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Visscher J, Hiwase M, Bonevski B, O'Callaghan M. The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024; 27:222-229. [PMID: 37500786 DOI: 10.1038/s41391-023-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Urinary and sexual dysfunction after radical prostatectomy remains a major cause of morbidity, despite widespread availability of pharmacological and rehabilitative treatments. Smoking is a modifiable risk factor known to correlate with erectile and urinary dysfunction and we hypothesise that smoking cessation may improve post-prostatectomy urinary and sexual function recovery. Our objective is to systematically evaluate literature describing the association of smoking status with urinary and sexual function in men following radical prostatectomy. METHODS In total, 310 unique records were identified through a systematic search of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and CENTRAL databases up to February 2023. Nine studies reported smoking status and post radical prostatectomy urinary and sexual function outcomes in men with localized prostate cancer. Risk of bias was assessed and meta-analysis included six studies. RESULTS Smokers had inferior erectile function after prostatectomy compared to non-smokers (OR 0.73, [95% CI 0.56-0.95]) during follow-up, while urinary incontinence was not statistically different between groups (OR 1.20, [95% CI 0.75-1.91]). Smoking cessation improved the EPIC-26 sexual domain score with 6.6 points on average [p = 0.03] to a clinically significant maximum of 12.5 points at 18-24 months. CONCLUSIONS Smoking is associated with impaired sexual function recovery after radical prostatectomy and quitting may improve sexual function >18 months. Current evidence shows no such association for urinary outcomes. Further studies are needed to corroborate findings.
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Affiliation(s)
- Jordi Visscher
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Mrunal Hiwase
- Department of Surgery, Central Adelaide Health Network, Adelaide, SA, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael O'Callaghan
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Urology Unit, Adelaide, SA, Australia
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Paula Domino M, Vertosick EA, Vickers AJ, Eastham JA, Sandhu JS. The Association Between Low Preoperative Serum Testosterone and Post-radical Prostatectomy Urinary Function. Urology 2023; 180:190-193. [PMID: 37516254 DOI: 10.1016/j.urology.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine if hypogonadism leads to delayed urinary function recovery post-radical prostatectomy (RP) by studying the effect of preoperative factors including age, membranous urethral length, radiation therapy, and Body Mass Index on urinary continence in patients with or without hypogonadism. MATERIALS AND METHODS We identified 1209 patients treated by RP with both pretreatment T and post-treatment urinary outcome. We assessed whether there was an association between low preoperative T level (prenoon T ≤ 300 ng/dL) and continence (using ≤1 pad/d) at 6 and 12months post-RP. Patient-reported continence was used when available, otherwise, surgeon-assessed continence was used. Logistic regression models were used, adjusted for age at RP and nerve-sparing status. RESULTS Median age at RP was 61 (Intraquatile Range (IQR) 56, 66), 92% of patients had at least one nerve spared and 99% were continent at baseline. Continence in patients with low T was nonsignificantly lower at 6months (odds ratio 0.69, 95% confidence interval 0.44, 1.06; P = .10) and nonsignificantly higher at 12months (odds ratio 1.07, 95% confidence interval 0.71, 1.58; P = .8). Sensitivity analyses excluding patients with preoperative metastasis or treated with androgen deprivation therapy (ADT) and including testosterone as a continuous predictor were consistent with the primary analysis; similarly finding no evidence of an association. CONCLUSION Although we cannot rule out an effect on early continence, overall the evidence does not suggest that low serum testosterone adversely impacts urinary function recovery after RP. This finding can be used to counsel patients enrolled in neoadjuvant ADT trials or those patients undergoing RP who have had prior ADT, such as in the setting of oligometastatic disease.
