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Kadono Y, Nohara T, Kawaguchi S, Naito R, Kadomoto S, Iwamoto H, Yaegashi H, Shigehara K, Izumi K, Yoshida K, Gabata T, Mizokami A. Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI. Sci Rep 2023; 13:2902. [PMID: 36801949 PMCID: PMC9938893 DOI: 10.1038/s41598-023-30132-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/16/2023] [Indexed: 02/20/2023] Open
Abstract
Retzius-sparing robot-assisted radical prostatectomy (RARP) has been reported to exhibit better postoperative urinary continence, but the reasons behind this are unknown. This study included 254 cases who underwent RARP and underwent postoperative dynamic MRI. We measured the urine loss ratio (ULR) immediately after postoperative urethral catheter removal and investigated its affecting factors and the mechanisms. Nerve-sparing (NS) techniques was performed in 175 (69%) unilateral and 34 (13%) bilateral cases, whereas Retzius-sparing in 58 (23%) cases. The median ULR early after indwelling catheter removal in all patients was 4.0%. The multivariate analysis was performed on factors that reduce ULR and found that the following factors were associated with ULR: younger age, NS and Retzius-sparing, which were significant. Additionally, dynamic MRI findings showed that membranous urethral length and the anterior rectal wall movement toward the pubic bone during abdominal pressure were significant factors. The movement observed on the dynamic MRI during abdominal pressure was thought to reflect an effective urethral sphincter closure mechanism. Long membranous urethral length and an effective urethral sphincter closure mechanism during abdominal pressure were considered effective for favorable urinary continence after RARP. NS and Retzius-sparing were clearly shown to have an additive effect in preventing urinary incontinence.
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Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.
| | - Takahiro Nohara
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Shohei Kawaguchi
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Renato Naito
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Suguru Kadomoto
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Hiroaki Iwamoto
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Hiroshi Yaegashi
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Kazuyoshi Shigehara
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Kouji Izumi
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
| | - Kotaro Yoshida
- grid.9707.90000 0001 2308 3329Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Toshifumi Gabata
- grid.9707.90000 0001 2308 3329Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Atsushi Mizokami
- grid.9707.90000 0001 2308 3329Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640 Japan
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Latest Evidence on Post-Prostatectomy Urinary Incontinence. J Clin Med 2023; 12:jcm12031190. [PMID: 36769855 PMCID: PMC9917389 DOI: 10.3390/jcm12031190] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
A radical prostatectomy is frequently used as the first-line treatment for men with prostate cancer. Persistent urinary incontinence after surgery is one of the most severe adverse events. We report the results of a comprehensive literature search focused on post-prostatectomy urinary incontinence (PPI), performed by a panel of experts on non-neurogenic lower urinary tract symptoms. The data on the prevalence and timing of PPI are very heterogeneous. The etiology of PPI can be multifactorial and mainly dependent on patient characteristics, lower urinary tract function or surgical issues. The medical history with a physical examination, the use of validated questionnaires with a voiding diary and pad tests are determinants in identifying the contributing factors and choosing the right treatment. Lifestyle intervention and urinary containment are the most frequently used strategies for the conservative management of PPI, while antimuscarinics, beta-3 agonists and duloxetine (off-label) are drugs indicated to manage PPI with a concomitant overactive bladder. Surgical therapies for the management of post-prostatectomy SUI include non-adjustable trans-obturator slings in men with mild-to-moderate incontinence and an artificial urinary sphincter in men with moderate-to-severe incontinence.
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Tatenuma T, Makiyama K, Ito Y, Muraoka K, Hasumi H, Hayashi N, Kondo K, Nakaigawa N, Yao M. Correlation of urinary loss rate after catheter removal and long-term urinary continence after robot-assisted laparoscopic radical prostatectomy. Int J Urol 2021; 28:440-443. [PMID: 33508874 PMCID: PMC8049105 DOI: 10.1111/iju.14488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
Objectives To assess the correlation of urine loss rate after catheter removal with long‐term continence after robot‐assisted radical prostatectomy. Methods We enrolled 163 patients on whom robot‐assisted radical prostatectomy was carried out and whose urine loss rate we were able to evaluate after catheter removal. Urinary incontinence was evaluated from immediately after removal of the catheter to the date of discharge, and at 1, 3, 6 and 12 months after surgery. Urine loss rate was defined as the urine loss volume divided by the total urine volume. Results The continence rates of patients with ≤1% urine loss rate on the day of catheter removal were 100% at 6 and 12 months after surgery. A multivariate analysis proved that ≤10% urine loss rate on the day of catheter removal was a significant predictor of continence at 3 months after surgery. Furthermore, the continence rate at 12 months of patients who did not achieve ≤10% urine loss rate on the day of catheter removal was 79.5%. Among them, the continence rate at 12 months of patients who achieved ≥15% urine loss rate improvement from the day of catheter removal to the next day was 95.2%; the factor differed significantly between the continence and incontinence groups at 12 months after surgery. Conclusions The urine loss rate on the day of catheter removal is significantly related to the acquisition of urinary continence. Furthermore, our findings suggest that long‐term urinary continence can be expected, even in the event of poor urine loss rate on the day of catheter removal, if it improves on the next day.
