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Mian AH, Tollefson MK, Shah P, Sharma V, Mian A, Thompson RH, Boorjian SA, Frank I, Khanna A. Navigating Now and Next: Recent Advances and Future Horizons in Robotic Radical Prostatectomy. J Clin Med 2024; 13:359. [PMID: 38256493 PMCID: PMC10815957 DOI: 10.3390/jcm13020359] [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: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) has become the leading approach for radical prostatectomy driven by innovations aimed at improving functional and oncological outcomes. The initial advancement in this field was transperitoneal multiport robotics, which has since undergone numerous technical modifications. These enhancements include the development of extraperitoneal, transperineal, and transvesical approaches to radical prostatectomy, greatly facilitated by the advent of the Single Port (SP) robot. This review offers a comprehensive analysis of these evolving techniques and their impact on RARP. Additionally, we explore the transformative role of artificial intelligence (AI) in digitizing robotic prostatectomy. AI advancements, particularly in automated surgical video analysis using computer vision technology, are unprecedented in their scope. These developments hold the potential to revolutionize surgeon feedback and assessment and transform surgical documentation, and they could lay the groundwork for real-time AI decision support during surgical procedures in the future. Furthermore, we discuss future robotic platforms and their potential to further enhance the field of RARP. Overall, the field of minimally invasive radical prostatectomy for prostate cancer has been an incubator of innovation over the last two decades. This review focuses on some recent developments in robotic prostatectomy, provides an overview of the next frontier in AI innovation during prostate cancer surgery, and highlights novel robotic platforms that may play an increasing role in prostate cancer surgery in the future.
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Affiliation(s)
- Abrar H. Mian
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Paras Shah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ahmed Mian
- Urology Associates of Green Bay, Green Bay, WI 54301, USA
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Abhinav Khanna
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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Zazzara M, Gardiman MP, Dal Moro F. The bladder neck preservation in robot assisted radical prostatectomy: Surgical and pathological outcome. Arch Ital Urol Androl 2023; 95:12138. [PMID: 38193218 DOI: 10.4081/aiua.2023.12138] [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: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. AIM The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. MATERIALS AND METHODS Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. RESULTS According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. CONCLUSIONS The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncological procedure resulting in a good functional outcome, about post-prostatectomy continence, working on two anatomic components responsible for post-prostatectomy continence. The bladder neck PSM are linked to neoplasia with adverse pathological features, rather than the bladder neck preservation.
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Affiliation(s)
- Michele Zazzara
- Urology Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua, Padua.
| | - Marina P Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua.
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua, Padua.
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Ferretti S, Dell’Oglio P, Ciavarella D, Galfano A, Schips L, Marchioni M. Retzius-Sparing Robotic-Assisted Prostatectomy: Technical Challenges for Surgeons and Key Prospective Refinements. Res Rep Urol 2023; 15:541-552. [PMID: 38106985 PMCID: PMC10725648 DOI: 10.2147/rru.s372803] [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: 08/01/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023] Open
Abstract
Robotic-assisted radical prostatectomy (RARP) is the gold standard for localized prostate cancer. Several RARP approaches were developed and described over the years, aimed at improving oncological and functional outcomes. In 2010, Galfano et al described a new RARP technique, known as Retzius-sparing RARP (RS-RARP), a posterior approach through the Douglas space that spares the anterior support structures involved with urinary continence and sexual potency. This approach has been used increasingly in many centers around the world comparing its results with those of the most used standard anterior approach. Several randomized controlled trials, systematic reviews and meta-analyses demonstrated an important advantage relative to standard anterior RARP in terms of early urinary continence recovery, with comparable perioperative and long-term oncological outcomes. Several surgeons are concerned regarding RS-RARP because it appears to increase the risk of positive surgical margins (PSMs). However, this statement is based on low-certainty evidence. Indeed, the available studies compared the results of surgeons who had an initial experience with posterior RARP with those who had a solid experience with anterior RARP. Recent evidence strongly suggests that RS-RARP is feasible and safe not only in low- and intermediate-risk prostate cancer patient but also in challenging scenario such as high-risk setting, salvage prostatectomy and after transurethral resection of the prostate.
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Affiliation(s)
- Simone Ferretti
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Paolo Dell’Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Davide Ciavarella
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, Urology Unit, Chieti, Italy
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Baunacke M. [Urinary incontinence after radical prostatectomy: risk factors and utilisation of care]. Aktuelle Urol 2023; 54:443-448. [PMID: 37348540 DOI: 10.1055/a-2097-3475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Stress urinary incontinence is a relevant risk of radical prostatectomy (RP), which significantly affects patients' quality of life. The risk of developing stress urinary incontinence depends on pre-, intra- and postoperative factors. In particular, intraoperative factors regarding different surgical techniques are often focused on in order to improve continence rates. If stress urinary incontinence develops after RPE, patients affected should be treated adequately. In this respect, there are indications of healthcare insufficiencies in Germany. On the one hand, these include deficits in the use of incontinence materials. On the other hand, surgical treatment of stress urinary incontinence after RPE is insufficient.
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Sakaguchi K, Ebara S, Tatenuma T, Sasaki T, Ikehata Y, Nakayama A, Kawase M, Toide M, Yoneda T, Teishima J, Makiyama K, Inoue T, Kitamura H, Saito K, Koie T, Koga F, Urakami S. Early and late urinary continence outcomes after unilateral and bilateral nerve-sparing robot-assisted radical prostatectomy: A retrospective multicentre cohort study in Japan (the MSUG94 group). Int J Med Robot 2023:e2593. [PMID: 37984071 DOI: 10.1002/rcs.2593] [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: 07/12/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established. MATERIAL AND METHODS We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method. RESULTS The pad-free rates at 12 months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12 months of surgery did not significantly differ between the unilateral and bilateral NS groups. CONCLUSIONS NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12 months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP.
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Affiliation(s)
| | - Shin Ebara
- Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | | | - Akinori Nakayama
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsuaki Yoneda
- Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | | | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | | | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Katsimperis S, Juliebø-Jones P, Ta A, Tandogdu Z, Al-Bermani O, Bellos T, Esperto F, Tonyali S, Mitsogiannis I, Skolarikos A, Varkarakis I, Somani BK, Tzelves L. Surgical techniques to preserve continence after robot-assisted radical prostatectomy. Front Surg 2023; 10:1289765. [PMID: 38026481 PMCID: PMC10655003 DOI: 10.3389/fsurg.2023.1289765] [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: 09/06/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Radical prostatectomy significantly impacts the inherent anatomy of the male pelvis and the functional mechanisms of urinary continence. Incontinence has a considerable negative influence on the quality of life of patients, as well as their social and psychological wellbeing. Numerous surgical techniques have been demonstrated to support the preservation of continence during robot-assisted radical prostatectomy (RARP). In this in-depth analysis, we give a general summary of the surgical techniques used in RARP and their impact on incontinence rates.
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Affiliation(s)
- Stamatios Katsimperis
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Anthony Ta
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Zafer Tandogdu
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Osama Al-Bermani
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Themistoklis Bellos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Senol Tonyali
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Iraklis Mitsogiannis
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Varkarakis
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar K. Somani
- Department of Urology, University of Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Lazaros Tzelves
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
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Kohada Y, Hieda K, Miyamoto S, Tasaka R, Asami A, Akiyama K, Sakamoto Y, Kirishima F, Saito K, Fukushima T, Takemoto K, Babasaki T, Kobatake K, Kitano H, Goto K, Ikeda K, Hayashi T, Hinata N. Retrospective evaluation of the improvement in the urinary status-related quality of life after robot-assisted radical prostatectomy. Int J Urol 2023; 30:1020-1027. [PMID: 37496371 DOI: 10.1111/iju.15251] [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] [Received: 12/16/2022] [Accepted: 06/29/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES This study aimed to investigate the characteristics of patients who report improvement in quality of life (QOL) related to urinary status after undergoing robot-assisted radical prostatectomy (RARP) for localized prostate cancer. METHODS We retrospectively reviewed the patients who underwent RARP between May 2010 and May 2021 at our institution and were preoperatively unsatisfied with their urinary status. Patients were grouped as Group 1 (improved patients: "satisfied" with urinary status based on international prostate symptom score QOL [IPSS-QOL] = 0-2 at 12 months after RARP) and Group 2 (unimproved group: "unsatisfied"-IPSS-QOL 3-6). Additionally, the Expanded Prostate Cancer Index Composite (EPIC) urinary subdomains (urinary function, urinary bother [UB], urinary incontinence, and urinary irritation/obstruction [UIR]) and IPSS were evaluated preoperatively and till 12 months after RARP. RESULTS Of the 237 patients, 72 (30.4%) were Group 1, and 165 (69.6%) were Group 2. Only UB and UIR improved at 12 months after RARP in Group 1, while other EPIC urinary subdomains remained unimproved at 12 months in both groups. On the other hand, IPSS improved at 12 months in both groups. Univariate and multivariate analysis revealed that the nerve-sparing, preoperative low IPSS (<11 vs. ≥11), and low IPSS-QOL (3 vs. 4-6) were associated with improvement in urinary status-related QOL (p < 0.05). CONCLUSIONS Improvement in UB and UIR are important factors to ascertain improvement in urinary status-related QOL after RARP. Nerve-sparing and preoperative IPSS/IPSS-QOL values are useful predictors of this improvement.
