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Lenart S, Holub M, Gutjahr G, Berger I, Ponholzer A. Prolonged indwelling catheter time after RARP does not lead to follow-up surgery. World J Urol 2024; 42:379. [PMID: 38888747 PMCID: PMC11189305 DOI: 10.1007/s00345-024-05080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Indwelling catheterization following radical prostatectomy is used to aid healing and urinary drainage. While early removal is well investigated, prolonged catheterization has only been investigated in terms of urinary incontinence. Other complications such as anastomotic strictures are unexplored so far. This study aims to analyze the sequelae of catheterization lasting more than 14 days after robotic-assisted radical prostatectomy (RARP). METHODS A prospective database of 3087 patients undergoing RARP was analyzed, focusing on 180 patients with catheterization exceeding 14 days (Group A) and 88 matched controls (Group B). Outcome measures included subsequent surgeries, complications, and functional outcomes. RESULTS Prolonged catheterization did not significantly increase the need for subsequent surgeries (6% in Group A vs. 7% in Group B, p = .95). However, anastomotic strictures were more common in Group A (3%) compared to Group B (0%) after exclusion of risk factors. Incontinence rates were similar between groups, although a subgroup analysis revealed higher incontinence rates in patients with catheterization exceeding 28 days. No significant differences were observed in erectile function or quality of life between the groups. CONCLUSION Prolonged catheterization after RARP does not independently increase the risk of anastomotic strictures in the general population. However, in patients without risk factors, prolonged catheter dwell time may elevate the risk of strictures and subsequent surgeries. Additionally, patients with catheterization exceeding 28 days may experience higher rates of long-term incontinence. Further studies with larger sample sizes are needed to confirm these findings and elucidate the long-term implications of prolonged catheterization.
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Affiliation(s)
- Sebastian Lenart
- Department of Urology and Andrology, St. John of God Hospital Vienna - Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott Platz 1, Vienna, 1020, Austria.
| | - Markus Holub
- Department of Urology and Andrology, St. John of God Hospital Vienna - Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott Platz 1, Vienna, 1020, Austria
| | - Georg Gutjahr
- Department of Mathematics, Center of Research in Analytics and Technologies for Education, Amrita Vishwa Vidyapeetham, Amritapuri, Kollam, India
| | - Ingrid Berger
- Department of Urology and Andrology, St. John of God Hospital Vienna - Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott Platz 1, Vienna, 1020, Austria
| | - Anton Ponholzer
- Department of Urology and Andrology, St. John of God Hospital Vienna - Krankenhaus der Barmherzigen Brüder Wien, Johannes-von-Gott Platz 1, Vienna, 1020, Austria
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2
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Tohi Y, Kohashiguchi K, Miura T, Miyauchi Y, Matsuoka Y, Kato T, Taoka R, Tsunemori H, Ueda N, Sugimoto M. Impact of the severity of urethrovesical anastomotic leakage on urinary continence following robot-assisted laparoscopic prostatectomy. J Robot Surg 2022; 16:1175-1181. [PMID: 35091968 DOI: 10.1007/s11701-021-01357-7] [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: 09/06/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
We assessed whether the severity of anastomotic urinary leakage detected during routine cystourethrography after robot-assisted laparoscopic prostatectomy (RALP) affects urinary continence recovery. Around 302 patients who underwent RALP between August 2013 and May 2019 were included retrospectively. According to routine cystourethrographic findings obtained on the sixth or eighth postoperative day, which indicated leakage severity, patients were divided into three groups: no-leakage, grade 1 (linear shaped leakage, but not spreading), and grade 2 (spreading strip-shaped leakage). The preoperative factors and intraoperative factors were compared between no-leakage and leakage group (grade 1 and grade 2). Continence recovery was compared between the three groups. Continence recovery was defined as no pad used or one security pad used in a day. Cystourethrography revealed anastomotic urinary leakage in 44 patients (14.5%), of which 20 patients (6.6%) had grade 1 leakage and 24 patients (7.9%) had grade 2 leakage. On multivariate logistic regression analysis, the only significant predictor for urethrovesical anastomotic urinary leakage on cystourethrography following RALP was intraoperative anastomotic leakage (OR 5.306; 95% CI 1.530-18.398, p = 0.009). Continence recovery rates for no-leakage, grade 1 leakage, and grade 2 leakage groups were 11%, 20%, and 25% after 1 month (P = 0.131); 25%, 25%, and 45.8% after 3 months (P = 0.474); 44.6%, 55%, and 60.8% after 6 months (P = 0.184); and 63.1%, 87.5%, and 78.2% after 12 months (P = 0.095), respectively. In conclusion, urinary leakage in urethrovesical anastomosis, even at its severity, had no negative effects on continence recovery after RALP.
