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Latest Evidence on Post-Prostatectomy Urinary Incontinence. J Clin Med 2023; 12:jcm12031190. [PMID: 36769855 PMCID: PMC9917389 DOI: 10.3390/jcm12031190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
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d’Altilia N, Mancini V, Falagario UG, Martino L, Di Nauta M, Calò B, Del Giudice F, Basran S, Chung BI, Porreca A, Bianchi L, Schiavina R, Brunocilla E, Busetto GM, Bettocchi C, Annese P, Cormio L, Carrieri G. A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques. Cancers (Basel) 2022; 14:cancers14184350. [PMID: 36139511 PMCID: PMC9496957 DOI: 10.3390/cancers14184350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence “without pads” or “social continence” based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.
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Affiliation(s)
- Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Ugo Giovanni Falagario
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Leonardo Martino
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Michele Di Nauta
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Beppe Calò
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
| | | | - Satvir Basran
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Benjamin I. Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 37138 Padua, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, 40126 Bologna, Italy
| | | | | | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-0881-733856
| | - Carlo Bettocchi
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy
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Ouanes Y, Hermi A, Chaker K, Bibi M, Mrad Daly K, Nouira Y. Impact of Urinary Incontinence on the Quality of Life After Open Retropubic Radical Prostatectomy. Cureus 2022; 14:e28106. [PMID: 36127995 PMCID: PMC9480611 DOI: 10.7759/cureus.28106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Radical retropubic prostatectomy is one of the standard treatments for localized prostate cancer. Evaluating the severity of postoperative urinary incontinence is primordial to guiding the treatment choice, and it still lacks standardization, hence the value of assessing the quality of life. Methods We conducted a retrospective study between January 2014 and December 2018 in the Urology Department of La Rabta Hospital, involving 30 patients followed for localized prostate cancer treated with radical prostatectomy for at least one year. Our work aimed to study urinary incontinence after radical retropubic prostatectomy and to evaluate the quality of life of patients who underwent surgery for localized prostate cancer by three validated questionnaires: The International Prostate Symptom Score (IPSS), The International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and the International Continence Society (ICS) scores. Results The preoperative IPSS score ranged from 5-22, averaging 11.13. After the surgery, it ranged between four and 23, with an average of 14.13. This increase was significant, with p = 0.001. The average preoperative ICIQ-SF score was 10.03, and the mean postoperative score was 14.23. The first question dealing with the frequency of episodes of urinary leakage has not demonstrated variation after surgery. In the second question, which deals with the amount of urine loss, we found a significant increase in this parameter with p=0.003. In the third question inherent to perceived discomfort, operated patients reported significant deterioration with p <0.001. We observed an increase in patients with urinary stress incontinence and enuresis on the ICS score after radical retropubic prostatectomy. Wearing protection or padding was required in 23.3% of patients. Conclusion IPSS, ICIQ-SF, and ICS scores are helpful to perform before and after radical retropubic prostatectomy. It helps to study urinary incontinence better, propose to each patient with postoperative complications the appropriate treatment option, and improve the quality of the urinary status.
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Amano K, Suzuki K. Self‐management
of lower urinary tract symptoms in
post‐prostatectomy
cancer patients: Content analysis. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2022. [DOI: 10.1111/ijun.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Koji Amano
- Doctoral Program, Graduate School of Nursing Osaka Medical and Pharmaceutical University Osaka Japan
- Faculty of Nursing Doshisha Women's College of Liberal Arts Kyoto Japan
| | - Kumi Suzuki
- Faculty of Nursing Osaka Medical and Pharmaceutical University Osaka Japan
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Changes in quality of life and lower urinary tract symptoms over time in cancer patients after a total prostatectomy: systematic review and meta-analysis. Support Care Cancer 2021; 30:2959-2970. [PMID: 34642791 DOI: 10.1007/s00520-021-06595-x] [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: 02/23/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to clarify associations between and changes over time in lower urinary tract symptoms (LUTS) and quality of life (QOL) in cancer patients after a total prostatectomy. METHODS The subjects were cancer patients who had undergone total prostatectomy and had participated in non-randomized controlled trials, cohort studies, or case-control studies with outcomes of changes over time in LUTS or QOL. Fourteen studies were included for systematic review and meta-analysis. RESULTS Compared to preoperatively, the International Prostate Symptom Score (IPSS)-a LUTS indicator-yielded the following, 3 months after operation (MD [95% confidence interval, CI] = -0.27 [-2.22 to 1.68], p = .7855), 6 months after operation (MD [95% CI] = -2.12 [-3.04 to -1.20], p < .0001), and 12 months after operation (MD [95% CI] = -2.27 [-2.63 to -1.92], p < .0001), demonstrating significant decrease and, therefore, improvement of symptoms after 6 months. International Prostate Symptom Score-Quality of Life (IPSS-QOL), a QOL indicator, was significantly reduced at 12 months after surgery, indicating improved QOL (MD [95% CI] = -0.49 [-0.87 to -0.11], p = .0107), but there was heterogeneity between different studies (I2 = 89.19%). A cumulative meta-analysis showed a tendency for greater improvements in IPSS-QOL at 12 months after surgery, the older the mean age and the higher the mean pre-surgery IPSS. Factors of age, prostate volume, and pre-surgery IPSS were related to postoperative LUTS; exacerbation of both urinary incontinence and urinary tract obstruction was related to QOL. CONCLUSION While LUTS improves over time after total prostatectomy, it takes 6 to 12 months after surgery. As there is an association between LUTS and QOL, support to promote self-management of LUTS is important.