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Affiliation(s)
- Yuki Kohada
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryo Tasaka
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Akihiro Asami
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kosuke Akiyama
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yuki Sakamoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Fumiaki Kirishima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kohei Saito
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Takafumi Fukushima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenshiro Takemoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Takashi Babasaki
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kohei Kobatake
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenichiro Ikeda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Wang F, Chen J, Wang W, Li M, Peng C, Pan S, Zhan C, Zhao K, Li Y, Zhang L, Xu G, Jin J. Quantitative Analysis of Quality of Life and Exploration of Influencing Factors in Patients Undergoing Radical Prostatectomy. Urology 2023; 181:105-111. [PMID: 37586423 DOI: 10.1016/j.urology.2023.06.035] [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: 05/03/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To quantify and evaluate the quality of life of patients undergoing radical prostatectomy using the FACT-P scoring system, and to explore the predictive factors for postoperative quality of life. METHODS Clinical data of 249 patients who underwent radical prostatectomy in our hospital from January 2021 to October 2022 were analyzed. According to the surgical method and whether the subjective quality of life of the patient decreased significantly, the patients were divided into groups, and the predictive factors for changes in subjective quality of life after surgery were analyzed. RESULTS A total of 192 cases were finally obtained (45 cases of fascia internal approach, 147 cases of traditional radical prostatectomy), and patients who underwent fascia internal approach (FACT-P: 110.15 ± 10.55) had better postoperative quality of life than those who underwent extra-fascial radical prostatectomy (FACT-P: 102.30 ± 6.75) (P < .01). One hundred fourteen patients reported a decrease in subjective quality of life, while 78 did not. The preoperative FACT-P score was an independent predictive factor (OR=0.719, P < .01), and when the preoperative score was <116 points, the possibility of no decrease in quality of life after surgery was higher. CONCLUSION Fascia internal approach should be performed as much as possible for suitable surgical patients, and for patients with a preoperative FACT-P score ≥116 points, the possibility of a decrease in quality of life after surgery should be fully communicated.
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Affiliation(s)
- Feiyang Wang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jiajun Chen
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China.
| | - Weihao Wang
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Mengyao Li
- Department of Pathology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Chao Peng
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Shouhua Pan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Chuanchuan Zhan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Keyuan Zhao
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Yulei Li
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Lulu Zhang
- Scientific Research Center,Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Gang Xu
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - Jing Jin
- Department of Urology, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
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Ippoliti S, Colalillo G, Egbury G, Orecchia L, Fletcher P, Piechaud T, Gaston R, Finazzi-Agrò E, Miano R, Asimakopoulos AD. Continence-Sparing Techniques in Radical Prostatectomy: A Systematic Review of Randomized Controlled Trials. J Endourol 2023; 37:1088-1104. [PMID: 37597197 DOI: 10.1089/end.2023.0188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence (EC) recovery; however, evidence regarding the best approach remains controversial. The objectives are to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomized control trials (RCTs); to summarize the immediate continence and the EC reported; and to propose a new standardization for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery was included. The heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised, and quality assessed. Results: In total, 39 RCTs were included: 19 of 39 studies were low-quality RCTs, presenting small cohort, monocentric, or single-surgeon data. The best RCT-supported evidence is in favor of robot-assisted radical prostatectomy (RARP) compared with laparoscopic radical prostatectomy (LRP) and of the Retzius-sparing (RS) technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament (PPL) preservation, posterior reconstruction with or without combination of anterior suspension technique, and nerve-sparing (NS) approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings, and the selective ligature of dorsal venous complex (DVC) were not significantly associated with EC improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, and DVC suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and RS have high-quality evidence supporting their ability to enhance postoperative EC recovery. NS, bladder neck, and PPL preservation may contribute to better EC recovery, although the evidence level is low. Further multicenter RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardization was proposed.
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Affiliation(s)
- Simona Ippoliti
- Department of Urology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Gaia Colalillo
- Department of Urology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Gerald Egbury
- School of Allied Health, Anglia Ruskin University, Cambridge, United Kingdom
| | - Luca Orecchia
- Department of Urology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Peter Fletcher
- Department of Urology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Enrico Finazzi-Agrò
- Department of Urology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Roberto Miano
- Department of Urology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
- Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
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10
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Bravi CA, Mottaran A, Sarchi L, Piro A, Paciotti M, Nocera L, Balestrazzi E, Peraire M, Farinha R, Pauwaert K, Herwaarden MV, Vinckier MH, Backer PD, D'Hondt F, Groote RD, Naeyer GD, Mottrie A. Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique. Int Braz J Urol 2023; 49:521-522. [PMID: 37267619 PMCID: PMC10482447 DOI: 10.1590/s1677-5538.ibju.2023.0027] [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: 01/18/2023] [Accepted: 01/26/2022] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5-7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). SURGICAL TECHNIQUE We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane - virtually until the seminal vesicles - prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. CONCLUSIONS Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention.
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Affiliation(s)
- Carlo A. Bravi
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Ospedale San RaffaeleUnit of UrologyDivision of OncologyMilanItalyDivision of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo Mottaran
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Azienda Ospedaliero-Universitaria di BolognaDivision of UrologyBolognaItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Sarchi
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Adele Piro
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- University of Modena and Reggio EmiliaDepartment of UrologyModenaItalyDepartment of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Paciotti
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCSHumanitas Research HospitalDepartment of UrologyMilanRozzanoItalyDepartment of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Luigi Nocera
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Ospedale San RaffaeleUnit of UrologyDivision of OncologyMilanItalyDivision of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eleonora Balestrazzi
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Azienda Ospedaliero-Universitaria di BolognaDivision of UrologyBolognaItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Peraire
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Rui Farinha
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Kim Pauwaert
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Manoe Van Herwaarden
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Marie-Hélène Vinckier
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | | | - Frederiek D'Hondt
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Ruben De Groote
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Alexandre Mottrie
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
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11
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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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12
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Samora NL, Wallis CJD, Huang L, Tallman JE, Zhao Z, Hoffman K, Morgans A, Cooperberg M, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan S, O'Neil B, Paddock LE, Stroup A, Wu X, Koyama T, Penson DF, Barocas DA. Association between body mass index and localized prostate cancer management and disease-specific quality of life. BJUI COMPASS 2022; 4:223-233. [PMID: 36816144 PMCID: PMC9931544 DOI: 10.1002/bco2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 02/17/2023] Open
Abstract
Purpose The purpose of this work is to describe the association between body mass index (BMI) and (1) management option for localized prostate cancer (PCa) and (2) disease-specific quality of life (ds-QoL) after treatment or active surveillance. Subjects/patients and methods We analysed data from men with localized PCa managed with radical prostatectomy (RP), radiation therapy (RT), or active surveillance (AS) in a prospective, population-based cohort study. We evaluated the association between BMI and management option with multivariable multinomial logistic regression analysis. The association between BMI and ds-QoL was assessed using multivariable longitudinal linear regression. Regression models were adjusted for baseline domain scores, demographics, and clinicopathologic characteristics. Results A total of 2378 men were included (medians [quartiles]: age 64 [59-69] years; BMI 27 kg/m2; 77% were non-Hispanic white); 29% were obese (BMI ≥ 30). Accounting for demographic and clinicopathologic features, BMI ≥ 28 kg/m2 was inversely associated with the likelihood of receiving RP (compared with RT) and became statistically significant at BMI ≥ 33 kg/m2 (maximum adjusted relative risk ratio = 0.80, 95% CI 0.67 to 0.95, p = 0.013 for BMI ≥ 33 vs. 25). Conversely, BMI was not significantly associated with the likelihood of receiving AS compared with RT. After stratification by management option, obese men who underwent definitive treatment were not found to have clinically worse ds-QoL. Obese men initially on AS appeared to have worse urinary incontinence than nonobese men, but this was not significant on an as-treated sensitivity analysis. Conclusions Among men with localized PCa, those with BMI ≥ 33 kg/m2 were less likely to receive surgery than radiation. Obesity was not associated with ds-QoL in men undergoing definitive treatment, nor in men who remained on AS.