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Affiliation(s)
- M Paula Domino
- Voiding Dysfunction and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaspreet S Sandhu
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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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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Kahlmeyer A, Fiebig C, Mueller M, Kraulich M, Brendel-Suchanek J, Kunath F, Wach S, Goebell PJ, Ritt M, Gassmann KG, Wullich B. Geriatric Assessments Can Predict Functional Outcome and Mortality after Urological Tumor Surgery. Urol Int 2021; 106:848-857. [PMID: 34537771 DOI: 10.1159/000518978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Older patients undergoing major urological tumor surgery are at severe risk of functional deterioration, complications, and mortality. We prospectively evaluated geriatric assessment tools and developed a novel easy-to-use assessment tool for clinical use. METHODS In 159 patients, geriatric assessment tools were used prior to cystectomy, prostatectomy, and renal tumor surgery, and their peri- and postoperative courses were recorded. Using all the tests, a short and easy-to-use assessment tool was developed, and nomograms were generated to predict functional outcomes and mortality. RESULTS Of all the patients, 13.8% underwent radical cystectomy, 37.7% underwent radical prostatectomy, and 48.4% underwent tumor surgery of the kidney at the age of 70 years or older. The average age was 75.6 years. Incomplete functional recovery at day 30 and day 180 was observed in 37.7% and 36.1% of the patients, respectively, and incomplete functional recovery was associated with impaired mobility, previous care dependency, frailty, comorbidities, and a high ASA score. The only predictor for high-grade complications was comorbidities, whereas mortality was associated with the geriatric screening tool scores, impaired mobility, preoperative care dependency, and comorbidities. The Erlangen Index (EI), a combination of the selected assessment tools, showed a good prediction of early (p = 0.002) and medium-term (p = 0.002) functional outcomes and mortality (p = 0.001). CONCLUSION Our prospective evaluation confirms the high risk of incomplete functional recovery, high-grade complications, and mortality in older patients undergoing major urological tumor surgery. The EI is an easy-to-use preoperative assessment tool and therefore should be used in preoperative patient counseling.
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Affiliation(s)
- Andreas Kahlmeyer
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Christian Fiebig
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Marco Mueller
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Matthias Kraulich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Jonas Brendel-Suchanek
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Peter J Goebell
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
| | - Martin Ritt
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien gGmbH, Erlangen, Germany
| | - Karl-Guenter Gassmann
- Department of Internal Medicine III (Medicine of Ageing), Geriatrics Centre Erlangen, Malteser Waldkrankenhaus St. Marien gGmbH, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich Alexander-University Erlangen-Nuernberg, Erlangen, Germany
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Köhler N, El-Bandar N, Maxeiner A, Ralla B, Miller K, Busch J, Friedersdorff F. Early Continence and Extravasation After Open Retropubic Radical Prostatectomy - Interrupted vs Continuous Suturing for Vesicourethral Anastomosis. Ther Clin Risk Manag 2021; 16:1289-1296. [PMID: 33380800 PMCID: PMC7767697 DOI: 10.2147/tcrm.s278454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare running suture (RS) and interrupted suture (IS) of vesicourethral anastomosis (VUA) during open retropubic radical prostatectomy (RRP) on early urinary continence and extravasation. Patients and Methods Single center analysis of 211 patients who underwent RRP performed by a single surgeon during 2008 to 2017 was retrospectively analyzed. For VUA, we used the standard interrupted suture technique (n=100) with a 3-0 PDS suture. The RS (n=111) was performed with 12-bite suture using 3-0 PDS. The primary endpoints were extravasation and early continence. Demographic and peri-operative data were collected and analyzed using Pearson's chi-square, t-Test and Mann-Whitney U-test. A binary logistic regression analysis was carried out to explore predictors that affected early continence after catheter removal. Results The rates of early urinary incontinence (UI) were 7.7% vs 42.2% (p<0.001). The duration of catheterization and hospitalization was significantly shorter in the interrupted group (4 days vs 5 days, p<0.001 and 5 days vs 6 days, p<0.001). The groups did not differ significantly in body mass index or prostate volume. There were older patients and higher PSA levels in the group with RS technique. No significant difference was found in the postoperative extravasation rates between both groups (13.5% vs 12%, p=0.742). Conclusion Running vesicourethral anastomosis increased the rate of early urinary incontinence. Both anastomosis techniques provided a similar rate of postoperative urine extravasation. VUA should only be one of the many criteria that must be considered for the preservation of urinary continence of patients after RRP.