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Lardas M, Grivas N, Debray TPA, Zattoni F, Berridge C, Cumberbatch M, Van den Broeck T, Briers E, De Santis M, Farolfi A, Fossati N, Gandaglia G, Gillessen S, O'Hanlon S, Henry A, Liew M, Mason M, Moris L, Oprea-Lager D, Ploussard G, Rouviere O, Schoots IG, van der Kwast T, van der Poel H, Wiegel T, Willemse PP, Yuan CY, Grummet JP, Tilki D, van den Bergh RCN, Lam TB, Cornford P, Mottet N. Patient- and Tumour-related Prognostic Factors for Urinary Incontinence After Radical Prostatectomy for Nonmetastatic Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2021; 8:674-689. [PMID: 33967010 DOI: 10.1016/j.euf.2021.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/23/2021] [Indexed: 12/22/2022]
Abstract
CONTEXT While urinary incontinence (UI) commonly occurs after radical prostatectomy (RP), it is unclear what factors increase the risk of UI development. OBJECTIVE To perform a systematic review of patient- and tumour-related prognostic factors for post-RP UI. The primary outcome was UI within 3 mo after RP. Secondary outcomes included UI at 3-12 mo and ≥12 mo after RP. EVIDENCE ACQUISITION Databases including Medline, EMBASE, and CENTRAL were searched between January 1990 and May 2020. All studies reporting patient- and tumour-related prognostic factors in univariable or multivariable analyses were included. Surgical factors were excluded. Risk of bias (RoB) and confounding assessments were performed using the Quality In Prognosis Studies (QUIPS) tool. Random-effects meta-analyses were performed for all prognostic factor, where possible. EVIDENCE SYNTHESIS A total of 119 studies (5 randomised controlled trials, 24 prospective, 88 retrospective, and 2 case-control studies) with 131 379 patients were included. RoB was high for study participation and confounding; moderate to high for statistical analysis, study attrition, and prognostic factor measurement; and low for outcome measurements. Significant prognostic factors for postoperative UI within 3 mo after RP were age (odds ratio [OR] per yearly increase 1.04, 95% confidence interval [CI] 1.03-1.05), membranous urethral length (MUL; OR per 1-mm increase 0.81, 95% CI 0.74-0.88), prostate volume (PV; OR per 1-ml increase 1.005, 95% CI 1.000-1.011), and Charlson comorbidity index (CCI; OR 1.28, 95% CI 1.09-1.50). CONCLUSIONS Increasing age, shorter MUL, greater PV, and higher CCI are independent prognostic factors for UI within 3 mo after RP, with all except CCI remaining prognostic at 3-12 mo. PATIENT SUMMARY We reviewed the literature to identify patient and disease factors associated with urinary incontinence after surgery for prostate cancer. We found increasing age, larger prostate volume, shorter length of a section of the urethra (membranous urethra), and lower fitness were associated with worse urinary incontinence for the first 3 mo after surgery, with all except lower fitness remaining predictive at 3-12 mo.
