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Mac Curtain BM, Sugrue DD, Qian W, O'Callaghan M, Davis NF. Membranous urethral length and urinary incontinence following robot-assisted radical prostatectomy: a systematic review and meta-analysis. BJU Int 2024; 133:646-655. [PMID: 37667431 DOI: 10.1111/bju.16170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
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.
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Affiliation(s)
- Benjamin M Mac Curtain
- School of Medicine, University of Galway, Galway, Ireland
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Diarmuid D Sugrue
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, South Australia, Australia
| | - Wanyang Qian
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | | | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
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Wang M, Deng R, Wang L, Li M, Zeng T, Na Y, Gu D. Association between 3D membranous urethral parameters and urinary continence recovery after RARP. Eur J Med Res 2024; 29:165. [PMID: 38475943 DOI: 10.1186/s40001-024-01758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES To evaluate whether the urinary continence (UC) recovery after robotic-assisted radical prostatectomy (RARP) relates to the membranous urethral length (MUL) and the membranous urethral complex volume (MUV). MATERIALS AND METHODS 120 patients who underwent RARP were enrolled according to the different times of UC recovery and examined using prostate magnetic resonance imaging (MRI) before surgery. The membranous urethral (MU) parameters were measured using the three-Dimensional (3D) model reconstructed by holographic technology, such as total MUV (tMUV), exposed MUV (eMUV), full MUL (fMUL) and exposed MUL (eMUL). Statistical software SPSS 26.0 was used to analyze the data and compare the MU parameters and baseline data in different groups. RESULTS Patients with larger tMUV (p = 0.038), eMUV (p = 0.003), longer fMUL (p = 0.025), eMUL (p = 0.044) had better UC after removal of the catheter, and eMUV (OR = 1.002, 95%CI = 1.001-1.004, p = 0.004) was a predictor; the patients with younger age (p = 0.021), lower VPSS score (p = 0.004) and larger eMUV (p = 0.012) and longer eMUL (p = 0.049) had better UC recovery one month after RARP while eMUV (OR = 1.002, 95% CI = 1.000-1.003, p = 0.008) and VPSS score (OR = 0.886, 95% CI = 0.806-0.973, p = 0.011) were independent risk factors; The patients with younger age (p = 0.018), larger tMUV (p = 0.029), eMUV (p = 0.016) had better UC recovery three months after RARP. eMUV (OR = 1.002, 95% CI = 1.000-1.004, p = 0.042) and age (OR = 0.904, 95% CI = 0.818-0.998, p = 0.046) were independent risk factors. CONCLUSION This clinical study shows that patients with larger MUV and longer MUL can return to UC earlier after surgery. Among that, eMUV is a better predictor.
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Affiliation(s)
- Ming Wang
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ruiqi Deng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lei Wang
- Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
| | - Mingzhao Li
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tao Zeng
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanqun Na
- Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China.
| | - Di Gu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Maruo M, Goto Y, Miyazaki K, Inoue A, Kurokawa K, Enomoto A, Tanaka S, Katsura S, Sugawara S, Fuse M, Chiba K, Imamura Y, Sakamoto S, Nagata M, Ichikawa T. Novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation and long-term outcomes for a single surgeon. Sci Rep 2024; 14:926. [PMID: 38195985 PMCID: PMC10776665 DOI: 10.1038/s41598-024-51598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/07/2024] [Indexed: 01/11/2024] Open
Abstract
Although novel techniques for avoiding incontinence during robot-assisted radical prostatectomy have been developed, long-term oncological outcomes are unknown. The objective of this study was to determine the long-term oncological outcomes and functional outcomes of novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation for a single surgeon. Data from 100 patients who underwent structure-preserving prostatectomies performed by a single surgeon were retrospectively analyzed. The median console time was 123 min. Bilateral nerve-sparing was performed in 43% of patients underwent, and 57% underwent unilateral nerve-sparing surgery. Most patients (96%) reached complete pad-zero urinary continence by one year after surgery. Satisfactory erectile function was achieved in 97% of patients who underwent bilateral nerve-sparing surgery, and 80% of patients who underwent unilateral nerve-sparing surgery. The surgical margin was positive for 25% of patients, and the biochemical recurrence-free rate at 5 years was 77%. The cancer-specific survival rate was 100% during the median follow-up period of 4.5 years. Clavien-Dindo grade III complications occurred in 1% of cases. The outcomes for novel nerve-sparing robot-assisted radical prostatectomy with endopelvic fascia preservation were similar to previously reported oncological outcomes, with satisfactory functional outcomes. This operative method may be useful for patients who are eligible for nerve-sparing surgery.
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Affiliation(s)
- Masafumi Maruo
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yusuke Goto
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan.
| | | | - Atsushi Inoue
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Koichiro Kurokawa
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Akiko Enomoto
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Satoki Tanaka
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Sota Katsura
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Sho Sugawara
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Miki Fuse
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Kazuto Chiba
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Yusuke Imamura
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
| | - Maki Nagata
- Department of Urology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, Japan
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Kadono Y. Editorial Comment from Dr Kadonoo to Minimal residual membranous urethral length and membranous urethral length predict poor recovery from incontinence after robot-assisted radical prostatectomy and after open radical prostatectomy. Int J Urol 2022; 29:1524-1525. [PMID: 36102746 DOI: 10.1111/iju.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Haga N, Miyazaki T, Gunge N, Okabe Y, Matsuzaki H. Editorial Comment from Dr Haga et al. to Minimal residual membranous urethral length and membranous urethral length predict poor recovery from incontinence after robot-assisted radical prostatectomy and after open radical prostatectomy. Int J Urol 2022; 29:1523-1524. [PMID: 36102778 DOI: 10.1111/iju.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nobuhiro Haga
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takeshi Miyazaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naotaka Gunge
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yu Okabe
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Matsuzaki
- Department of Urology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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