Myosteatosis as a novel predictor of urinary incontinence after robot-assisted radical prostatectomy

Membranous urethral length and urinary incontinence following robot-assisted radical prostatectomy: a systematic review and meta-analysis

OBJECTIVE

To provide an update on the association between preoperative membranous urethral length (MUL) and postoperative urinary incontinence (UI) in men who undergo robot-assisted radical prostatectomy (RARP)/robot-assisted laparoscopic prostatectomy (RALP).

MATERIALS AND METHODS

Urinary incontinence is common after RARP/RALP, and early recovery of continence is one of the most important functional outcomes following surgery. MUL has been identified as a factor associated with continence recovery after RARP/RALP. A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Embase, and Scopus databases. Inclusion criteria were English language full journal articles authored within the last 5 years that assessed continence using the Expanded Prostate Cancer Index Composite. The Critical Appraisal Skills Programme tool for retrospective cohort studies was used to evaluate study quality. A random-effects meta-analysis was performed to pool odds ratios (ORs) from available studies relating to continence as a function of MUL. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to synthesise evidence.

RESULTS

Six studies including 970 patients reported an association between MUL and continence at 12 months. Longer MUL was associated with reduced UI odds at 12 months after surgery (pooled OR 0.74, 95% confidence interval 0.68-0.87, P < 0.001). Significant methodological and statistical heterogeneity was encountered.

CONCLUSIONS

Preoperative MUL measured on magnetic resonance imaging (MRI) is significantly associated with postoperative continence in men undergoing RARP/RALP. We recommend consideration of MRI measurement of MUL prior to RARP/RALP to guide treatment decisions in this population.

Myosteatosis as a novel predictor of new-onset diabetes mellitus after kidney transplantation

OBJECTIVES

We evaluate the effect of myosteatosis on new-onset diabetes mellitus after kidney transplantation.

METHODS

Consecutive patients who had renal transplant between 2006 and 2021 were reviewed, and 219 patients were finally included. Psoas muscle index was used to evaluate sarcopenia and average total psoas density (calculated by computed tomography before surgery) for myosteatosis. We used Cox proportional regression analyses in investigation of whether skeletal muscle depletion before surgery inclusive of sarcopenia and myosteatosis is a new additional predictor of new-onset diabetes mellitus.

RESULTS

Median recipient age and body mass index were 45 years and 21.1 kg/m2 , respectively, and 123 patients (56%) were male. Preoperative impaired glucose tolerance was present in 58 patients (27%) and new-onset diabetes mellitus in 30 patients (14%), with median psoas muscle index of 6 cm2 /m2 and average total psoas density of 41 Hounsfield Unit. In multivariate analysis, significant risk factors were body mass index ≥25 kg/m2 (p < 0.01), impaired glucose tolerance (p < 0.01), and average total psoas density < 41.9 Hounsfield Unit (p = 0.03). New-onset diabetes mellitus had incidence rates of 3.7% without risk factors, 10% with a single risk factor, 33% with two, and 60% with three. Patients with new-onset diabetes mellitus were effectively stratified by the number of risk factors (p < 0.01).

CONCLUSIONS

Myosteatosis could be a new risk factor used to predict new-onset diabetes mellitus.

A scoping review of risk factors for urinary incontinence in older men

BACKGROUND

Most epidemiological studies have not systematically identified or categorized risk factors for urinary incontinence (UI) in older men, despite a higher prevalence than in younger men. Considering the burden of UI, an understanding of risk factors can inform cost-effective prevention/treatment programs. This scoping review aimed to identify and categorise risk factors for UI in older men, identify gaps in the evidence, and opportunities for future research.

METHODS

The Joanna Briggs Institute (JBI) method for scoping reviews guided the conduct and reporting of this review alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI's Population, Concept, and Context approach framed the inclusion criteria (all evidence sources on UI risk factors that included older men [65 +]). We employed JBI's three-step search strategy, which included a limited initial search in Ovid MEDLINE, a detailed comprehensive database search, and a search of reference lists of included studies, Google Scholar and grey literature. There were no restrictions on language, study type, or publication date. Two independent reviewers screened, selected, and extracted eligible studies. Data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

Forty-seven articles that met the inclusion criteria identified 98 risk factors across six categories. Behavioural risk factors, reported by only two studies, were the least investigated of all the categories, whereas medical factors/diseases were the most investigated. No genetic factors were documented. The top five risk factors were increasing age/advanced age (n = 12), Benign Prostatic Hyperplasia (n = 11), Diabetes Mellitus (n = 11), Detrusor overactivity (n = 10), limitation in physical function/ADL disability (n = 10), increased Body Mass Index (BMI)/overweight/obesity (n = 8), Dementia (n = 8), and Parkinson's disease (n = 7).

CONCLUSION

There is a dearth of evidence to describe the role behavioural risk factors have in UI in older men. These factors may play a role in health promotion and disease prevention in this area.

REGISTRATION

A protocol detailing the methods was developed and published, and is registered in the Open Science Framework [Feb 07 2023; https://osf.io/xsrge/ ].