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Affiliation(s)
- Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece.
| | - Nikos Grivas
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fabio Zattoni
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | | | | | | | - Maria De Santis
- Department of Urology, Charité Universitätsmedizin Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Andrea Farolfi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Nicola Fossati
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
| | - Ann Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Matthew Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - Malcolm Mason
- Division of Cancer & Genetics, Cardiff University School of Medicine, Velindre Cancer Centre, Cardiff, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | | | - Olivier Rouviere
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul Willemse
- Department of Oncological Urology, University Medical Center, Utrecht Cancer Center, Utrecht, The Netherlands
| | - Cathy Y Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thomas B Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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Tienza A, Robles JE, Hevia M, Algarra R, Diez-Caballero F, Pascual JI. Prevalence analysis of urinary incontinence after radical prostatectomy and influential preoperative factors in a single institution. Aging Male 2018; 21:24-30. [PMID: 28857655 DOI: 10.1080/13685538.2017.1369944] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
AIMS To assess prevalence of urinary incontinence (UI) after radical prostatectomy (RP) and to analyze which preoperative characteristics of the patients have influence on UI. METHODS Between 2002 and 2012, 746 consecutive patients underwent RP for clinically localized prostate cancer. We defined UI according to International Continence Society (ICS) definition: "the complaint of any involuntary leakage of urine" after 12 months of recovery, international consultation on incontinence questionnaire (ICIQ-SF) and pads/day was collected too. Clinical features and magnetic resonance imaging measurements were assessed. A multivariable logistic regression model predicting incontinence were built-in after adjust by cofounding factors and bootstrapping. RESULTS About 172 (23%) of the patients were classified as incontinent according to the ICS definition. The mean value of the ICIQ-SF was 10.87 (±4). 17.8% of patients use at least one pad/day, 11.9% use more than one pad/day. The preoperative factors independently influential in UI are: age [OR: 1.055; CI 95% (1.006-1.107), p = .028], urethral wall thickness [OR: 5.03; CI 95% (1.11-22.8), p = .036], history of transurethral resection of the prostate [OR: 6.13; CI 95% (1.86-20.18), p = .003] and membranous urethral length [OR: 0.173; CI 95% (0.046-0.64), p = .009]. The predictive accuracy of the model is 78.7% and the area under the curve (AUC) value 71.7%. CONCLUSIONS Urinary incontinence after radical prostatectomy has different prevalence depending on the definition. Age, prior transurethral resection of the prostate (TURP), membranous urethral length (MUL) and urethral wall thickness (UWT) were risk factors.
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Affiliation(s)
- Antonio Tienza
- a Department of Urology , Clinica Universidad de Navarra , Pamplona , Spain
| | - Jose E Robles
- a Department of Urology , Clinica Universidad de Navarra , Pamplona , Spain
| | - Mateo Hevia
- a Department of Urology , Clinica Universidad de Navarra , Pamplona , Spain
| | - Ruben Algarra
- a Department of Urology , Clinica Universidad de Navarra , Pamplona , Spain
| | | | - Juan I Pascual
- a Department of Urology , Clinica Universidad de Navarra , Pamplona , Spain
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Abuodeh YA, Naghavi AO, Juan TH, Ma Z, Wilder RB. Quality of Life after post-prostatectomy intensity modulated radiation therapy to the prostate bed with or without the use of gold fiducial markers for image guidance or higher total radiotherapy doses. Int Braz J Urol 2017; 43:628-637. [PMID: 28379660 PMCID: PMC5557437 DOI: 10.1590/s1677-5538.ibju.2016.0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate quality of life (QoL) after post-prostatectomy intensity modulated radiation therapy (IMRT) in the “adjuvant” setting starting within 4 months of radical prostatectomy for adverse features; and “salvage” setting for a PSA≥0.2ng/mL. Materials and Methods Retrospective review of 130 patients who underwent IMRT to the prostate bed±gold fiducial marker placement for image guidance to 64.8-72.0Gy (median, 70.2Gy) between 2004 and 2013. Higher doses were defined as 70.2-72.0Gy and lower doses were defined as 64.8-68.4Gy. Androgen deprivation therapy (ADT) was given to 4/48 (8%) adjuvant patients and 9/82 (11%) salvage patients. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and Expanded Prostate Cancer Index Composite-26-bowel (EPIC-26-bowel) questionnaires were used to assess urinary, sexual, and bowel QoL, respectively. Results Median follow-up was 46 months. There were better urinary (p=0.03) and sexual (p=0.002) QoL scores with adjuvant IMRT relative to salvage IMRT. The use of prostate bed fiducial markers did not significantly affect urinary, sexual, or bowel QoL (p=0.39, p=0.49, and p=0.40, respectively). Higher total radiotherapy doses did not significantly affect urinary, sexual, or bowel QoL (p=0.21, p=0.61, and p=0.36, respectively). Conclusions There was no significant change in urinary, sexual, and bowel sexual QoL with post-prostatectomy IMRT regardless of whether prostate bed fiducial markers or higher total radiotherapy doses were used. QoL with IMRT in the present study compares favorably with prior reports for three-dimensional conformal radiation therapy.