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Affiliation(s)
- Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Kana Kohashiguchi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takayoshi Miura
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasuyuki Miyauchi
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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3
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Iwamoto H, Kadono Y, Nakagawa R, Makino T, Kadomoto S, Yaegashi H, Iijima M, Kawaguchi S, Nohara T, Shigehara K, Izumi K, Mizokami A. Examination of Necessity for Pelvic Drain Placement After Robot-assisted Radical Prostatectomy. In Vivo 2021; 35:2895-2899. [PMID: 34410984 DOI: 10.21873/invivo.12579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pelvic drain (PD) placement is commonly performed after robot-assisted radical prostatectomy (RARP), but the need for PD placement is unclear. This study aimed to assess the need for PD placement after RARP. PATIENTS AND METHODS This retrospective study analysed the effect of PD placement on postoperative complications in patients who underwent RARP between 2009 and 2018. All patients prior to October 1, 2016 had a PD placed; those after did not. RESULTS Of the 308 study patients, 231 received a PD (PD group) and 77 did not (ND group). The incidence of ileus, urinary tract infection and anastomotic leak did not differ significantly between the groups; nor did the incidence of asymptomatic and symptomatic lymphocele at 2 weeks and 1 year after surgery. Multivariate analysis showed that lymph node dissection is a predictor of asymptomatic lymphocele development two weeks after surgery. CONCLUSION PD placement is not necessary after RARP.
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Affiliation(s)
- Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan;
| | - Ryunosuke Nakagawa
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomoyuki Makino
- Department of Urology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Suguru Kadomoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masashi Iijima
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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4
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Kakutani S, Takeshima Y, Yamada Y, Fujimura T, Nagamoto S, Enomoto Y, Hakozaki Y, Kimura N, Teshima T, Akiyama Y, Sato Y, Kawai T, Yamada D, Kume H. Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study. BMC Urol 2021; 21:75. [PMID: 33941161 PMCID: PMC8091677 DOI: 10.1186/s12894-021-00844-1] [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: 02/08/2021] [Accepted: 04/20/2021] [Indexed: 05/31/2023] Open
Abstract
Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.
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Affiliation(s)
- Shigenori Kakutani
- Department of Urology, Chiba Tokushukai Hospital, Chiba, Japan.,Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yuta Takeshima
- Division of Innovative Cancer Therapy, Advanced Research Center, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | | | | | - Yutaka Enomoto
- Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yuji Hakozaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Naoki Kimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Taro Teshima
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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5
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Köhler N, El-Bandar N, Maxeiner A, Ralla B, Miller K, Busch J, Friedersdorff F. Early Continence and Extravasation After Open Retropubic Radical Prostatectomy - Interrupted vs Continuous Suturing for Vesicourethral Anastomosis. Ther Clin Risk Manag 2021; 16:1289-1296. [PMID: 33380800 PMCID: PMC7767697 DOI: 10.2147/tcrm.s278454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare running suture (RS) and interrupted suture (IS) of vesicourethral anastomosis (VUA) during open retropubic radical prostatectomy (RRP) on early urinary continence and extravasation. Patients and Methods Single center analysis of 211 patients who underwent RRP performed by a single surgeon during 2008 to 2017 was retrospectively analyzed. For VUA, we used the standard interrupted suture technique (n=100) with a 3-0 PDS suture. The RS (n=111) was performed with 12-bite suture using 3-0 PDS. The primary endpoints were extravasation and early continence. Demographic and peri-operative data were collected and analyzed using Pearson's chi-square, t-Test and Mann-Whitney U-test. A binary logistic regression analysis was carried out to explore predictors that affected early continence after catheter removal. Results The rates of early urinary incontinence (UI) were 7.7% vs 42.2% (p<0.001). The duration of catheterization and hospitalization was significantly shorter in the interrupted group (4 days vs 5 days, p<0.001 and 5 days vs 6 days, p<0.001). The groups did not differ significantly in body mass index or prostate volume. There were older patients and higher PSA levels in the group with RS technique. No significant difference was found in the postoperative extravasation rates between both groups (13.5% vs 12%, p=0.742). Conclusion Running vesicourethral anastomosis increased the rate of early urinary incontinence. Both anastomosis techniques provided a similar rate of postoperative urine extravasation. VUA should only be one of the many criteria that must be considered for the preservation of urinary continence of patients after RRP.