The Efficacy of Urinary Continence in Patients Undergoing Robot-Assisted Radical Prostatectomy with Bladder-Prostatic Muscle Reconstruction and Bladder Neck Eversion Anastomosis

Background and Objectives: To evaluate the efficacy of bladder-prostatic muscle reconstruction and bladder neck eversion anastomosis in the recovery of urinary continence after robot-assisted radical prostatectomy (RARP). Materials and Methods: From January 2020 to May 2022, 69 patients who underwent RARP in our hospital were recruited. Thirty-seven patients underwent RARP with the Veil of Aphrodite technique (control group). On the basis of the control group, 32 patients underwent bladder-prostatic muscle reconstruction and bladder neck eversion anastomosis during RARP (observation group). The recovery of urinary continence was followed up at 24 h and 1, 4, 12, and 24 weeks after catheter removal. Results: There were no significant differences in operative time (127.76 ± 21.23 min vs. 118.85 ± 24.71 min), blood loss (118.27 ± 16.75 mL vs. 110.77 ± 19.63 mL), rate of leakage (3.13% vs. 2.70%), rate of positive surgical margin (6.25% vs. 10.81%), or postoperative Gleason score [7 (6−8) vs. 7 (7−8)] between the observation group and the control group (p > 0.05). After catheter removal, the rates of urinary continence at 24 h, 1 week, 4 weeks, 12 weeks, and 24 weeks were 46.88%, 68.75%, 84.38%, 90.63%, and 93.75% in the observation group, respectively. Meanwhile, the rates of urinary continence in the control group were 21.62%, 37.84%, 62.16%, 86.49%, and 91.89%, respectively. There was a significant difference between the two groups (p = 0.034), especially at 24 h, 1 week, and 4 weeks after catheter removal (p < 0.05). Conclusions: Bladder-prostatic muscle reconstruction and bladder neck eversion anastomosis were beneficial to the recovery of urinary continence after RARP, especially early urinary continence.

Prognostic Impact of Lymphatic Invasion in Patients with High-Risk Prostate Cancer after Robot-Assisted Radical Prostatectomy and Extended Lymph Node Dissection: A Single-Institution Prospective Cohort Study

The prognostic impact of lymphatic invasion in patients with high-risk prostate cancer (PC) remains unclear. The aim of our single-institution prospective cohort study was to examine the impact of lymphatic invasion on biochemical recurrence (BCR) in patients with high-risk PC according to National Comprehensive Cancer Network (NCCN) criteria who underwent robot-assisted radical prostatectomy (RARP) and extended lymph node dissection (eLND). A total of 183 patients were included who underwent RARP and eLND for NCCN high-risk PC between June 2014 and August 2019. Lymphatic invasion in resected specimens was observed in 47 patients (26%), whereas lymph node metastasis was observed in 17 patients (9%). During follow-up, BCR was observed in 48 patients (26%). The BCR rate in patients with lymphatic invasion was significantly higher than that in patients without lymphatic invasion (p < 0.01). According to multivariable Cox proportional hazards regression analyses, lymphatic invasion was a significant independent predictor of BCR in the overall patient group and was independently associated with BCR, even in patients without lymph node metastasis. In conclusion, evaluation of lymphatic invasion could be useful in predicting BCR in patients undergoing RARP and eLND for high-risk PC.

Sarcopenia Is Associated with Fecal Incontinence in Patients with Dysphagia: Implication for Anal Sarcopenia

OBJECTIVES

To examine the relationship between sarcopenia and fecal incontinence in patients with dysphagia.

DESIGN

Cross-sectional study using the Japanese sarcopenic dysphagia database.

SETTING

19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation center.

PARTICIPANTS

460 dysphagic patients, aged 20 years and older.

MEASUREMENTS

Sarcopenia was diagnosed by the 2019 criteria of the Asian Working Group for Sarcopenia. Fecal incontinence was assessed by health care professionals at baseline according to the definition of the Japanese Practice Guidelines for Fecal Incontinence. We examined whether there was a significant difference between the rate of fecal incontinence in patients with/without sarcopenia. Age, sex, type of dwelling, Barthel index, Charlson comorbidity index (CCI), calf circumference, handgrip strength, body mass index, malnourishment, C-reactive protein level, serum albumin level, and delivery of enteral nutrition by nasogastric and/or gastrostomy tube were measured. To examine the relationship between sarcopenia and fecal incontinence, logistic regression analysis was performed with adjustments for age, sex, sarcopenia, CCI, enteral nutrition, and dwelling.

RESULTS

The mean age of patients was 81 ± 10 years. Of the 460 study patients, 404 (88%) patients had sarcopenia and 104 had fecal incontinence (23%). The rate of fecal incontinence was higher in the sarcopenia group than the non-sarcopenia group (25% vs. 7%, P = 0.003). Logistic regression analysis showed that sarcopenia was independently associated with fecal incontinence (odds ratio: 3.114, 95% confidence interval: 1.045, 9.282).

CONCLUSION

The prevalence of fecal incontinence was 23% in patients with dysphagia. Sarcopenia was independently associated with fecal incontinence, which suggests the presence of anal sarcopenia. Defecation control should be assessed in patients with sarcopenia.