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Affiliation(s)
- Yazan A Abuodeh
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Tzu-Hua Juan
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Zhenjun Ma
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Seo HJ, Lee NR, Son SK, Kim DK, Rha KH, Lee SH. Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis. Yonsei Med J 2016; 57:1165-77. [PMID: 27401648 PMCID: PMC4960383 DOI: 10.3349/ymj.2016.57.5.1165] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/08/2016] [Accepted: 07/08/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. MATERIALS AND METHODS Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. RESULTS A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. CONCLUSION RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP.
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Affiliation(s)
- Hyun Ju Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Na Rae Lee
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea
| | - Soo Kyung Son
- Department of Health Technology Assessment, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University, Seoul, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Seon Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea.
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Zachovajevienė B, Šiupšinskas L, Zachovajevas P, Milonas D. Dynamics of pelvic floor muscle functional parameters and their correlations with urinary incontinence in men after radical prostatectomy. Neurourol Urodyn 2015; 36:126-131. [DOI: 10.1002/nau.22887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 09/01/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Brigita Zachovajevienė
- Institute of Sports; Medical Academy; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Laimonas Šiupšinskas
- Institute of Sports; Medical Academy; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Pavelas Zachovajevas
- Department of Rehabilitation and Applied Biology; Lithuanian Sport University; Kaunas Lithuania
| | - Daimantas Milonas
- Clinical Department of Urology; Medical Academy; Lithuanian University of Health Sciences; Kaunas Lithuania
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Haga N, Ogawa S, Yabe M, Akaihata H, Hata J, Sato Y, Ishibashi K, Hasegawa O, Kikuchi K, Shishido F, Kojima Y. Factors Contributing to Early Recovery of Urinary Continence Analyzed by Pre- and Postoperative Pelvic Anatomical Features at Robot-Assisted Laparoscopic Radical Prostatectomy. J Endourol 2015; 29:683-90. [DOI: 10.1089/end.2014.0708] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Soichiro Ogawa
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Michihiro Yabe
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hidenori Akaihata
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Junya Hata
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuichi Sato
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kei Ishibashi
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Osamu Hasegawa
- Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ken Kikuchi
- Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fumio Shishido
- Department of Radiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshiyuki Kojima
- Department of Urology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Dumoulin C, Alewijnse D, Bo K, Hagen S, Stark D, Van Kampen M, Herbert J, Hay-Smith J, Frawley H, McClurg D, Dean S. Pelvic-Floor-Muscle Training Adherence: Tools, Measurements and Strategies-2011 ICS State-of-the-Science Seminar Research Paper II of IV. Neurourol Urodyn 2015; 34:615-21. [PMID: 25998493 DOI: 10.1002/nau.22794] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/17/2015] [Indexed: 11/05/2022]
Abstract
AIMS This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. METHOD Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. RESULTS The literature was scarce for most of the studied populations except for limited research on women with UI. OUTCOME MEASURES Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. STRATEGIES Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. CONCLUSION The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations.