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Affiliation(s)
- Nora Köhler
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Nasrin El-Bandar
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Bernhard Ralla
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Jonas Busch
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität Zu Berlin, and Berlin Institute of Health, Berlin 10117, Germany
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6
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Li J, Zhang Q, Xie J, Yin B. Continuous poliglecaprone suture versus bidirectional barded suture for urethrovesical anastomosis during laparoscopic radical prostatectomy: a single-institute retrospective analysis of Chinese patients. Gland Surg 2020; 9:1305-1312. [PMID: 33224805 PMCID: PMC7667099 DOI: 10.21037/gs-20-371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/31/2020] [Indexed: 08/18/2023]
Abstract
BACKGROUND To compare the outcomes of bidirectional barbed suture and continuous poliglecaprone suture for urethrovesical anastomosis (UVA) during laparoscopic radical prostatectomy (LRP). METHODS Single-needle poliglecaprone suture was used for UVA in Group 1 (n=27), and double-needle bidirectional barbed suture was used for UVA (n=27) in Group 2. Age, body mass index (BMI), prostate-specific antigen (PSA) level, prostate volume, operative time, anastomosis time, estimated blood loss, Gleason score, number of hospitalization days, and urinary continence at postoperative month 1, 3, 6, and 12 were analyzed statistically. RESULTS There were no significant differences in age, BMI, prostate volume, PSA level, Gleason score, and indwelling catheter time between the two groups. However, bidirectional barbed suture was associated with a significantly shorter anastomosis time (P=0.007), operation time (P=0.008) and hospitalization duration (P<0.001), and a significantly lower blood loss volume (P=0.005). At the first-month follow-up, urinary continence was achieved in 5 (19%) and 15 (56%) patients in Group 1 and 2, respectively (P=0.005); postoperative third month: 11 (41%) and 23 (85%) patients in Group 1 and 2 respectively (P=0.001); postoperative sixth month: 21 (78%) and 25 (93%) patients in Group 1 and 2 respectively (P=0.250); postoperative first year: 25 (93%) and 27 (100%) patients in Group 1 and 2 respectively (P=0.471). Multivariate regression analysis showed that anastomosis time (HR =0.636; P<0.001) was an independent predictor of postoperative continence. CONCLUSIONS The current findings show that bidirectional barbed suture for UVA during LRP can shorten UVA time and provide better outcomes in terms of early urinary continence recovery.
