Tanaka H, Yoshida S, Masuda H, Fujii Y. Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy. Low Urin Tract Symptoms 2024; 16:e12507. [PMID: 37984074 DOI: 10.1111/luts.12507] [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: 08/07/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non-irradiated patients. METHODS This retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non-RT group, respectively) who were treated with primary AUS implantation for post-radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model. RESULTS In the RT and non-RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow-up of 38 months, ICIQ-SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non-RT groups. In the RT group, ICIQ-SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non-RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ-SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non-RT group (p < .001, and .015, respectively). CONCLUSIONS Longitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.
Collapse
Affiliation(s)
- Madoka Kataoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yudai Ishikawa
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Masuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Casas-Nebra J, Blanco-Gomez B, Medina-González A, Formoso-Garcia I, Escaf-Barmadah S, Alvarez-Arenal A. Impact of a radical prostatectomy on the urodynamic results of prostate cancer patients treated with intensity modulated radiation therapy. Actas Urol Esp 2022; 46:431-441. [PMID: 35339398 DOI: 10.1016/j.acuroe.2022.03.003] [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: 05/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the effect of radical prostatectomy and age on urodynamics before and after intensity-modulated radiation therapy administered to prostate cancer patients. MATERIALS AND METHODS The sample consisted of 40 prostate cancer patients, 22 of whom had undergone a radical prostatectomy. Urodynamic parameters before and after an average of 4.2 months of radiotherapy were measured and compared. External radiotherapy was administered via Volumetric Modulated Arc Therapy (VMAT), Intensity Modulated Radiation Therapy (IMRT) techniques. RESULTS Uroflowmetry presented no significant parameters. In the case of Cystomanometry, the data did not show an increase in secondary stress urinary incontinence, although there is 7 percent increase in urge urinary incontinence. There were statistically significant changes in reduced bladder capacity with a strong desire to void, with an urge to void and also in the detrusor pressure with a normal desire to void. Furthermore, pressure/flow analysis revealed a statistically significant reduction of residual urine volume. CONCLUSIONS The effect of prostatectomy and age varies according to the evolution of urodynamics. There was a significant reduction in terms of residual urine volume and detrusor pressure with a normal desire to void in patients without a prostatectomy and in those under 75 years old. In addition to an increase in urge incontinence, there was also a significant worsening of the bladder filling urodynamics and a decrease in the cystomanometric bladder capacity with a strong desire and an urge to void. None of these were modified by age or prostatectomy.
Collapse
Affiliation(s)
- J Casas-Nebra
- Servicio de Urología, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - B Blanco-Gomez
- Servicio de Urología, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - A Medina-González
- Servicio de Urología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - I Formoso-Garcia
- Service de Oncología Radioterápica, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - S Escaf-Barmadah
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Cirugía y Especialidades Medicoquirúrgicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| | - A Alvarez-Arenal
- Departamento de Cirugía y Especialidades Medicoquirúrgicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
3
|
De Novo Detrusor Underactivity and Other Urodynamic Findings after Radical Prostatectomy: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58030381. [PMID: 35334557 PMCID: PMC8949898 DOI: 10.3390/medicina58030381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity investigated with the means of urodynamic evaluation. Materials and Methods: The review was performed in accordance with the PRISMA statement and was registered in the PROSPERO (ID#: CRD42020223480). The studied population was limited to men with prostate cancer who underwent urodynamic study prior to and after radical prostatectomy. Eight hundred twenty-seven studies were screened, with twenty-five finally included. A qualitative analysis was performed. Rates of detrusor underactivity (DU) before surgery were reported in eight studies and ranged from 1.6% to 75% (median of 40.8%). DU occurred de novo after RP in 9.1% to 37% of patients (median of 29.1%). On the other hand, preexisting DU resolved in 7% to 35.5% of affected men. Detrusor overactivity (DO) was the most frequently reported outcome, being assessed in 23 studies. The rate of DO preoperatively was from 5% to 76% (median of 25%). De novo was reported in 2.3–54.4% of patients (median of 15%) and resolved after RP in 19.6% to 87.5% (median of 33%) of affected patients. Baseline rates of bladder outlet obstruction (BOO) varied between studies from 19% to 59.3%, with a median of 27.8%. The most pronounced change after surgery was the resolution of BOO in 88% to 93.8% (median of 92%) of affected patients. Results: Rates of de novo impaired bladder compliance (IBC) varied from 3.2% to 41.3% (median of 13.3%), whereas the resolution of IBC was reported with rates ranging from 0% to 47% (median of 4.8%). Conclusions: BOO, DO, and DU are frequently diagnosed in men scheduled for RP. BOO is improved after RP in most patients; however, there is still a substantial rate of patients with de novo DU as well as DO which may impair functional outcomes and quality of life.