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Affiliation(s)
- Chantal Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Canada.,Urogynacological Health and Aging Chair, Research Centre of the Institut Universitaire de Geriatrie de Montreal, Montreal, Canada
| | - Dianne Alewijnse
- Patient Education, PR and Marketing, Gelre Hospitals, Apeldoorn and Zutphen, The Netherlands
| | - Kari Bo
- Departement of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Suzanne Hagen
- Health Services Research, Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Diane Stark
- Functional Bowel Service, Clinic 2 Balmoral Building, Leicester Royal infirmary, Leicester, United Kingdom
| | - Marijke Van Kampen
- Faculty of Kinesiology and Rehabilitation Sciences, K.U. Leuven, Leuven, Belgium
| | | | - Jean Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand.,Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Helena Frawley
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Research, Cabrini Health, Melbourne, Australia
| | - Doreen McClurg
- Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Sarah Dean
- Psychology Applied to Health, University of Exeter Medical School, Exeter, United Kingdom
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Li HC, Chen KM, Lin YH, Chen TB. Lower urinary tract symptoms of prostate cancer patients undergoing treatments over eight-month follow-up. J Clin Nurs 2015; 24:2239-46. [PMID: 25950902 DOI: 10.1111/jocn.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To examine the changes in lower urinary tract symptoms after open radical prostatectomy, laparoscopic radical prostatectomy and brachytherapy and to determine which treatment resulted in improved lower urinary tract symptoms at 8 months follow-up. BACKGROUND Lower urinary tract symptoms are a primary side effect after prostate cancer treatment. DESIGN A time-series survey design with descriptive and comparative elements. METHODS A sample of 51 prostate cancer patients was recruited: open radical prostatectomy = 20, laparoscopic radical prostatectomy = 23 and brachytherapy = 8. Data were collected at six time points: before treatment/baseline, 1 week post-treatment, 1 month post-treatment, 2 month post-treatment, 3 month post-treatment and 8 months post-treatment. The lower urinary tract symptoms were assessed using the International Prostate Symptom Score, with a higher score indicating a worse condition. One-way anova was used to predict the progress of urinary symptoms after treatments. Bootstrap re-sampling was conducted to assess the stability of the outcomes. RESULTS Although there were no significant differences in the lower urinary tract symptoms among the three groups after treatments, the laparoscopic radical prostatectomy group had the lowest International Prostate Symptom Score score at baseline. Compared with the baseline symptoms for patients undergoing each treatment, there were significant improvements after 2 months in the open radical prostatectomy and brachytherapy groups, and after 3 months in the laparoscopic radical prostatectomy group. CONCLUSIONS The prostate cancer patients undergoing the three treatments have similar lower urinary tract symptoms over 8-month follow-up although different lower urinary tract symptoms were presented before treatments. RELEVANCE TO CLINICAL PRACTICE Results could be applied to educating and counselling prostate cancer patients regarding symptoms during recovery after surgery. It could also help patients better understand the outcomes related to the differing treatment methods.
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Affiliation(s)
- Hui-Chi Li
- Department of Nursing, I-Shou University, Taiwan.,College of Nursing, Kaohsiung Medical University, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Taiwan
| | - Yu-Hua Lin
- Department of Nursing, I-Shou University, Taiwan
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
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14
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Tholomier C, Bienz M, Hueber PA, Trinh QD, Hakim AE, Alhathal N, Lebeau T, Benayoun S, Valdivieso R, Liberman D, Saad F, Lattouf JB, Widmer H, Begin L, Latour M, Zorn KC. Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience. Can Urol Assoc J 2014; 8:195-201. [PMID: 25024790 DOI: 10.5489/cuaj.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada. METHODS Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative. RESULTS The median follow-up (Q1-Q3) was 18 months (9-36). The D'Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radio-therapy and/or hormonal therapy. CONCLUSIONS This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting.
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Affiliation(s)
- Côme Tholomier
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Marc Bienz
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Quoc Dien Trinh
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Assaad El Hakim
- Division of Robotic Urology, Department of Surgery, Hopital du Sacre Coeur de Montreal, Montreal, QC
| | - Naif Alhathal
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC; ; Division of Robotic Urology, Department of Surgery, Hopital du Sacre Coeur de Montreal, Montreal, QC
| | - Thierry Lebeau
- Division of Robotic Urology, Department of Surgery, Hopital du Sacre Coeur de Montreal, Montreal, QC
| | - Serge Benayoun
- Division of Robotic Urology, Department of Surgery, Hopital du Sacre Coeur de Montreal, Montreal, QC
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Dan Liberman
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Fred Saad
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Jean-Baptiste Lattouf
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Hugues Widmer
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Louis Begin
- Department of Pathology, Centre Hospitalier de l'Universite de Montreal, Montreal, QC
| | - Mathieu Latour
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
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15
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Chen RC, Chang P, Vetter RJ, Lukka H, Stokes WA, Sanda MG, Watkins-Bruner D, Reeve BB, Sandler HM. Recommended patient-reported core set of symptoms to measure in prostate cancer treatment trials. J Natl Cancer Inst 2014; 106:dju132. [PMID: 25006192 DOI: 10.1093/jnci/dju132] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The National Cancer Institute (NCI) Symptom Management and Health-Related Quality of Life Steering Committee convened four working groups to recommend core sets of patient-reported outcomes to be routinely incorporated in clinical trials. The Prostate Cancer Working Group included physicians, researchers, and a patient advocate. The group's process included 1) a systematic literature review to determine the prevalence and severity of symptoms, 2) a multistakeholder meeting sponsored by the NCI to review the evidence and build consensus, and 3) a postmeeting expert panel synthesis of findings to finalize recommendations. Five domains were recommended for localized prostate cancer: urinary incontinence, urinary obstruction and irritation, bowel-related symptoms, sexual dysfunction, and hormonal symptoms. Four domains were recommended for advanced prostate cancer: pain, fatigue, mental well-being, and physical well-being. Additional domains for consideration include decisional regret, satisfaction with care, and anxiety related to prostate cancer. These recommendations have been endorsed by the NCI for implementation.