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Affiliation(s)
- Jiaxing Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianwei Xie
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bo Yin
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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7
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Riikonen J, Pakarainen T, Siltari A, Pienimäki JP, Koskimäki J, Murtola TJ. Urine colour as an indicator for anastomotic leakage after robot-assisted radical prostatectomy. Scand J Urol 2020; 54:201-207. [PMID: 32308088 DOI: 10.1080/21681805.2020.1750474] [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: 10/24/2022]
Abstract
Objectives: To determine whether macroscopic haematuria predicts urethrovesical anastomotic leakage after robot-assisted laparoscopic radical prostatectomy (RALP) as well as a cystogram.Patients and methods: Participants were recruited before cystogram and catheter removal 5-14 days after RALP surgery. Urine colour in the collection bag was classified according to a three-step scale (clear, light red and dark red) and leakages in cystogram were graded with a four-step scale (Grade 0-3). Diagnostic accuracy parameters were calculated for urine colour. A multivariate logistic regression model was used to evaluate other leakage risk factors.Results: Of 214 patients, 201 (94%) had clear, six (3%) had light red and seven (3%) had dark red coloured urine. In the cystogram, 20 (9%) patients had leakage; 14 had Grade 1, five Grade 2 and one Grade 3 leakage. Overall, specificity and sensitivity of urine colour in predicting anastomotic leakage were 0.97 (95% CI = 0.95-100) and 0.38 (95% CI = 0.17-0.59), respectively. Negative and positive predictive values were 94% and 62%, respectively. Other significant risk factors for anastomotic leakage were previous transurethral resection or radiation therapy to the prostate, non-waterproof anastomosis at surgery, postoperative pelvic haematoma, long catheterization and surgeon's inexperience. In patients with no other risk factors, test sensitivity improved to 0.80 (95% CI = 0.45-1.15) and negative and positive predictive values to 99% and 44%, respectively.Conclusion: This prospective single-arm trial indicates that in patients with clear urine and no other risk factors for anastomotic leakage, a cystogram examination before urethral catheter removal can be safely omitted.
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Affiliation(s)
- Jarno Riikonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Tomi Pakarainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Aino Siltari
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha-Pekka Pienimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Juha Koskimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAYS Cancer Center, Department of Urology, Tampere University Hospital, Tampere, Finland.,Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
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8
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Modig KK, Godtman RA, Bjartell A, Carlsson S, Haglind E, Hugosson J, Månsson M, Steineck G, Thorsteinsdottir T, Tyritzis S, Lantz AW, Wiklund P, Stranne J. Vesicourethral Anastomotic Stenosis After Open or Robot-assisted Laparoscopic Retropubic Prostatectomy-Results from the Laparoscopic Prostatectomy Robot Open Trial. Eur Urol Focus 2019; 7:317-324. [PMID: 31711932 DOI: 10.1016/j.euf.2019.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vesicourethral anastomotic stenosis is a well-known late complication after open radical retropubic prostatectomy (RRP) with previously reported incidences of 2.7-15%. There are few reports of the incidence after robot-assisted laparoscopic radical prostatectomy (RALP) compared with RRP. OBJECTIVE The aim was to compare the risk of developing symptomatic stenosis after RRP and RALP, and to explore potential risk factors and the influence of stenosis on the risk of urinary incontinence. DESIGN, SETTING, AND PARTICIPANTS Between 2008 and 2011, 4003 men were included in a prospective trial comparing RRP and RALP at 14 Swedish centres. Clinical data and patient questionnaires were collected before, during, and after surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Stenosis was identified by either patients' reports in questionnaires or case report forms. The primary endpoint is reported as unadjusted as well as adjusted relative risks (RRs), calculated with log-binomial regression models. Data on incontinence were analysed by means of a log-binomial regression model, with stenosis as an independent and incontinence as a dependent variable. RESULTS AND LIMITATIONS Symptomatic stenosis developed in 1.9% of 3706 evaluable men within 24 mo. The risk was 2.2 times higher after RRP than after RALP (RR 2.21, 95% confidence interval [CI] 1.38-3.53). Overall, urinary incontinence was twice as common in patients who had stenosis (RR 2.01, 95% CI 1.43-2.64). CONCLUSIONS This large prospective study found an overall low rate of vesicourethral anastomotic stenosis after radical prostatectomy, but the rate was significantly lower after robot-assisted prostatectomy. The risk of stenosis seems to be associated with the number of sutures/takes in the anastomosis, but this was statistically significant only in the RALP group. PATIENT SUMMARY We investigated the risk of developing vesicourethral anastomotic stenosis after open and robot-assisted radical prostatectomy. We found that the risk was generally lower than previously reported and lower after robot-assisted radical prostatectomy than after radical retropubic prostatectomy. Urinary incontinence was twice as common in patients with stenosis.