Collapse
|
4
|
Casas-Nebra J, Blanco-Gomez B, Medina-González A, Formoso-Garcia I, Escaf-Barmadah S, Alvarez-Arenal A. Impacto de la prostatectomía radical en los resultados urodinámicos de pacientes con cáncer de próstata tratados con radioterapia de intensidad modulada. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
5
|
Yao HH, Hoe V, Crump RT, Sengupta S, O'Connell HE, Carlson KV, Baverstock RJ. Impact of radical prostatectomy on bladder function as demonstrated on urodynamics study-A systematic review. Neurourol Urodyn 2021; 40:582-603. [PMID: 33476072 DOI: 10.1002/nau.24606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 01/13/2023]
Abstract
AIMS This study aims to describe the effects of radical prostatectomy (RP) on bladder function by performing a systematic review of urodynamics study findings before and after RP. METHODS This systematic review was conducted in accordance with the PRISMA guideline and registered on PROSPERO (CRD42020206844). A systematic search was conducted using PubMed, Cochrane, and Embase. Studies were included if they involved men who underwent RP and had urodynamics study performed preoperatively, postoperatively, or both. Studies that included only subgroups of patients based on symptoms were excluded. Three hundred and four articles were screened, with 20 articles included. A qualitative analysis was performed. RESULTS The rate of baseline bladder outlet obstruction (BOO) pre-RP was 19%-67%. All six studies with comparative data pre- and postoperatively demonstrated a decrease in the rate of patients with equivocal or clear obstruction. The baseline rates of detrusor overactivity (DO) varied widely from 11% to 61.2%. Six of eight studies with 6 months or more follow-up showed an improvement in the rates of DO ranging from 3.0% to 12.5%. The rate of de novo DO ranged from 0% to 54.5%. Four studies reported an increased rate of impaired bladder contractility and two of three studies showed a worsening rate of impaired bladder compliance following RP. This review is limited by the absence of level I/II studies. CONCLUSIONS Urodynamics study shows that BOO is improved following RP in most patients. RP resolves DO in some patients and cause de novo DO in others. The net effect is a reduced overall rate of DO in most studies. Bladder compliance and contractility may be impaired after RP.
Collapse
Affiliation(s)
- Henry H Yao
- Department of Urology, Western Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Vesia (Alberta Bladder Centre), Southern Alberta Institute of Urology, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Venetia Hoe
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Robert T Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Shomik Sengupta
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helen E O'Connell
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Kevin V Carlson
- Vesia (Alberta Bladder Centre), Southern Alberta Institute of Urology, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Richard J Baverstock
- Vesia (Alberta Bladder Centre), Southern Alberta Institute of Urology, Calgary, Alberta, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
6
|
Yokoyama M, Masuda H, Ito M, Waseda Y, Moriyama S, Toide M, Uchida Y, Uehara S, Kijima T, Yoshida S, Ishioka J, Matsuoka Y, Saito K, Fujii Y. Longitudinal changes in patient-reported outcomes after artificial urinary sphincter implantation. Low Urin Tract Symptoms 2020; 12:240-244. [PMID: 32281740 DOI: 10.1111/luts.12311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the time course of lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation based on individual longitudinal changes of patient-reported outcomes. METHODS This retrospective study included 66 male patients with severe urinary incontinence who were treated with primary AUS implantation between 2009 and 2019. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and International Prostate Symptom Score (IPSS) questionnaires were used to evaluate continence status and LUTS preoperatively, 1, 3, and 12 months after activation, and then annually. The annual changes in scores were calculated with a linear mixed model. RESULTS Of the 66 patients, 63 (95%) achieved complete or social continence (number of pads used ≤1/d) at 1 month after activation. Mean preoperative ICIQ-SF, IPSS, and IPSS-quality of life (QOL) score were 18.9, 14.9, and 5.4, respectively; the corresponding scores at 1 month after activation were 4.5, 9.0, and 1.7 (all P < .001), respectively. During the mean follow-up period of 36 months, the annual changes in the scores from 1 month after activation were 0.51 (P = .002), -0.30 (P = .184), and 0.19 (P < .001), respectively. As for individual IPSS items, while incomplete emptying, frequency, urgency, and weak stream improved significantly 1 month after activation, no significant changes from 1 month after activation were observed except for longitudinal deterioration of incomplete emptying score (0.08/y, P = .029). CONCLUSION Continence status and QOL score markedly improved by AUS implantation immediately, but deteriorated over time. Improved LUTS were maintained without a worsening trend, however.
Collapse
Affiliation(s)
- Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Masuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Urology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Urology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Shingo Moriyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Uchida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshiki Kijima
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
7
|
Effect of Radiation on Male Stress Urinary Incontinence and the Role of Urodynamic Assessment. Urology 2019; 125:58-63. [DOI: 10.1016/j.urology.2018.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 02/03/2023]
|
8
|
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
|