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Affiliation(s)
- Nora Köhler
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Nasrin El-Bandar
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Bernhard Ralla
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Jonas Busch
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
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Rajih E, Meskawi M, Alenizi AM, Zorn KC, Alnazari M, Zanaty M, Alhathal N, El-Hakim A. Perioperative predictors for post-prostatectomy urinary incontinence in prostate cancer patients following robotic-assisted radical prostatectomy: Long-term results of a Canadian prospective cohort. Can Urol Assoc J 2018; 13:E125-E131. [PMID: 30332593 DOI: 10.5489/cuaj.5356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to report the impact of perioperative factors that have not been well-studied on continence recovery following robotic-assisted radical prostatectomy (RARP). METHODS We analyzed data of 322 men with localized prostate cancer who underwent RARP between October 2006 and May 2015 in a single Canadian centre. All patients were assessed at one, three, six, 12, and 24 months after surgery. We evaluated risk factors for post-prostatectomy urinary incontinence from a prospectively collected database in multivariate Cox regression analysis. The primary endpoint was continence, defined as 0 pad usage per day. RESULTS 0-pad continence rates were 126/322 (39%), 187/321 (58%), 222/312 (71%), 238/294 (80%), and 233/257 (91%) at one, three, six, 12, and 24 months, respectively. Bladder neck preservation (hazard ratio [HR] 0.71; 95% confidence interval [CI] 0.5-0.99; p=0.04), and prostate size (HR 0.99; 95% CI 0.98-0.99; p=0.02) were independent predictors of continence recovery after RARP. Smoking at time of surgery predicted delayed continence recovery on multivariate analysis (HR 1.42; 95% CI 1.01-1.99; p=0.04). Neurovascular bundles preservation was associated with continence recovery after 24 months. No statistically significant correlation was found with other variables, such as age, body mass index, Charlson comorbidity index, preoperative oncological baseline parameters, presence of median lobe, or thermal energy use. CONCLUSIONS Our results confirmed known predictors of postprostatectomy incontinence (PPI), namely bladder neck resection and large prostate volume. Noteworthy, cigarette smoking at the time of RARP was found to be a possible independent risk factor for PPI. This study is hypothesis-generating.
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Affiliation(s)
- Emad Rajih
- Department of Urology, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Malek Meskawi
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Abdullah M Alenizi
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Mansour Alnazari
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Marc Zanaty
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Naif Alhathal
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
| | - Assaad El-Hakim
- Department of Surgery, Division of Robotic Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada
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Perez FSB, Rosa NC, da Rocha AF, Peixoto LRT, Miosso CJ. Effects of Biofeedback in Preventing Urinary Incontinence and Erectile Dysfunction after Radical Prostatectomy. Front Oncol 2018. [PMID: 29535970 PMCID: PMC5834912 DOI: 10.3389/fonc.2018.00020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this study, we present a biofeedback method for the strengthening of perineal muscles during the preoperative procedures for radical prostatectomy, and we evaluate this technique as a prevention measure against complications such as urinary incontinence (UI) and erectile dysfunction (ED), which affect prostatectomy patients after surgery. In the experimental protocol, the patients performed specific exercises with the help of a device that provided the patient with visual biofeedback, based on a plot of the anal pressure. For the experimental protocol, we selected 20 male patients, with an average age of 64.0 years, and submitted them to ten therapeutic sessions each. A control group consisting of 32 men with an average age of 66.3 years, who were treated with the same surgical procedure but not with the preoperative procedures, also took part in the experiment. To evaluate UI and ED after the surgery in both control and experimental groups, we used two validated questionnaires-to assess UI, we used the King's Health Questionnaire (KHQ) and, for ED, we used the International Index of Erectile Function (IIEF-5) Questionnaire. We compared the variables associated with UI and ED after the surgery for the control and experimental groups. The occurrence of UI after radical prostatectomy in the control group (100% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. Likewise, the occurrence of erectile dysfunction after prostatectomy in the control group (48.6% of the patients) was higher than that for the experimental group (5% of the patients), with p < 0.0001. The number of nocturia events also decreased as a consequence of the intervention (p < 0.0001), as did the number of disposable underwear units for urinary incontinence (p < 0.0001). Furthermore, we compared, only for the experimental group, the anal pressure before the biofeedback intervention and after the surgery, and we verified that the anal pressure after surgery was significantly higher (p < 0.0001). The results strongly suggest that the preoperative biofeedback procedure was effective in decreasing urinary incontinence and erectile dysfunction after radical prostatectomy. As future work, we intend to extend this analysis for larger samples and considering a broader age range.
