1
|
Oszczudlowski M, Cymbalista G, Bilski K, Dobruch J. Detrusor underactivity after radical prostatectomy: A prospective observational study. Neurourol Urodyn 2024; 43:638-645. [PMID: 38273775 DOI: 10.1002/nau.25396] [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: 11/09/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To evaluate the impact of radical prostatectomy (RP) on bladder function with special interest in detrusor underactivity (DU) and to appraise clinical significance of DU in postprostatectomy patients. MATERIAL AND METHODS This was a prospective, observational study conducted on male patients subjected to laparoscopic RP (LPR). Urodynamic studies were performed at the day before surgery (visit 1), 3-6 months postoperatively (visit 2) and more than 12 months after surgery (visit 3). Incidence of DU that occurred after LPR (de novo DU), incidence of persisting de novo DU after 12 months, clinical relevance of DU after LPR and predictive factors of de novo DU were assessed. RESULTS 99 of 100 patients underwent preoperative urodynamic study (visit 1) and those were included in further analysis. 84 and 76 patients were available for follow-up at second and third visit respectively. De novo DU occurred after LPR in 25 (29.7%) patients at visit 2 (p < 0.001). Sixteen from 24 patients (66,7%) who developed de novo DU after RP (visit 2) continued to have DU 1 year after surgery (visit 3) (p = 0.04). On the multivariate analysis, urinary incontinence requiring more than 1 pad per day (odds ratio [OR] 5.11; confidence interval [CI] 1.69-17.19; p = 0.005) and preoperative IPSS storage sub-score (OR 1.25; CI 1.03-1.63; p = 0.030) were significantly associated with de novo DU. Postprostatectomy patients with DU had significantly lower Urinary Assessment of the Expanded Prostate Cancer Index Composite (EPIC) total score (819 vs. 911, p = 0.02), EPIC Function domain score (300 vs. 357, p = 0.002) and EPIC Urinary incontinence domain (137 vs. 224, p = 0.002) when compared to their counterparts without DU. CONCLUSIONS RP substantially influences bladder function, causing de novo DU, which persists in substantial number of patients 1 year postoperatively. Furthermore, significant correlation between DU and postprostatectomy urinary incontinence may play a role when anti-incontinence surgery is considered.
Collapse
Affiliation(s)
| | - Grzegorz Cymbalista
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Konrad Bilski
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
2
|
Soda T, Otsuka H, Koike S, Okada T. Baseline factors and surgical procedures affecting changes in lower urinary tract symptoms after robot-assisted radical prostatectomy: the impact of nerve-sparing. Int Urol Nephrol 2024; 56:989-997. [PMID: 37907707 DOI: 10.1007/s11255-023-03859-9] [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: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To determine baseline factors and surgical procedures associated with clinically meaningful improvement or deterioration of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP). METHODS We retrospectively reviewed our RARP database and analyzed the changes in the International Prostate Symptom Score (IPSS) at baseline and 1, 3, 6, and 12 months postoperatively. Multivariable ordinal logistic regression analysis was performed to determine variables that predicted clinically meaningful improvement (∆IPSS ≤ -5) or deterioration (∆IPSS ≥ 5) in LUTS after RARP. RESULTS A total of 172 patients were eligible for analysis. Patients aged ≥ 70 reported a higher IPSS before and after RARP (all p < 0.05). Patients with a prostate volume of > 30 mL or body mass index of < 24 kg/m2 had worse preoperative LUTS; however, the difference disappeared after RARP. While patients with or without nerve-sparing (NS) had a similar preoperative LUTS burden, the NS group reported significantly lower IPSS than the non-NS group at all postoperative time points (p < 0.05). Twelve months after RARP, LUTS improved in 27% and worsened in 6% of patients in the NS group, compared with 20% and 24% of those in the non-NS group, respectively (p = 0.018). Preoperative IPSS (OR, 0.84; 95% CI, 0.79-0.89) and NS (OR, 0.39; 95% CI, 0.18-0.83) were independently associated with clinically meaningful changes of LUTS at 12 months after RARP. CONCLUSION Other than baseline LUTS severity, NS was the only independent factor associated with clinically meaningful changes in LUTS after RARP.