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Affiliation(s)
| | | | - Li‐Ching Huang
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jacob E. Tallman
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zhiguo Zhao
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Karen Hoffman
- Department of Radiation OncologyThe University of Texas MD Anderson CenterHoustonTexasUSA
| | - Alicia Morgans
- Dana Farber Cancer InstituteHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Michael Goodman
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Sheldon Greenfield
- Department of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Ann S. Hamilton
- Department of Population and Public Health SciencesKeck School of Medicine at the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mia Hashibe
- Department of Family and Preventative MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Sherrie Kaplan
- Department of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Brock O'Neil
- Department of UrologyUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Lisa E. Paddock
- Department of EpidemiologyRutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Antoinette Stroup
- Department of EpidemiologyRutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Xiao‐Cheng Wu
- Department of EpidemiologyLouisiana State University New Orleans School of Public HealthNew OrleansLouisianaUSA
| | - Tatsuki Koyama
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - David F. Penson
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Geriatric Research Education and Clinical CenterVeterans Affairs Tennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - Daniel A. Barocas
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
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13
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Kohjimoto Y, Higuchi M, Yamashita S, Kikkawa K, Hara I. Bladder neck size and its association with urinary continence after robot-assisted radical prostatectomy. BJUI COMPASS 2022; 4:181-186. [PMID: 36816148 PMCID: PMC9931543 DOI: 10.1002/bco2.188] [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: 03/27/2022] [Revised: 07/24/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives This study aims to determine whether bladder neck size (BNS) measured during surgery is associated with urinary continence after robot-assisted radical prostatectomy. Patients and Methods Between June 2015 and March 2019, 365 consecutive eligible patients undergoing robot-assisted radical prostatectomy were enrolled into a prospective observational cohort study. The primary outcome was patient-reported urinary continence status at 1, 3, 6, 12 and 24 months postoperatively, with continence defined as 0 pad/day. The primary exposure was BNS (largest diameter) measured intraoperatively just before performance of vesicourethral anastomosis. Other covariates included age, body mass index, NCCN risk category, nerve-sparing, membranous urethral length measured intraoperatively and weight of the resected specimen. Results Well-preserved neurovascular bundle (bilateral/unilateral/none) was highly correlated with urinary continence status at every point after surgery. No difference could be seen between the group with BNS ≤17 mm and the >17-mm group at 1, 3 and 6 months after surgery, but there was better urinary rate of continence in narrow BNS group (≤17 mm) at 12 and 24 months after surgery. Multivariate analysis showed both nerve sparing and bladder neck diameter to be independent factors affecting urinary continence at 12 and 24 months after surgery. Conclusion Preservation of neurovascular bundles was associated with better urinary continence after surgery. Smaller BNS was associated with better urinary continence in late stages after surgery (12-24 months after surgery).
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Affiliation(s)
- Yasuo Kohjimoto
- Department of UrologyWakayama Medical UniversityWakayamaJapan
| | | | | | - Kazuro Kikkawa
- Department of UrologyWakayama Medical UniversityWakayamaJapan
| | - Isao Hara
- Department of UrologyWakayama Medical UniversityWakayamaJapan
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14
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Sood A, Grauer R, Jeong W, Butaney M, Mukkamala A, Borchert A, Baumgarten L, Hensley PJ, Abdollah F, Menon M. Evaluating post radical prostatectomy mechanisms of early continence. Prostate 2022; 82:1186-1195. [PMID: 35579026 DOI: 10.1002/pros.24371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/11/2022] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND To identify the periprostatic structures associated with early return of urinary continence after radical prostatectomy (RP). METHODS We compared total continence results between four different techniques of robot-assisted radical prostatectomy (RARP). Specifically, we studied 1-week and 1-month zero-pad continence rates of anterior (n = 60), posterior (n = 59), a novel hybrid posterior-anterior (n = 12), and transvesical (n = 12) approaches of RARP. Each technique preserved a unique set of periprostatic anatomic structures, thereby, allowing evaluation of the individual impact of preservation of nerves, bladder neck, and space of Retzius with associated anterior support structures on early continence. Urethral length was preserved in all approaches. The space of Retzius was preserved in posterior and transvesical approaches, while the bladder neck was preserved in posterior and hybrid approaches. Nerve sparing was done per preoperative oncological risk. For all patients, 24-h pad usage rates and 24-h pad weights were noted at 1 week and 1 month after catheter removal. Multivariable logistic regression analysis was performed to identify predictors of early continence. Data were obtained from prospective studies conducted between 2015 and 2021. RESULTS At 1 week, 15%, 42%, 45%, and 8% of patients undergoing anterior, posterior, hybrid, and transvesical RARP approaches, respectively, were totally continent (p = 0.003). These rates at 1 month were 35%, 66%, 64%, and 25% (p = 0.002), respectively. The transvesical approach, which preserved the space of Retzius but not the bladder neck, was associated with the poorest continence rates, while the posterior and hybrid approaches in which the bladder neck was preserved with or without space of Retzius preservation were associated with quickest urinary continence recovery. Bladder neck preservation was the only significant predictor of 1-week and 1-month total continence recovery in adjusted analysis, Odds ratios 9.06 (p = 0.001) and 5.18 (p = 0.004), respectively. CONCLUSIONS The beneficial effect of the Retzius-sparing approach on early continence recovery maybe associated with bladder neck preservation rather than space of Retzius preservation.
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Affiliation(s)
- Akshay Sood
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York CIty, New York, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anudeep Mukkamala
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alex Borchert
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lee Baumgarten
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Patrick J Hensley
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Firas Abdollah
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mani Menon
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, Michigan, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York CIty, New York, USA
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15
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Xiangyun L, Zhen L, Mengyao H, Lin Z, Xiaonan S, Jingxiong W, Chunhui L, Wenwen C, Weigang Y, Yancai L. Curative effect of pelvic floor muscle exercise on urinary incontinence after radical prostatectomy—Comparisons of different approaches at different time point. Andrologia 2022; 54:e14373. [PMID: 35279870 DOI: 10.1111/and.14373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lu Xiangyun
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Liang Zhen
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Hu Mengyao
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Zhou Lin
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Sun Xiaonan
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Wu Jingxiong
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Liu Chunhui
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Chen Wenwen
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Yan Weigang
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
| | - Liang Yancai
- Department of Urology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Dongcheng District, Beijing China
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16
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Hoeh B, Wenzel M, Hohenhorst L, Köllermann J, Graefen M, Haese A, Tilki D, Walz J, Kosiba M, Becker A, Banek S, Kluth LA, Mandel P, Karakiewicz PI, Chun FKH, Preisser F. Anatomical Fundamentals and Current Surgical Knowledge of Prostate Anatomy Related to Functional and Oncological Outcomes for Robotic-Assisted Radical Prostatectomy. Front Surg 2022; 8:825183. [PMID: 35273992 PMCID: PMC8901727 DOI: 10.3389/fsurg.2021.825183] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 01/23/2023] Open
Abstract
Context Meticulous knowledge about the anatomy of the prostate and surrounding tissue represents a crucial and mandatory requirement during radical prostatectomy for reliable oncological and excellent replicable, functional outcomes. Since its introduction two decades ago, robotic-assisted laparoscopic radical prostatectomy (RALP) has evolved to become the predominant surgical approach in many industrialized countries. Objective To provide and highlight currently available literature regarding prostate anatomy and to help in improving oncological and functional outcomes in RALP. Methods/Evidence Acquiring PubMed database was searched using the following keywords: “robotic-assisted radical prostatectomy,” “anatomy,” “neurovascular bundle,” “nerve,” “periprostatic fascia,” “pelvis,” “sphincter,” “urethra,” “urinary incontinence,” and “erectile dysfunction.” Relevant articles and book chapters were critically reviewed and if eligible, they were included in this review. Results New evidence in regards to prostatic anatomy and surgical approaches in RALP has been reported in recent years. Besides detailed anatomical studies investigating the meticulous structure of the fascial structures surrounding the prostate and neurovascular bundle preservation, debate about the optimal RALP approach is still ongoing, inspired by recent publications presenting promising functional outcomes following modifications in surgical approaches. Conclusions This review provides a detailed overview of the current knowledge of prostate anatomy, its surrounding tissue, and its influence on key surgical step development for RALP.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- *Correspondence: Benedikt Hoeh
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Marina Kosiba
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Severine Banek
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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17
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Kohada Y, Ito J, Kaiho Y, Kusumoto H, Kukimoto T, Mikami J, Hinata N, Sato M. Importance of considering interest in sex when evaluating satisfaction after robot-assisted radical prostatectomy. Int J Urol 2022; 29:446-454. [PMID: 35133043 DOI: 10.1111/iju.14813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the impact of patients' interest in sex on the satisfaction after robot-assisted radical prostatectomy, longitudinal changes of urinary and sexual functions and bothers were evaluated. METHODS A total of 101 patients underwent robot-assisted radical prostatectomy in our institution. Based on sexual interest, they were divided into the high-interest and low-interest groups. Overall satisfaction, urinary function, urinary bother, sexual function, and sexual bother were evaluated using the expanded prostate cancer index composite questionnaire preoperatively and at 1, 3, 6, and 12 months after robot-assisted radical prostatectomy. We investigated the associations between the overall satisfaction and urinary function/urinary bother/sexual function/sexual bother scores (with higher score indicating better function and less impairment). RESULTS In the high-interest group (n = 45), satisfaction correlated with high urinary function and urinary bother scores early after robot-assisted radical prostatectomy (urinary function: 1 and 3 months, urinary bother: 3 months postoperatively; P < 0.05) and then with high sexual bother score thereafter (sexual bother at 6 and 12 months after surgery; P < 0.05). Sexual function score did not correlate with satisfaction. In the low-interest group (n = 56), satisfaction correlated with high urinary function and urinary bother scores over time (urinary function: 3 and 6 months, urinary bother: at 3, 6 and 12 months postoperatively; P < 0.05). Neither sexual function nor sexual bother correlated with satisfaction postoperatively in the low-interest group. CONCLUSIONS The impact of urinary and sexual functions and bothers on patients' overall satisfaction differed between patients with high- and low-interest in sex. The patient's interest in sex should be considered when assessing satisfaction after robot-assisted radical prostatectomy.