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Affiliation(s)
- Ronald C Chen
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS).
| | - Peter Chang
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - Richard J Vetter
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - Himansu Lukka
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - William A Stokes
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - Martin G Sanda
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - Deborah Watkins-Bruner
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - Bryce B Reeve
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
| | - Howard M Sandler
- Affiliations of authors: Department of Radiation Oncology (RCC, WAS), and Department of Health Policy and Management, Gillings School of Global Public Health (BBR), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (RCC, WAS); Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (PC); Mayo Clinic, Rochester, MN (RJV); Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada (HL); Department of Urology (MGS), and Nell Hodgson Woodruff School of Nursing (DW-G), Emory University, Atlanta, GA; Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (HMS)
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Counseling the post-radical prostatectomy patients about functional recovery: high predictiveness of current status. Urology 2014; 84:158-63. [PMID: 24824411 DOI: 10.1016/j.urology.2014.02.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To develop prediction models to help counsel post-radical prostatectomy patients about functional recovery. METHODS The study included 2162 patients undergoing radical prostatectomy at a major cancer center, who reported urinary and erectile function at 1 year or at 2 years and at least 1 prior follow-up at 3, 6, 9, or 12 months. We created logistic regression models predicting function at one or 2 years on the basis of function at 3, 6, 9, and 12 months (2 years only), with the additional predictors of age, stage, grade, prostate-specific antigen levels, nerve-sparing status and baseline functional score. RESULTS No variable other than current functional score had a consistent statistically significant relationship with outcome. The area under the curves for predicting function at 2 years based on current function alone at 3, 6, 9, and 12 months were respectively 0.796, 0.831, 0.882, and 0.885 for erectile function and 0.789, 0.862, 0.869, and 0.876 for urinary function. Patients using 1 pad at 6 months had only a 50% probability of being pad free at 2 years; this dropped to 36% for patients using 2 pads. This suggests that there is an opportunity for early identification and possible referral of patients likely to have long-term urinary dysfunction. CONCLUSION Assessment of urinary and erectile function in the first postoperative year is strongly predictive of long-term outcome and can guide patient counseling and decisions about rehabilitative treatments.
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17
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Singla N, Singla AK. Post-prostatectomy incontinence: Etiology, evaluation, and management. Turk J Urol 2014; 40:1-8. [PMID: 26328137 PMCID: PMC4548645 DOI: 10.5152/tud.2014.222014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
Abstract
Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.
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Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Ajay K. Singla
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA
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18
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Al-Hathal N, El-Hakim A. Perioperative, oncological and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases. Can Urol Assoc J 2013; 7:326-32. [PMID: 24319511 DOI: 10.5489/cuaj.319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Robotic-assisted radical prostatectomy (RARP) is being increasingly done in Canada. Despite this, the Canadian literature lacks publications on the oncologic and functional outcomes of RARP. The objective of this study is to report the longest single surgeon experience in the province of Quebec. METHODS We collected prospective data from 250 consecutive patients who underwent RARP by a single fellowship trained surgeon (AEH) from October 2006 to October 2012. Mean follow-up was 28 months (range: 1-72). The D'Amico risk stratification distribution was 34% in low-risk, 48% in intermediate-risk and 18% in high-risk groups. RESULTS The mean operation time (±SD) was 194 ± 60.6 minutes, and estimated blood loss 318 ± 179 mL. The transfusion rate was only 0.4%. All procedures were completed robotically. The mean hospital stay was 1.2 days, and 88% of patients were discharged on postoperative day 1. The mean catheterization time was 7 days (range: 6-13). There were 2% major (Clavien III-IV) and 7.2% minor (Clavien I-II) postoperative complications, and no mortalities. On final pathology, 76% of patients were organ-confined and 70% specimen-confined. Pathological Gleason sum ≥7 accounted for 86%. Return of urinary continence (0-pads) at 3, 6, 12, and 24 months was 73.3%, 83.5%, 92.3%, 96.5%, respectively. Potency rate (successful penetration with or without medication) at 6, 12, and 24 months was 49.3%, 85%, and 95.3%, respectively. Operative time and positive surgical margin (PSM) in organ-con-fined disease (pT2) decreased significantly after 50 cases. Seventeen patients (6.8%) had no undetectable prostate-specific antigen (PSA) at first visit (PSA <0.1 ng/mL). Of remaining 233 patients, biochemical recurrence (PSA >0.2 ng/mL) was 4.7% (11 patients), and another 3.4% (8 patients) received early salvage radiotherapy (rising PSA, but <0.2 ng/mL). No patients with undetectable PSA required salvage treatments within 6 months postoperatively. CONCLUSIONS Our results compare favourably with high-volume RARP programs, despite mainly intermediate- to high-risk disease. Initial learning curve was estimated to be 50 cases. Fellowship training was instrumental in achieving adequate functional and oncological outcomes, while maintaining low complications rate.