Collapse
Affiliation(s)
- Takeshi Soda
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan.
| | - Hikari Otsuka
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Shuhei Koike
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan
| | - Takuya Okada
- Department of Urology, Medical Research Institute Kitano Hospital, 2-4-20 Ogimachi, Kita-Ku, Osaka, 530-8480, Japan
| |
Collapse
|
3
|
Wang J, Ren L, Liu X, Liu J, Ling Q. Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives. Int J Mol Sci 2023; 24:15517. [PMID: 37958499 PMCID: PMC10648240 DOI: 10.3390/ijms242115517] [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: 09/18/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
Underactive bladder (UAB) is a prevalent but under-researched lower urinary tract symptom that typically occurs alongside detrusor underactivity (DU). Unlike UAB, DU is a urodynamic diagnosis which the International Continence Society (ICS) defines as "a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span". Despite the widespread prevalence of UAB/DU, there are significant gaps in our understanding of its pathophysiological mechanisms, diagnosis, and treatment compared with overactive bladder (OAB) and detrusor overactivity (DO). These gaps are such that clinicians regard UAB/DU as an incurable condition. In recent years, the understanding of UAB has increased. The definition of UAB has been clarified, and the diagnostic criteria for DU have been considered more comprehensively. Meanwhile, a number of non-invasive diagnostic methods have also been reported. Clinical trials involving novel drugs, electrical stimulation, and stem cell therapy have shown promising results. Therefore, this review summarizes recent reports on UAB and DU and highlights the latest advances in their diagnosis and treatment.
Collapse
Affiliation(s)
- Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lida Ren
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xinqi Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| |
Collapse
|
4
|
Wang J, Ren L, Liu X, Xu W, Liu M, Hu P, Wang T, Liu J, Ling Q. Transcriptomics Reveals Molecular Features of the Bilateral Pelvic Nerve Injury Rat Model of Detrusor Underactivity. Biomolecules 2023; 13:1260. [PMID: 37627325 PMCID: PMC10452637 DOI: 10.3390/biom13081260] [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: 07/19/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
The pathogenesis of detrusor underactivity (DU) is unclear, and the available therapeutic effects are unsatisfactory. We propose to find key molecules and pathways related to DU based on transcriptome sequencing. A rat model of bilateral pelvic nerve injury (BPNI) was established. Bladder tissues from the sham-operated group, 3 and 28 days after BPNI mapping, were taken for urodynamics, histopathology, and RNA-seq. An enrichment analysis of the screened differential expression genes was performed. Three days after BPNI, the results showed urodynamic features of overflow incontinence, while there was a recovery at 28 days after the operation. Masson staining revealed collagen deposition accompanied by progressive thickening of the smooth muscle layer as DU progressed. RNA-seq results suggested that a total of 1808 differentially expressed genes (DEGs) differed among the groups. RNA-seq and subsequent analysis confirmed that the cell cycle and immune response were significantly activated 3 days after BPNI, while extracellular matrix remodeling occurred 28 days after BPNI. Partial DEGs and pathways were verified by qRT-PCR. Validation of key proteins involved in cell cycle, inflammation, and fibrosis was performed by immunohistochemical staining and western blot, respectively. These molecular expression patterns at different time points after BPNI injury provide valuable insights into the search for therapeutic targets for DU.
Collapse
Affiliation(s)
- Jiaxin Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Lida Ren
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xinqi Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenchao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Man Liu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Peng Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (J.W.)
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| |
Collapse
|
5
|
Kadono Y. Editorial Comment to Predictive factors of de novo overactive bladder in clinically localized prostate cancer patients after robot-assisted radical prostatectomy. Int J Urol 2023; 30:62. [PMID: 36515413 DOI: 10.1111/iju.15074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| |
Collapse
|