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Affiliation(s)
- Yuki Kohada
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.,Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Jun Ito
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuhiro Kaiho
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroki Kusumoto
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takashi Kukimoto
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Jotaro Mikami
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Makoto Sato
- Division of Urology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Elsayed AS, Ely HB, Abdelhakim MA, Saad IR, Jing Z, Iqbal U, Ramahi Y, Joseph J, Houenstein H, James G, Peabody JO, Razzak OA, Hussein AA, Guru KA. Preservation of Endopelvic Fascia, Puboprostatic Ligaments, Dorsal Venous Complex and Hydrodissection of the Neurovascular Bundles during Robot-Assisted Radical Prostatectomy: A Video Demonstration and Propensity Score Matched Outcomes. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100143] [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] Open
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19
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Anıl H, Karamık K, Yıldız A, Savaş M. Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes? Arch Ital Urol Androl 2021; 93:399-403. [PMID: 34933525 DOI: 10.4081/aiua.2021.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/19/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. MATERIALS AND METHODS The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. RESULTS Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). CONCLUSIONS Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.
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Affiliation(s)
- Hakan Anıl
- Department of Urology, Adana Seyhan State Hospital, Adana.
| | - Kaan Karamık
- Department of Urology, Antalya Korkuteli State Hospital, Antalya.
| | - Ali Yıldız
- Department of Urology, Okan University Hospital, Faculty of Medicine, Istanbul.
| | - Murat Savaş
- Department of Urology, Antalya Memorial Hospital, Antalya.
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20
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Neurovascular structure-adjacent frozen-section examination robotic-assisted radical prostatectomy: outcomes from 500 consecutive cases in the UK. J Robot Surg 2021; 16:951-956. [PMID: 34716876 DOI: 10.1007/s11701-021-01324-2] [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: 08/18/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
Abstract
The purpose is to report the United Kingdom's largest single-centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure-adjacent frozen-section (NeuroSAFE) technique. We describe the utilisation and outcomes of this technique. This is a retrospective study from 2012 to 2019 on 520 patients undergoing NeuroSAFE RALP at our Institution. Our Institution's database was analysed for false-positive frozen-section (FS) margins as confirmed on paraffin histopathological analysis: functional outcomes of potency, continence, and biochemical recurrence (BCR). The median (range) of console time was 145 (90-300) min. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of our patients' cohort (147/160). The neurovascular bundles (NVBs) that underwent secondary resection contained tumour in 26.8% (43/160) of the cases. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. There were insufficient evidence of a statistical association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. NeuroSAFE enables intraoperative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by ipsilateral wide resection. This spared 1 in 4 men from positive margins posterolaterally in our series. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre.
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21
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Schifano N, Capogrosso P, Tutolo M, Dehò F, Montorsi F, Salonia A. How to Prevent and Manage Post-Prostatectomy Incontinence: A Review. World J Mens Health 2021. [PMID: 33151045 DOI: 10.5534/wjmh.200114)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To provide an overview of the currently available evidence relating to the prevention and management strategies of urinary incontinence (UI) after radical prostatectomy (RP). MATERIALS AND METHODS A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning post-RP UI. The search strategy included these words: urinary continence; urinary continence recovery; urinary incontinence; radical prostatectomy; and prostate cancer. RESULTS Post-RP UI still represents a challenging issue for both urologic patients and clinicians. A complete preoperative assessment of the risk factors associated with post-RP UI aids both in counseling those patients with a higher estimated likelihood of postoperative UI and in identifying those who would probably benefit from preventive strategies in the preoperative and in the intraoperative settings. Over the last decades different surgical strategies based on either the "preservation" or the "reconstruction" of the anatomical elements responsible for urinary continence (UC) led to an overall improvement of postoperative functional outcomes. Finally, several therapeutic strategies should be evaluated for the postoperative UI management. Artificial urinary sphincter implantation represents the gold standard for treatment, notwithstanding its wide adoption is limited due to high costs and significant risk of surgical revision. In this context, male sling positioning seems the most promising strategy, in particular in mild and moderate post-RP UI. CONCLUSIONS To enhance the likelihood of obtaining an optimal UC recovery after RP, it is here strongly suggested to intervene throughout the overall clinical management process thus including the pre-, intra- and postoperative settings.
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Affiliation(s)
- Nicolò Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.
| | - Manuela Tutolo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.,University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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22
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Lim E, Leslie S, Thanigasalam R, Steffens D. To sling or not to sling? Impact of intraoperative sling procedures during radical prostatectomy on postoperative continence outcomes: A systematic review and meta‐analysis. BJUI COMPASS 2021; 2:226-237. [PMID: 35475296 PMCID: PMC8988831 DOI: 10.1002/bco2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose This systematic review and meta‐analysis investigates the efficacy of intraoperative sling procedures in reducing postprostatectomy urinary incontinence compared to having no slings. Methods A comprehensive search of PubMed, Medline, Embase, and the Cochrane library from inception to November 2020 was performed. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized studies and Newcastle‐Ottawa Scale for nonrandomized studies. The GRADE approach was used for critical appraisal of evidences and meta‐analyses were conducted using random‐effects models. Results Ten studies were included (n = 1,447). Quality of evidence ranged from moderate to very low. Sling procedure was generally favorable for short‐term continence outcomes, although discrepancies exist due to variability in continence definition. Sling procedure resulted in reduced urinary pad weight at 1 month postoperatively (MD: 21.55; 95%CI: 12.58 to 30.52). Patient‐reported questionnaires were also favorable for the sling group for up to 3 months (IPSS; (MD: 1.44; 95%CI: 0.14 to 2.74), ICIQ‐SF; (MD: 2.25; 95%CI: 1.26 to 3.24), EPIC‐U; (MD: 5.30; 95%CI: 1.12 to 9.39)) postoperatively. Sling procedure improved the number of continent patients at 1 month with continence definition of zero pad use/day (RR:1.41; 95%CI: 1.10 to 1.83) but not with the definition of ≤ 1pad/day. Similarly, it reduced the time to continence with the ≤ 1 pad/day definition (MD: 0.5; 95%CI: 0.1 to 0.9) but not with the zero pad/day definition. Conclusion The current literature suggests that intraoperative sling procedures during radical prostatectomy may promote early return of continence compared to having no sling, however, there are no long‐term differences.