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Affiliation(s)
- Naif Al-Hathal
- Hôpital du Sacré Cœur de Montréal, Montreal, Montreal, QC
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19
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Elliott CS, Comiter CV. Detrusor Underactivity in Men Following Radical Retropubic Prostatectomy - Prevalence, Importance and Evaluation. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Does the Presence of Preoperative LUTS Affect Urinary Outcomes after Radical Prostatectomy? CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Wallerstedt A, Carlsson S, Steineck G, Thorsteinsdottir T, Hugosson J, Stranne J, Wilderäng U, Haglind E, Wiklund NP. Patient and tumour-related factors for prediction of urinary incontinence after radical prostatectomy. Scand J Urol 2012; 47:272-81. [DOI: 10.3109/00365599.2012.733410] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wolski Z, Tworkiewicz M, Szabela-Polak A. Psychological aspect of qualification to implant an artificial urethral sphincter AMS 800. Cent European J Urol 2012; 65:21-3. [PMID: 24578917 PMCID: PMC3921758 DOI: 10.5173/ceju.2012.01.art6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/21/2011] [Accepted: 12/27/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Implantation of the AMS 800 artificial urethral sphincter is a "gold standard" in the treatment of total urinary incontinence in men. Appropriate qualification of patients to urinary incontinence treatment determines the higher effectiveness of this method. Service of this device requires physical fitness and mental efficiency from a patient. MATERIAL AND METHODS The Urological Clinic hospitalized 16 patients, aged from 60 to 80 years, after first qualification for artificial urethral sphincter implantation. Psychological assessment was carried out during anamnesis and medical examination using the MMSE and the GDS. RESULTS Psychological deviations were found in 7 out of 16 examined patients, but finally 2 patients were disqualified because of their cognitive function disorders with elements of low level depressive syndrome (1) and benign cognitive and member function disorders (1). Among the patients who were examined by a psychologist: four of them showed mild (3) and temperate (1) features of depressive syndrome and one patient showed benign cognitive disorder without dementia. However, none of these findings were contraindications to incontinence treatment with an artificial urethral sphincter. CONCLUSIONS 1. Mild and temperate features of depression syndrome are not absolute contraindications for a sphincter AMS 800 implantation. These patients need only pharmacological treatment. 2. Cognitive and other memory disorders are contraindications to this method. 3. The qualification to implantation an artificial urethral sphincter should include a psychological assessment, especially in older patients in whom mental disorders are suspected.