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Affiliation(s)
- Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Yusuke Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kentaro Muraoka
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Narihiko Hayashi
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Keiichi Kondo
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Noboru Nakaigawa
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy. BMC Urol 2020; 20:29. [PMID: 32188426 PMCID: PMC7079466 DOI: 10.1186/s12894-020-00601-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long-term urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP. Methods This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from September 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1 to 48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages. Results No significant difference was detected in the CR from 12 to 48 months postoperatively (P = 0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence. Conclusions The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.
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Fujisaki A, Goto A, Endo F, Muraishi O, Hattori K, Yasumura S. Practical Index of Urinary Incontinence Following Holmium Laser Enucleation of the Prostate: A Case-Series Study of the 24-Hour Pad Test Immediately after Catheter Removal. Urol Int 2016; 97:310-319. [DOI: 10.1159/000449016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
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Matsushima M, Miyajima A, Hattori S, Takeda T, Mizuno R, Kikuchi E, Oya M. Comparison of continence outcomes of early catheter removal on postoperative day 2 and 4 after laparoscopic radical prostatectomy: a randomized controlled trial. BMC Urol 2015; 15:77. [PMID: 26227018 PMCID: PMC4520008 DOI: 10.1186/s12894-015-0065-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal timing of catheter removal following laparoscopic radical prostatectomy (LRP) has not yet been determined. This prospective study was designed to compare the efficacy and safety of catheter removal on postoperative day (POD) 2 versus POD 4 after LRP and its impact on urinary continence outcomes. METHODS One hundred and thirteen patients underwent LRP and were prospectively randomized into two groups: group 1 (n = 57) had the urinary catheter removed on POD 2 while group 2 (n = 56) had the catheter removed on POD 4. The urine loss ratio (ULR) was defined as the weight of urine loss in the pad divided by the daily micturition volume. Continence was defined as a pad-free status. RESULTS No significant differences were observed in clinical features between groups 1 and 2. Acute urinary retention (AUR) after catheter removal occurred in 21 patients (18.6%) (13 (22.8%) in group 1 and 8 (14.3%) in group 2 (p = 0.244). The first-day mean ULR values were 1.16 ± 4.95 in group 1 and 1.02 ± 3.27 in group 2 (p = 0.870). The last-day mean ULR values were 0.57 ± 1.60 in group 1 and 2.78 ± 15.49 in group 2 (p = 0.353). Continence rates at 3, 6, 9, and 12 months were 21.8, 41.1, 58.0, and 71.4% in group 1 and 34.5, 66.0, 79.2, and 83.7% in group 2 (p = 0.138, 0.009, 0.024, and 0.146, respectively). In AUR cases, continence rates at 3, 6, 9, and 12 months were 0, 23.1, 38.5, and 54.5% in group 1 and 37.5, 75.0, 87.5, and 87.5% in group 2 (p = 0.017, 0.020, 0.027, and 0.127, respectively). A multivariate analysis identified AUR after catheter removal on POD 2 as the only predictive factor for incontinence 6 and 9 months after LRP (p = 0.030 and 0.018, respectively). CONCLUSIONS Our results demonstrated that early catheter removal on POD 2 after LRP may increase the risk of incontinence. TRIAL REGISTRATION The study was registered as Clinical trial: (UMIN000014944); registration date: 12 March 2012.
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Affiliation(s)
- Masashi Matsushima
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Seiya Hattori
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Li LY, Gao X. Editorial comment to simple and reliable predictor of urinary continence after radical prostatectomy: serial measurement of urine loss ratio after catheter removal. Int J Urol 2014; 21:652. [PMID: 24571260 DOI: 10.1111/iju.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Liao-Yuan Li
- Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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