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Affiliation(s)
- Eunice Lim
- RPA Institute of Academic Surgery (IAS) Royal Prince Alfred Hospital University of Sydney Sydney NSW Australia
- Concord Institute of Academic Surgery Concord Repatriation General Hospital Sydney NSW Australia
- Faculty of Medicine and Health University of Sydney Sydney NSW Australia
- Surgical Outcomes Research Centre (SOuRCe) Sydney NSW Australia
| | - Scott Leslie
- RPA Institute of Academic Surgery (IAS) Royal Prince Alfred Hospital University of Sydney Sydney NSW Australia
- Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Ruban Thanigasalam
- RPA Institute of Academic Surgery (IAS) Royal Prince Alfred Hospital University of Sydney Sydney NSW Australia
- Concord Institute of Academic Surgery Concord Repatriation General Hospital Sydney NSW Australia
- Faculty of Medicine and Health University of Sydney Sydney NSW Australia
| | - Daniel Steffens
- Faculty of Medicine and Health University of Sydney Sydney NSW Australia
- Surgical Outcomes Research Centre (SOuRCe) Sydney NSW Australia
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23
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Faria EF, Maciel CVM, Berger A, Mitre A, Dauster B, Freitas CH, Fraga C, Chade D, Dall'Oglio M, Carvalho F, Campos F, Carvalhal GF, Lemos GC, Guimarães G, Zampolli H, Alves JR, Manzano JP, Fortes MA, Rocha MFH, Rubinstein M, Luz M, Romanelli P, Coelho R, Rocha R, Machado RD, Dos Reis RB, Zequi S, Guida R, Muglia V, Tobias-Machado M. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus. J Robot Surg 2021; 15:829-839. [PMID: 33426578 DOI: 10.1007/s11701-020-01186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.
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Affiliation(s)
| | | | - André Berger
- Hospital Moinhos de Vento, Porto Alegre , RS, Brazil
| | - Anuar Mitre
- University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Daher Chade
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
| | | | | | - Franz Campos
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | - Murilo Luz
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
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24
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Anastomosis quality score during robot-assisted radical prostatectomy: a new simple tool to maximize postoperative management. World J Urol 2021; 39:2921-2928. [PMID: 33388913 DOI: 10.1007/s00345-020-03549-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The urethro-vesical anastomosis represents one of the most challenging steps of robotic prostatectomy (RARP). To maximize postoperative management, we specifically designed our anastomosis quality score (AQS), based on the intraoperative characteristics of the urethra and bladder neck. METHODS This is a prospective study, conducted from April 2019 to March 2020. All the patients were classified into three different AQS categories (low, intermediate, high) based on the quality of the anastomosis. The postoperative management was modulated accordingly. RESULTS We enrolled 333 patients. According to AQS, no differences were recorded in intraoperative complications (p = 0.9). Median hospital stay and catheterization time were longer in AQS 1 group (p < 0.001). Additionally, the occurrence of postoperative complication was higher in AQS 1 category (p = 0.002) but, when focusing on the complications related to the quality of the anastomosis, no differences were found neither for acute urinary retention (p = 0.12) nor urine leakage (p = 0.11). Finally, concerning the continence recovery, no significant differences were found among the three groups for each time point. The highest potency recovery rate at one month of follow-up was recorded in AQS 3 category (p = 0. 03). CONCLUSION The AQS proposed revealed to be a valid too to intraoperatively categorize patients who underwent RARP on the basis of the urethral and bladder neck features. The modulated postoperative management for each specific score category allowed to limit the occurrence of complications and to maximize the functional outcomes.
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25
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Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020; 9:3036-3048. [PMID: 33457277 PMCID: PMC7807332 DOI: 10.21037/tau.2020.03.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients’ quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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26
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Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020. [PMID: 33457277 DOI: 10.21037/tau.2020.03.36)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients' quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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27
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Davis M, Egan J, Marhamati S, Galfano A, Kowalczyk KJ. Retzius-Sparing Robot-Assisted Robotic Prostatectomy: Past, Present, and Future. Urol Clin North Am 2020; 48:11-23. [PMID: 33218585 DOI: 10.1016/j.ucl.2020.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.
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Affiliation(s)
- Meghan Davis
- Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA. https://twitter.com/MeghanFDavis1
| | - Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA. https://twitter.com/JillianEganMD
| | - Shawn Marhamati
- Austin Hospital, Department of Urology, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
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28
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Schifano N, Capogrosso P, Tutolo M, Dehò F, Montorsi F, Salonia A. How to Prevent and Manage Post-Prostatectomy Incontinence: A Review. World J Mens Health 2020; 39:581-597. [PMID: 33151045 PMCID: PMC8443978 DOI: 10.5534/wjmh.200114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/25/2020] [Accepted: 08/14/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To provide an overview of the currently available evidence relating to the prevention and management strategies of urinary incontinence (UI) after radical prostatectomy (RP). MATERIALS AND METHODS A comprehensive research was carried out on MEDLINE/PubMed database to identify pertinent studies concerning post-RP UI. The search strategy included these words: urinary continence; urinary continence recovery; urinary incontinence; radical prostatectomy; and prostate cancer. RESULTS Post-RP UI still represents a challenging issue for both urologic patients and clinicians. A complete preoperative assessment of the risk factors associated with post-RP UI aids both in counseling those patients with a higher estimated likelihood of postoperative UI and in identifying those who would probably benefit from preventive strategies in the preoperative and in the intraoperative settings. Over the last decades different surgical strategies based on either the "preservation" or the "reconstruction" of the anatomical elements responsible for urinary continence (UC) led to an overall improvement of postoperative functional outcomes. Finally, several therapeutic strategies should be evaluated for the postoperative UI management. Artificial urinary sphincter implantation represents the gold standard for treatment, notwithstanding its wide adoption is limited due to high costs and significant risk of surgical revision. In this context, male sling positioning seems the most promising strategy, in particular in mild and moderate post-RP UI. CONCLUSIONS To enhance the likelihood of obtaining an optimal UC recovery after RP, it is here strongly suggested to intervene throughout the overall clinical management process thus including the pre-, intra- and postoperative settings.
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Affiliation(s)
- Nicolò Schifano
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.
| | - Manuela Tutolo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.,University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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29
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Egan J, Marhamati S, Carvalho FLF, Davis M, O'Neill J, Lee H, Lynch JH, Hankins RA, Hu JC, Kowalczyk KJ. Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. Eur Urol 2020; 79:839-857. [PMID: 32536488 DOI: 10.1016/j.eururo.2020.05.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to improve continence. However, questions remain regarding feasibility and generalizability of technique and outcomes. OBJECTIVE To compare the outcomes of 140 consecutive standard robot-assisted radical prostatectomy (S-RARP) versus RS-RARP. DESIGN, SETTING, AND PARTICIPANTS A total of 70 S-RARPs were performed followed by 70 RS-RARPs. Demographic, pathologic, and functional outcomes were compared preoperatively and through 12 mo. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) was used to compare functional outcomes. Logistic and linear regression analyses were utilized to analyze variables associated with EPIC-CP urinary incontinence and overall quality of life (QOL) scores, and oncologic outcomes. Cox regression analysis was used to analyze incontinence at 12 mo. SURGICAL PROCEDURE RS-RARP versus S-RARP. MEASUREMENTS Patient and tumor characteristics (age, body mass index, prostate-specific antigen, Charlson Comorbidity Index, Gleason group, clinical stage, and Prostate Imaging Reporting and Data System score), perioperative outcomes (console time, estimated blood loss, postoperative complications, and length of stay), oncologic outcomes (positive surgical margin [PSM], and biochemical recurrence), overall and 12-mo continence rates (zero pads and zero to one safety pad), time to continence, potency (erection sufficient for sexual activity), EPIC-CP urinary incontinence, sexual function, and overall QOL scores. RESULTS AND LIMITATIONS Median follow-up for S-RARP versus RS-RARP was 46.3 versus 12.3 mo. RS-RARP versus S-RARP had improved overall continence rates at total follow-up (95.7% vs 85.7%, p = 0.042) and 12-mo follow-up (97.6% vs 81.4%, p = 0.002), and faster return to continence (zero to one safety pad, 44 vs 131 d, p < 0.001). RS-RARP EPIC-CP urinary incontinence and overall QOL scores remained significantly better at 12 mo. There were no differences in overall PSM rates, although RS-RARP had lower rates of nonfocal PSMs. There were no differences in sexual function. In multivariate analysis, RS-RARP was significantly associated with improved 12-mo EPIC-CP urinary incontinence and improved QOL scores, but was not associated with PSM or biochemical recurrence. Limitations include retrospective study design and unequal follow-up; however, significantly better RS-RARP continence at 12 mo is striking despite fewer patients attaining 12-mo follow-up. CONCLUSIONS RS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL. PATIENT SUMMARY Retzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control.
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Affiliation(s)
- Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shawn Marhamati
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Filipe L F Carvalho
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Meghan Davis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John O'Neill
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Harry Lee
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John H Lynch
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ryan A Hankins
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.