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Affiliation(s)
- Katarina Koss Modig
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital, Malmö, Sweden; Division of Urological Cancers, Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stefan Carlsson
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Oncology andPathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Thordis Thorsteinsdottir
- Research Institute in Emergency Care, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Stavros Tyritzis
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden; Department of Urology, Hygeia Hospital, Athens, Greece
| | - Anna Wallerstedt Lantz
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute, Stockholm, Sweden; Icahn School of medicine at Mount Sinai Health System, New York City, NY, USA
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Campos-Juanatey F, Portillo Martín JA. [Management of vesicourethral anastomotic stenosis after radical prostatectomy]. Rev Int Androl 2018; 17:110-118. [PMID: 30237067 DOI: 10.1016/j.androl.2018.05.003] [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: 01/15/2018] [Revised: 05/13/2018] [Accepted: 05/20/2018] [Indexed: 11/24/2022]
Abstract
Vesicourethral anastomotic stenosis is a relatively uncommon problem after radical prostatectomy, but it could become recurrent and difficult to treat. Risk factors are known, and they can help to decrease the incidence. When discussing the therapeutic plan, we must consider the stenosis risk, and also the urinary continence after the prostatectomy. Many treatment schedules are proposed, some of them with low available evidence, limited to case series with different number of patient and follow-up length, or reviews on the subject. Endoscopic options are the commonest, obtaining different success rates depending on the incision, resection or vaporization of the tissue. They could also benefit from the use of adjuvant local injections of drugs regulating tissue growth. Recurrent or obliterated cases could require surgical reconstruction using perineal, abdominal or combined approaches, or even suprapubic urinary diversions.
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Affiliation(s)
- Félix Campos-Juanatey
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | - José Antonio Portillo Martín
- Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, España
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10
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Kahokehr AA, Peterson AC, Lentz AC. Posterior urethral stenosis after prostate cancer treatment: contemporary options for definitive management. Transl Androl Urol 2018; 7:580-592. [PMID: 30211048 PMCID: PMC6127549 DOI: 10.21037/tau.2018.04.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Posterior urethral stenosis (PUS) is an uncommon but challenging problem following prostate cancer therapy. A review of the recent literature on the prevalence of PUS and treatment modalities used in the last decade was performed. A summative narrative of current accepted techniques in management of PUS is presented, and supplement with our own experience and algorithms.
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Affiliation(s)
- Arman A Kahokehr
- Division of Urology, Duke University Medical Center, Durham, NC 27710, USA
| | - Andrew C Peterson
- Division of Urology, Duke University Medical Center, Durham, NC 27710, USA
| | - Aaron C Lentz
- Division of Urology, Duke University Medical Center, Durham, NC 27710, USA
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Burttet LM, Varaschin GA, Berger AK, Cavazzola LT, Berger M, Silva B. Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital. Int Braz J Urol 2018; 43:1176-1184. [PMID: 28727367 PMCID: PMC5734083 DOI: 10.1590/s1677-5538.ibju.2016.0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/16/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature. Materials and Methods: We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature. Results: Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status. Conclusion: Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.
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Affiliation(s)
| | | | - Andre Kives Berger
- Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Leandro Totti Cavazzola
- Universidade Federal do Rio Grande do Sul, RS, Brasil.,Departamento de Cirurgia Geral, Hospital de Clínicas de Porto Alegre, RS, Brasil
| | - Milton Berger
- Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Brasil Silva
- Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, RS, Brasil
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Myers JB, Brant WO, Hotaling JN, Lenherr SM. Urethral Strictures and Artificial Urinary Sphincter Placement. Urol Clin North Am 2017; 44:93-103. [DOI: 10.1016/j.ucl.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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