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Affiliation(s)
- Zbigniew Wolski
- Department of General, Oncological, and Pediatric Urology, The Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maciej Tworkiewicz
- Department of General, Oncological, and Pediatric Urology, The Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Anna Szabela-Polak
- Department of Geriatrics, The Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Post-Prostatectomy Voiding Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-011-0103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bladder neck preservation during classic laparoscopic radical prostatectomy - point of technique and preliminary results. Wideochir Inne Tech Maloinwazyjne 2011; 7:89-95. [PMID: 23256008 PMCID: PMC3516968 DOI: 10.5114/wiitm.2011.25981] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 11/07/2011] [Accepted: 11/16/2011] [Indexed: 11/17/2022] Open
Abstract
Introduction Stress urinary incontinence after radical prostatectomy for prostate cancer organ-confined patients can significantly affect quality of life. The article presents a technique of bladder neck preservation, because it is believed that this point is one of many crucial points responsible for fast recovery of continence after laparoscopic radical prostatectomy (LRP). Material and methods Laparoscopic radical prostatectomy with the intention of bladder neck preservation was performed in 194 patients of clinically organ-confined prostate cancer (cT2 ≤ N0M0). The working space was done by tissues-fingers dissections and insufflation of the cavity under full visual control, without the Gaur-balloon device. We insert two 10 mm trocars, three trocars of 5 mm and both 0° and 30° laparoscopes. The most important points of technique include: identification of landmarks of bladder neck and prostate base; dissection of muscle fibres of the very superficial bladder wall; mobilization of the posterior part of the urethra and simultaneous seminal vesicles release; neuro-vascular bundles preservation. This procedure resulted in a long bladder neck which can be easily anastomosed with the urethra. Tension-free and end-to-end (bladder neck-urethra) anastomosis are the results. Results In all cases radical prostatectomy was performed laparoscopically in the extraperitoneal space. There were no complications of bladder neck preservation during laparoscopic radical prostatectomy (LRP) apart from 22 cases with a large medium lobe. The mean time of operation was 150 min (110-210 min). The mean blood loss during LRP was 150 ml (110-350 ml). Blood transfusion was not necessary. There were no postoperative complications. Mean hospitalization time was 5 days. Pathological result of the postoperative specimens was pT2a in 30%, pT2b in 60%, pT3a in 6%, and pT3b in 4% of patients. In 7% of patients a positive surgical margin was affirmed, but the bladder neck was not affected in any case. Full continence after 3, 6, and 12 months was observed in 75%, 85%, and 92% of analysed patients, respectively. Conclusions Bladder neck preservation during LRP is an effective, safe procedure that offers good functional results based on fast recovery of continence. Bladder neck preservation offers full tight anastomosis, especially in cases with no large median lobe of prostatic adenoma. Continence of patients who underwent bladder neck preservation was improved during short-term follow-up. Long-term results are still not conclusive. We think that this technique applied to laparoscopy will finally result in real progress of continence preservation after radical prostatectomy, but larger groups of patients have to be compared.
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Post-prostatectomy incontinence: implications for home health clinicians. ACTA ACUST UNITED AC 2011; 28:542-8; quiz 549-50. [PMID: 20881798 DOI: 10.1097/nhh.0b013e3181f2f2ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prostate cancer is the most frequently diagnosed cancer in men in the United States, often requiring a prostatectomy. Incontinence is an almost inevitable consequence of this surgery, either temporary or ongoing. It is important that this quality-of-life issue be considered preoperatively and that patients considering surgery have information about the potential for incontinence. Teaching about noninvasive management of incontinence can begin before surgery and continue in the postoperative period. Home healthcare clinicians and Wound, Ostomy and Continence (WOC) nurses can play a pivotal role in educating patients on the potential sequela of surgery and ways to prevent or treat these conservatively.
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Herschorn S, Bruschini H, Comiter C, Grise P, Hanus T, Kirschner-Hermanns R, Abrams P. Surgical treatment of stress incontinence in men. Neurourol Urodyn 2010; 29:179-90. [DOI: 10.1002/nau.20844] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Van Kampen M, Geraerts I, De Weerdt W, Van Poppel H. An Easy Prediction of Urinary Incontinence Duration After Retropubic Radical Prostatectomy Based on Urine Loss the First Day After Catheter Withdrawal. J Urol 2009; 181:2641-6. [DOI: 10.1016/j.juro.2009.02.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Indexed: 11/29/2022]
Affiliation(s)
- M. Van Kampen
- Department of Rehabilitation Science (Faculty of Kinesiology and Rehabilitation Science), University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Physiotherapy, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - I. Geraerts
- Department of Rehabilitation Science (Faculty of Kinesiology and Rehabilitation Science), University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - W. De Weerdt
- Department of Rehabilitation Science (Faculty of Kinesiology and Rehabilitation Science), University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - H. Van Poppel
- Division of Urology, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
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Early Recovery of Urinary Continence After Radical Prostatectomy Using Early Pelvic Floor Electrical Stimulation and Biofeedback Associated Treatment. J Urol 2009; 181:1788-93. [DOI: 10.1016/j.juro.2008.11.104] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Indexed: 11/27/2022]
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