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30
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Averbeck MA, Marcelissen T, Anding R, Rahnama'i MS, Sahai A, Tubaro A. How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S119-S126. [PMID: 31821626 DOI: 10.1002/nau.23972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023]
Abstract
AIMS To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). METHODS This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" RESULTS Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. CONCLUSIONS Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
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Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Mohammad S Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University 2nd School of Medicine, Sant Andrea Hospital, Rome, Italy
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Dal Moro F, Zazzara M, Morlacco A, Gardiman MP, Costa G, Zattoni F. Is "extreme" bladder neck preservation in robot-assisted radical prostatectomy a safe procedure? Urologia 2020; 87:149-154. [PMID: 31964317 DOI: 10.1177/0391560319899253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim was to investigate the surgical and pathological outcomes of an "extreme" bladder neck preservation in prostate cancer patients treated with robotic radical prostatectomy. The greatest concern about the "extreme" bladder neck preservation is the potential risk of creating a positive surgical margin at the level of bladder neck. MATERIALS AND METHODS We prospectively collected data from 88 patients with diagnosed prostate cancer who underwent robotic radical prostatectomy with "'extreme' bladder neck preservation." All surgical procedures were performed by the same expert surgeon (F.D.M.). In this study, "'extreme' bladder neck preservation" was considered when the length of the spared intraprostatic segment of bladder neck was ⩾1 cm. We compared the histopathologic data with those of a homogeneous similar cohort of 88 consecutive patients who underwent robotic radical prostatectomy without bladder neck preservation. RESULTS The two groups analyzed were comparable according to clinical and pathological characteristics. A positive surgical margin at the level of bladder neck was found in five (5.7%) cases in the "extreme" bladder neck preservation group and in six cases (6.8%) in the no-bladder neck preservation group. The prostatic base was involved by neoplasia in 14 and 19 patients (15.9% and 21.6%, respectively); of these, five (35.7%) and six (31.6%) had positive surgical margin at the level of bladder neck, respectively. The pathological staging in positive surgical margin at the level of bladder neck patients was pT3 in five (100%) cases in the "extreme" bladder neck preservation group and in four (66.7%) cases when we decided not to preserve the bladder neck. CONCLUSION We demonstrated that "extreme" bladder neck preservation is a safe oncological procedure with similar pathologic findings of a comparable no-bladder neck preservation series. Positive surgical margins at the level of bladder neck are linked to neoplasia with adverse pathological features, rather than the "extreme" bladder neck preservation procedure.
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Affiliation(s)
- Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Padova, Italy.,Urologic Clinic, "Santa Maria della Misericordia" Hospital, University of Udine, Udine, Italy
| | - Michele Zazzara
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Padova, Italy
| | - Alessandro Morlacco
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Padova, Italy
| | | | - Giovanni Costa
- Department of Surgery, Oncology and Gastroenterology-Urology, University of Padova, Padova, Italy
| | - Fabio Zattoni
- Urologic Clinic, "Santa Maria della Misericordia" Hospital, University of Udine, Udine, Italy
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Salazar A, Regis L, Planas J, Celma A, Díaz F, Gallardo I, Trilla E, Morote J. Early continence after radical prostatectomy: A systematic review. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.acuroe.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Early continence after radical prostatectomy: A systematic review. Actas Urol Esp 2019; 43:526-535. [PMID: 31606163 DOI: 10.1016/j.acuro.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/11/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary incontinence is the adverse effect with more impact on patients' quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. EVIDENCE ACQUISITION We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. EVIDENCE SYNTHESIS The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. CONCLUSIONS The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique.
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Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8122068. [PMID: 31771310 PMCID: PMC6947283 DOI: 10.3390/jcm8122068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3–4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52–5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10–3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13–9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72–1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21–1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.
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Preisser F, Busto Martin L, Pompe RS, Heinze A, Haese A, Graefen M, Tilki D. Effect of bladder neck sparing at robot-assisted laparoscopic prostatectomy on postoperative continence rates and biochemical recurrence. Urol Oncol 2019; 38:1.e11-1.e16. [PMID: 31586543 DOI: 10.1016/j.urolonc.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/15/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Previous studies reported improved continence recovery by bladder neck sparing (BNS) in prostate cancer patients treated with robot-assisted laparoscopic radical prostatectomy (RALP), without compromising biochemical recurrence (BCR). We compared the continence outcomes, surgical margin rates, and BCR risk of BNS vs. bladder neck reconstruction (BNR) patients during RALP. METHODS Overall, 1,512 patients who underwent RALP with BNS or BNR between 2010 and 2017 in a single high-volume center, were identified. Logistic regression models tested the effect of BNS on continence and surgical margin rates. Cox regression models tested the effect of BNS on BCR. Continence was defined as the use of 0 or 1-safety pad per day. RESULTS Three hundred and eighty-two vs. 1,130 patients underwent BNS vs. BNR. The median time to catheter removal was significantly shorter (5 vs. 8 days) in patients with BNS. Pad-free rates at 7 days after catheter removal were 60.0% vs. 54.5%, continence rates were 80.1% vs. 78.3% after 3 months and 85.3% vs. 89.6% after 1 year for BNS and BNR, respectively. Multivariable models revealed that BNS is an independent predictor to be pad-free at 7 days after catheter removal (OR: 1.39, P = 0.04), but no predictor for continence at 3 months (OR: 1.02, P = 0.9) and 1 year (OR: 0.78, P = 0.4) after RALP, as well as for positive surgical margin (OR: 0.95, P = 0.8) and BCR (Hazard ratio: 0.95, P = 0.9). CONCLUSION Patients with BNS had a better chance to be pad-free at 7 days after catheter removal and had a significant shorter time to catheter removal. However, this beneficial effect disappeared with time and no differences in continence rates at 3 months and 1 year were recorded. Moreover, BNS did not negatively affect positive margin or BCR rates.
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Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Luis Busto Martin
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa S Pompe
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Heinze
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Zattoni F, Artibani W, Patel V, Montorsi F, Porpiglia F, Hampton LJ, Rocco B, Dasgupta P, Hemal AK, Mottrie A, Tewari A, Dal Moro F. Technical innovations to optimize continence recovery after robotic assisted radical prostatectomy. MINERVA UROL NEFROL 2019; 71:324-338. [DOI: 10.23736/s0393-2249.19.03395-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Cao L, Yang Z, Qi L, Chen M. Robot-assisted and laparoscopic vs open radical prostatectomy in clinically localized prostate cancer: perioperative, functional, and oncological outcomes: A Systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15770. [PMID: 31145297 PMCID: PMC6709105 DOI: 10.1097/md.0000000000015770] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To perform a systematic review and meta-analysis evaluating the perioperative, functional, and oncological outcomes and cost of robot-assisted radical prostatectomy (RARP), or laparoscopic radical prostatectomy (LRP) comparing with open radical prostatectomy (ORP) in men with clinically localized prostate cancer through all prospective comparative studies. METHODS A comprehensive literature search was performed in August 2018 using the Pubmed, Medline, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) and prospective studies including patients with clinically localized prostate cancer were eligible for study inclusion. Cumulative analysis was conducted using Review Manager v. 5.3 software. RESULTS Two RCTs and 9 prospective studies were included in this systematic review. There were no significant differences between RARP/LRP and ORP in overall complication rate, major complication rate, overall positive surgical margin (PSM) rate, ≤pT2 tumor PSM rate, ≥pT3 tumor PSM rate. Moreover, RARP/LRP and ORP showed similarity in biochemical recurrence (BCR) rate at 3, 12, 24 months postoperatively. Urinary continence and erectile function at 12 months postoperatively between RARP and ORP are also comparable. RARP/LRP were associated with significantly lower estimated blood loss [mean difference (MD) -749.67, 95% CI -1038.52 to -460.82, P = .001], lower transfusion rate (OR 0.17, 95% CI 0.10 to 0.30, P < .001) and less hospitalization duration (MD -1.18, 95% CI -2.18 to -0.19, P = .02). And RARP/LRP required more operative time (MD 50.02, 95% CI 6.50 to 93.55, P = .02) and cost. CONCLUSION RARP/LRP is associated with lower blood loss, transfusion rate and less hospitalization duration. The available data were insufficient to prove the superiority of any surgical approach in terms of postoperative complications, functional and oncologic outcomes.