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Affiliation(s)
- Fabiana S B Perez
- Medical Sciences Graduate Program, University of Brasilia, Brasilia, Brazil.,Department of Physiotherapy, Alfredo Nasser College, Aparecida de Goiania, Brazil
| | - Nathalia C Rosa
- Department of Physiotherapy, Alfredo Nasser College, Aparecida de Goiania, Brazil
| | - Adson F da Rocha
- Medical Sciences Graduate Program, University of Brasilia, Brasilia, Brazil.,Biomedical Engineering Graduate Program, University of Brasilia, Brasilia, Brazil
| | - Luciana R T Peixoto
- Biomedical Engineering Graduate Program, University of Brasilia, Brasilia, Brazil
| | - Cristiano J Miosso
- Biomedical Engineering Graduate Program, University of Brasilia, Brasilia, Brazil
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A match-pair analysis of continence in intermediate and high-risk prostate cancer patients after robot-assisted radical prostatectomy: the role of urine loss ratio and predictive analysis. Prostate Int 2017; 6:94-98. [PMID: 30140658 PMCID: PMC6104473 DOI: 10.1016/j.prnil.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 08/17/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to study the continence between intermediate and high-risk cancer patients and the influential factors to recover continence. Materials and methods In total, 655 patients underwent surgery by robot-assisted radical prostatectomy between 2010 and 2015. Of 655 patients, 294 were classified according to D'Amico risk groups as intermediate risk or high risk and completed the micturition protocol. Patients with intermediate risk were matched in a 1:1 ratio to patients with high risk for age and body mass index. Urine loss ratio (ULR) was defined as urine loss divided by micturition volumes. Immediate continence was defined with the best cut-off value of ULR. Results In total, 117 patients with intermediate risk were matched to those with high risk. The comparison did not show any statistically significant difference in the ULR value (P = 0.359) or continence rate (P = 0.449). Predictive analysis was performed for the 294 patients (intermediate and high risk), of which 9.5% were classified as incontinent (>1 pad/d). Immediate continence was defined as ULR < 0.049 in 232 (78.9%) patients. Age, preoperative hemoglobin, and duration of catheterization were found influent by univariate analysis. Only age [odds ratio (OR) = 1.072; 95% confidence interval (CI) = 1.020–1.127; P = 0.006] and duration of catheterization (OR = 1.060; 95% CI = 1.003–1.120; P = 0.040) were independent influential factors to predict immediate continence. Conclusion D'Amico intermediate- and high-risk groups do not differ in continence terms. The ULR value of < 0.049 identifies those patients who recover continence earlier. Age and duration of catheterization were influential factors in predicting immediate continence.
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Bier S, Hennenlotter J, Rausch S, Aufderklamm S, Martzog JC, Stenzl A, Schwentner C, Todenhöfer T. Return to Work and Normal Daily Life Activity after Open and Robot-Assisted Radical Prostatectomy - A Single Surgeon Analysis. Urol Int 2016; 96:280-6. [DOI: 10.1159/000437335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022]
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Mager R, Kurosch M, Hüsch T, Reiter M, Tsaur I, Haferkamp A. [Prevention of postprostatectomy incontinence: etiology and risk factors]. Urologe A 2014; 53:327-8, 330, 332. [PMID: 24522692 DOI: 10.1007/s00120-013-3348-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevention of postprostatectomy incontinence has always been a challenge for urologists. Improved understanding of male continence and changes in pelvic anatomy after radical prostatectomy and the implementation of new surgical techniques raised hope of reduced incontinence rates. Despite using the full potential of continence-sparing techniques and atraumatic robot-assisted surgery, postprostatectomy incontinence still occurs in 5-20 % of cases. Recently published data showed a trend of improved early return to continence using anterior suspension or posterior reconstruction in robot-assisted prostatectomy. Postprostatectomy incontinence has a negative impact on quality of life and causes high costs of treatment. Therefore, further research in the amelioration of postoperative continence is mandatory.
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Affiliation(s)
- R Mager
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Frankfurt, Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland,
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