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Affiliation(s)
| | - Zhenyu Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minfeng Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Gerbaud F, Charlanes A, Chesnel C, Voiry C, Le Breton F, Amarenco G, Manceau P. Effect of radical prostatectomy on involuntary pelvic floor muscle contraction. Neurourol Urodyn 2019; 38:1093-1099. [PMID: 30843273 DOI: 10.1002/nau.23959] [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: 08/21/2018] [Revised: 11/18/2018] [Accepted: 02/03/2019] [Indexed: 11/08/2022]
Abstract
AIMS Radical prostatectomy may cause stress urinary incontinence (SUI). We compared continent and incontinent men after radical prostatectomy, in regard to the change of the temporal pattern of pelvic floor activation during cough. METHODS Twenty-two patients were included in this prospective, multicentric study. All patients gave their informed consent. Simultaneous recordings of electromyographic activity of external anal sphincter (EAS EMG) and external intercostal muscle (EIC EMG) during cough were performed with a pair of pregelled surface electrodes. Cough effort caused an involuntary pelvic contraction. Intercostal muscles recording was chosen because they are one of the muscular components of cough initiation with diaphragm muscle. Twenty-four-hour pad-weighing test was used to quantify urinary incontinence. The primary endpoint was the latency between the onset of EIC EMG and EAS EMG (RT3), during a cough effort. We also measured the contraction time, the maximum EAS EMG activity, and the area under the curve. RESULTS All the patients were analyzed: 12 continent and 10 with SUI. The median age was 66 years old. Both groups were similar except in term of follow-up. Median latency was increased by -1.7 ms (-47.9; +34.2) to 55.8 ms (+47.5; +80) in patients with SUI (P = 0.0033; Table 2). The duration of the contraction, the maximum EAS EMG activity and the area under the curve were not different. CONCLUSIONS The latency between the onset of EIC EMG and EAS EMG is increased in patients with SUI after radical prostatectomy. It may be one of the reasons for SUI in these patients.
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Affiliation(s)
- Florian Gerbaud
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Audrey Charlanes
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Camille Chesnel
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Caroline Voiry
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Frederique Le Breton
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Gérard Amarenco
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Philippe Manceau
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
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Arroyo C, Martini A, Wang J, Tewari AK. Anatomical, surgical and technical factors influencing continence after radical prostatectomy. Ther Adv Urol 2019; 11:1756287218813787. [PMID: 30671134 PMCID: PMC6329031 DOI: 10.1177/1756287218813787] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
Radical prostatectomy (RP) is the most frequent treatment with curative intent performed for prostate cancer to date. Different surgical approaches (perineal, transperitoneal, and extraperitoneal) and techniques (laparoscopic and robot assisted) have been described to increase the efficiency and potentially diminish the postoperative complications of this procedure. The aim of this narrative review is to investigate and define the factors that influence postprostatectomy urinary continence. We highlighted the anatomical landmarks and the modifications of surgical techniques aimed at improving the continence rates and thus, patient quality of life. After RP, the long-term continence rates range from 84% to 97%. In order to achieve good continence rates, a careful dissection along with meticulous anatomical reconstruction is required. To this end, a detailed knowledge of the periprostatic anatomy is mandatory.
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Affiliation(s)
- Carlos Arroyo
- Department of Urology, Hospital Ángeles Puebla, Universidad Anahuac, School of Medicine, Puebla, c.p.72820, Puebla, Mexico
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Joanna Wang
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
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Manfredi M, Fiori C, Amparore D, Checcucci E, Porpiglia F. Technical details to achieve perfect early continence after radical prostatectomy. MINERVA CHIR 2019; 74:63-77. [DOI: 10.23736/s0026-4733.18.07761-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ko YH. Functional recovery after radical prostatectomy for prostate cancer. Yeungnam Univ J Med 2018; 35:141-149. [PMID: 31620586 PMCID: PMC6784702 DOI: 10.12701/yujm.2018.35.2.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/12/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
With the enthusiasm regarding robotic application in radical prostatectomy in accordance with the widespread use of serum prostate-specific antigen as a screening test, the number of surgeries performed for complete removal of the gland is increasing continuously. However, owing to the adjacent anatomical location of the prostate to the nerve and urethral sphincter complex, functional recovery, namely improvement from post-prostatectomy incontinence (PPI) and post-prostatectomy erectile dysfunction, still remains a main problem for patients who are reluctant to undergo surgery and tend to choose alternative ways instead. Since the late 1980s, the introduction of radical prostatectomy by open surgical modalities, the depth of the anatomical understanding of the structure surrounding the prostate is getting tremendous, which leads to the development of new surgical modalities and techniques that are consequently aimed at reducing the incidences of PPI and erectile dysfunction. Briefly, recent data from robotic radical prostatectomy, particularly on PPI, are quite acceptable, but by contrast, the reported potency regain rate still remains <20%, which indicates the need for advanced surgical modification to overcome it. In this review, the authors summarized the recent findings on the anatomy and surgical techniques reported up to now.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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Koizumi A, Narita S, Nara T, Takayama K, Kanda S, Numakura K, Tsuruta H, Maeno A, Huang M, Saito M, Inoue T, Tsuchiya N, Satoh S, Nanjo H, Habuchi T. Incidence and location of positive surgical margin among open, laparoscopic and robot-assisted radical prostatectomy in prostate cancer patients: a single institutional analysis. Jpn J Clin Oncol 2018; 48:765-770. [PMID: 29931077 DOI: 10.1093/jjco/hyy092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To evaluate the positive surgical margin rates and locations in radical prostatectomy among three surgical approaches, including open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. Methods We retrospectively reviewed clinical outcomes at our institution of 450 patients who received radical prostatectomy. Multiple surgeons were involved in the three approaches, and a single pathologist conducted the histopathological diagnoses. Positive surgical margin rates and locations among the three approaches were statistically assessed, and the risk factors of positive surgical margin were analyzed. Results This study included 127, 136 and 187 patients in the open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy groups, respectively. The positive surgical margin rates were 27.6% (open radical prostatectomy), 18.4% (laparoscopic radical prostatectomy) and 13.4% (robot-assisted radical prostatectomy). In propensity score-matched analyses, the positive surgical margin rate in the robot-assisted radical prostatectomy was significantly lower than that in the open radical prostatectomy, whereas there was no significant difference in the positive surgical margin rates between robot-assisted radical prostatectomy and laparoscopic radical prostatectomy. In the multivariable analysis, PSA level at diagnosis and surgical approach (open radical prostatectomy vs robot-assisted radical prostatectomy) were independent risk factors for positive surgical margin. The apex was the most common location of positive surgical margin in the open radical prostatectomy and laparoscopic radical prostatectomy groups, whereas the bladder neck was the most common location in the robot-assisted radical prostatectomy group. The significant difference of positive surgical margin locations continued after the propensity score adjustment. Conclusions Robot-assisted radical prostatectomy may potentially achieve the lowest positive surgical margin rate among three surgical approaches. The bladder neck was the most common location of positive surgical margin in robot-assisted radical prostatectomy and apex in open radical prostatectomy and laparoscopic radical prostatectomy. Although robot-assisted radical prostatectomy may contribute to the reduction of positive surgical margin, dissection of the bladder neck requires careful attention to avoid positive surgical margins.
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Affiliation(s)
- Atsushi Koizumi
- Department of Urology, Akita University School of Medicine, Akita
| | - Shintaro Narita
- Department of Urology, Akita University School of Medicine, Akita
| | - Taketoshi Nara
- Department of Urology, Akita University School of Medicine, Akita
| | | | - Sohei Kanda
- Department of Urology, Akita University School of Medicine, Akita
| | | | - Hiroshi Tsuruta
- Department of Urology, Akita University School of Medicine, Akita
| | - Atsushi Maeno
- Department of Urology, Akita University School of Medicine, Akita
| | - Mingguo Huang
- Department of Urology, Akita University School of Medicine, Akita
| | - Mitsuru Saito
- Department of Urology, Akita University School of Medicine, Akita
| | - Takamitsu Inoue
- Department of Urology, Akita University School of Medicine, Akita
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University School of Medicine, Yamagata
| | - Shigeru Satoh
- Department of Urology, Akita University School of Medicine, Akita
| | - Hiroshi Nanjo
- Department of Pathology, Akita University Hospital, Akita, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita
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Hajiha M, Baldwin DD. Factors affecting urinary incontinence during robotic radical prostatectomy. Transl Androl Urol 2018; 7:S93-S95. [PMID: 29644170 PMCID: PMC5881208 DOI: 10.21037/tau.2018.01.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohammad Hajiha
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
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Sridhar AN, Abozaid M, Rajan P, Sooriakumaran P, Shaw G, Nathan S, Kelly JD, Briggs TP. Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer. Curr Urol Rep 2018; 18:71. [PMID: 28718165 PMCID: PMC5514172 DOI: 10.1007/s11934-017-0717-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose of Review A variety of different surgical techniques are thought to impact on urinary continence (UC) recovery in patients undergoing robot assisted radical prostatectomy (RARP) for prostate cancer. Herein, we review current evidence and propose a composite evidence-based technique to optimize UC recovery after RARP. Recent Findings A literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. The available data from studies ranging from randomized control trials to retrospective cohort studies suggest that minimizing damage to the internal and external urinary sphincters and their neural supply, maximal sparing of urethral length, creating a secure vesicourethral anastomosis, and providing anterior and posterior myo- fascio-ligamentous support to the anastomosis can improve early UC recovery post RARP. Summary A composite evidence-based surgical technique incorporating the above principles could optimize early UC recovery post RARP. Evidence from randomized studies is required to prove benefit.
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Affiliation(s)
- Ashwin N. Sridhar
- Department of Urology, University College London Hospital, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Mohammed Abozaid
- Department of Urology, University College London Hospital, London, UK
| | - Prabhakar Rajan
- Department of Urology, University College London Hospital, London, UK
| | - Prasanna Sooriakumaran
- Department of Urology, University College London Hospital, London, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Greg Shaw
- Department of Urology, University College London Hospital, London, UK
| | - Senthil Nathan
- Department of Urology, University College London Hospital, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - John D. Kelly
- Department of Urology, University College London Hospital, London, UK
- Division of Surgery and Cancer, University College London, London, UK
| | - Tim P Briggs
- Department of Urology, University College London Hospital, London, UK
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Abstract
PURPOSE OF REVIEW Robotic-assisted radical prostatectomy has been rapidly adopted and is now the standard of care in the surgical management of prostate cancer. Since the initial description in 2001, the technique has evolved to optimize oncological functional outcomes. Herein, we review key techniques for the robotic-assisted radical prostatectomy. RECENT FINDINGS With the current influx of new technology such as focal therapy, stereotactic body radiation therapy and prostate-sparing treatments, there is greater emphasis on maximizing outcomes of robotic-assisted radical prostatectomy. The evidence-based techniques of optimizing oncological outcomes including the lymph node dissection and improving cancer control through minimizing positive surgical margins are reviewed. Improvements in functional recovery has also been seen with technical modifications such as nerve sparing, preservation of the urethral support structures and the bladder neck and the urethra-vesical reconstruction. SUMMARY Robotic prostatectomy has demonstrated adequate long-term oncologic success and satisfactory functional recovery. As technology and techniques in robotic-assisted surgery evolve, surgeons will continue to optimize techniques to maximize functional outcome recovery and cancer control. Further studies are actively being conducted to provide level one evidence in multiple aspects of the robotic-assisted radical prostatectomy.
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Complete bladder neck preservation promotes long-term post-prostatectomy continence without compromising midterm oncological outcome: analysis of a randomised controlled cohort. World J Urol 2017; 36:349-355. [PMID: 29214353 DOI: 10.1007/s00345-017-2134-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The only RCT available on complete bladder neck preservation (cBNP) during radical prostatectomy reported superior continence and QoL outcomes in the first 12 months after cBNP. We provide the first data on long-term urinary continence, QoL and biochemical recurrence (BCR) after complete bladder neck preservation in a randomised controlled cohort. METHODS After approval by IRB, 199 men recruited for the randomised, controlled single-blind Heidelberger cBNP Study had prostatectomy performed with (cBNP) or without (noBNP) complete bladder neck preservation. Only men with renewed consent for this follow-up were evaluated for continence, QoL outcomes and BCR by ICIQ-SF self-assessment questionnaire, Pad-use/day and PSA levels. Students-t test, Pearson´s Chi-square, Fishers exact test and multiple logistic regression analyses were applied. RESULTS Mean follow-up was approx. 4 years. There were no significant differences in baseline characteristics between responders/non-responders or between study groups. We noted significantly higher continence rates (p = 0.004), less pad-use (p < 0.001), reduced frequency (p = 0.023) and amount (p = 0.009) of urine loss, and higher QoL outcomes (p = 0.012) after cBNP. A younger age positively influenced continence (OR = 0.91), but the multivariate analysis found cBNP to be the only independent predictor of continence (p = 0.008; OR = 8.1). pT stage was the only predictor for positive surgical margins (PSM; p < 0.001). There was no significant difference in pT stage (p = 0.23) or BCR (p = 0.63) between study groups and also no significant correlation between BCR and presence (p = 0.26) or localisation (p = 0.11) of PSM, nerve sparing (p = 0.70), surgeon (p = 0.41), preoperative PSA (p = 0.53) or pT stage (p = 0.17). No cancer-related death was noted. CONCLUSIONS Results of this first follow-up on a prospective randomised controlled cohort demonstrate that cBNP is associated with significantly higher continence and QoL outcomes without compromising cancer control making cBNP a novel objective during radical prostatectomy.
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Bellangino M, Verrill C, Leslie T, Bell RW, Hamdy FC, Lamb AD. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy. Curr Urol Rep 2017; 18:99. [PMID: 29116405 PMCID: PMC5676800 DOI: 10.1007/s11934-017-0745-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. EVIDENCE ACQUISITION We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. EVIDENCE SYNTHESIS Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could include modification of intended approach to bladder neck dissection when anterior base lesions are identified on pre-operative MRI.
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Affiliation(s)
- Mariangela Bellangino
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Department of Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Leslie
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard W. Bell
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Freddie C. Hamdy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D. Lamb
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Dal Moro F. How robotic surgery is changing our understanding of anatomy. Arab J Urol 2017; 16:297-301. [PMID: 30140465 PMCID: PMC6104660 DOI: 10.1016/j.aju.2017.10.001] [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: 08/16/2017] [Accepted: 10/05/2017] [Indexed: 11/18/2022] Open
Abstract
The most recent revolution in our understanding and knowledge of the human body is the introduction of new technologies allowing direct magnified vision of internal organs, as in laparoscopy and robotics. The possibility of viewing an anatomical detail, until now not directly visible during open surgical operations and only partially during dissections of cadavers, has created a ‘new surgical anatomy’. Consequent refinements of operative techniques, combined with better views of the surgical field, have given rise to continual and significant decreases in complication rates and improved functional and oncological outcomes. The possibility of exploring new ways of approaching organs to be treated now allows us to reinforce our anatomical knowledge and plan novel surgical approaches. The present review aims to clarify some of these issues.
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Affiliation(s)
- Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology - Urology, University of Padua, Padua, Italy
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Hashimoto T, Yoshioka K, Gondo T, Hasama K, Hirasawa Y, Nakashima J, Tachibana M, Ohno Y. The Impact of Lateral Bladder Neck Preservation on Urinary Continence Recovery After Robot-Assisted Radical Prostatectomy. J Endourol 2017; 32:40-45. [PMID: 28978229 DOI: 10.1089/end.2017.0459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Urinary incontinence is one of the most bothersome adversities after robot-assisted radical prostatectomy (RARP). The aim of this study was to investigate the urinary continence recovery and the effect of various surgical techniques. MATERIALS AND METHODS We previously reported that posterior rhabdosphincter reconstruction and nerve-sparing were independent predictors of urinary continence recovery 1 month after catheter removal in 199 patients who underwent RARP. Retrospectively, we further reviewed those 199 patients for urinary continence recovery at 3 months or later after RARP. The relationships of urinary continence with perioperative findings, including surgical procedures, were evaluated at 3 to 12 months after RARP. The Fisher exact test and Mann-Whitney rank sum test were used for evaluating variables between the groups. Multivariate logistic regression analysis was performed to investigate the association between urinary continence and perioperative factors. RESULTS On univariate analyses, surgeon experience, lateral bladder neck preservation (BNP), anterior reconstruction, and posterior reconstruction were significantly associated with urinary continence recovery 3 months after RARP, but only lateral BNP was independently associated with urinary continence recovery in a multivariate analysis. Similarly, on univariate analyses, surgeon experience, lateral BNP, and posterior reconstruction were significantly associated with continence recovery at 6 months or later after surgery. However, multivariate analyses showed that only lateral BNP was significantly associated with urinary continence recovery 6 months or later after surgery. CONCLUSION Although the lateral BNP technique did not affect immediate urinary continence recovery, this procedure was significantly associated with continence recovery 3 months or later after RARP.
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Affiliation(s)
| | - Kunihiko Yoshioka
- 1 Department of Urology, Tokyo Medical University , Tokyo, Japan .,2 Institute for Urology , Shin-yurigaoka General Hospital, Kawasaki, Japan
| | - Tatsuo Gondo
- 1 Department of Urology, Tokyo Medical University , Tokyo, Japan
| | - Kazuki Hasama
- 1 Department of Urology, Tokyo Medical University , Tokyo, Japan
| | - Yosuke Hirasawa
- 1 Department of Urology, Tokyo Medical University , Tokyo, Japan
| | - Jun Nakashima
- 1 Department of Urology, Tokyo Medical University , Tokyo, Japan .,3 Department of Urology, Sanno Hospital , Tokyo, Japan .,4 Clinical Medicine Research Center, International University of Health and Welfare , Tokyo, Japan
| | | | - Yoshio Ohno
- 1 Department of Urology, Tokyo Medical University , Tokyo, Japan
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