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Liu L, Zhou S, Song D, Li Z, Yang S, Wu Y, Zhang G, Tang D, Liu J, Liao H, Zhang C. The predictors of short and long term urinary continence recovery after laparoscopic radical prostatectomy: a single cancer center report in China. World J Surg Oncol 2024; 22:150. [PMID: 38844951 PMCID: PMC11155079 DOI: 10.1186/s12957-024-03425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/24/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables. METHODS We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP. RESULTS After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P < 0.001), and at 3 mo (P < 0.001), 6 mo (P < 0.001) and 12 mo (P = 0.009) after surgery. CONCLUSION MUL is a significant independent factor that can contribute to short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment.
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Affiliation(s)
- Lei Liu
- Department of Urology, People's Hospital of Dayi County, Chengdu, 611300, China
| | - Shukui Zhou
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Dandan Song
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Zeng Li
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Shengke Yang
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Yi Wu
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Guiying Zhang
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Duocai Tang
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China
| | - Hong Liao
- Department of Urology, Sichuan Clinical Reasearch Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, China.
| | - Chuan Zhang
- Department of Urology, People's Hospital of Dayi County, Chengdu, 611300, China.
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Ragusa A, Brassetti A, Prata F, Iannuzzi A, Callè P, Tedesco F, Cacciatore L, Esperto F, Simone G, Scarpa RM, Papalia R. Predictors of Urinary Continence Recovery after Laparoscopic-Assisted Radical Prostatectomy: Is Surgical Urethral Length the Only Key Factor? Life (Basel) 2023; 13:1550. [PMID: 37511925 PMCID: PMC10381846 DOI: 10.3390/life13071550] [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: 06/12/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Several efforts in recent years have been made to predict urinary continence (UC) recovery after radical prostatectomy. The aim of our study was to investigate the impact of surgical urethral length preservation (SULP) on urinary continence after LARP (laparoscopic-assisted radical prostatectomy). We retrospectively queried our datasets from May 2021 to May 2022. After the application of exclusion criteria, a total of 100 patients who underwent LARP for prostate cancer at our institution were enrolled. Through a sterile ruler inserted by a 12 mm trocar, the length of the membranous urethra spared during LARP was assessed intra-operatively. The baseline and peri- and postoperative data of patients were collected, and UC was defined as 0 or 1 on a safety pad. The median SULP was 20.5 mm (IQR, 14.5-25), and the median intraoperative EBL were 150 mL (IQR, 100-200). The Kaplan-Meier curve showed a significant difference at 20 mm, which was used as the cut-off value for SULP (log-rank test, p < 0.001). Multivariate Cox proportional hazards models showed that SULP and EBL < 250 mL were associated with UC recovery (all p < 0.02). Surgical urethral length preservation seemed to improve early UC recovery after LARP. Further multicentric studies are needed to confirm our findings.
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Affiliation(s)
- Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Andrea Iannuzzi
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Pasquale Callè
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Tedesco
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Loris Cacciatore
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Francesco Esperto
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | - Roberto Mario Scarpa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
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Asimakopoulos AD, Annino F, Colalillo G, Gaston R, Piechaud T, Mauriello A, Anceschi U, Borri F. "Urethral-Sparing" Robotic Radical Prostatectomy: Critical Appraisal of the Safety of the Technique Based on the Histologic Characteristics of the Prostatic Urethra. Curr Oncol 2023; 30:1065-1076. [PMID: 36661731 PMCID: PMC9857678 DOI: 10.3390/curroncol30010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP). AIMS To describe the histologic features of the PU. METHODS The PU was evaluated using cystoprostatectomy and RALP specimens. Cases of PU infiltration by prostate cancer or distortion by benign hyperplastic nodules were excluded. The thickness of the chorion and distance between the urothelium and prostate glands were measured. Prostate-specific antigen expression in the PU epithelium was evaluated with immunohistochemistry. Descriptive statistics were used. RESULTS Six specimens of PU were examined. Histologically, the following layers of the PU were observed: (1) urothelium with basal membrane, (2) chorion, and (3) prostatic peri-urethral fibromuscular tissue. The chorion measures between 0.2 and 0.4 mm. There is not a distinct urethral muscle layer, but rather muscular fibers that originate near the prostatic stroma and are distributed around the PU. This muscular tissue appears to be mainly represented in the basal and apical urethra, but not in the middle urethra. The mean distance between the chorion and prostatic glands is 1.74 mm, with significant differences between base of the prostate, middle urethral portion, and apex (2.5 vs. 1.49 vs. 1.23 mm, respectively). PSA-expressing cells are abundant in the PU epithelium, coexisting with urothelial cells. CONCLUSIONS The exiguity of thickness of the PU chorion, short distance from glandular tissue, and coexistence of PSA-expressing cells in the epithelium raise important concerns about the oncologic safety of EPUP.
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Affiliation(s)
- Anastasios D. Asimakopoulos
- Urology Unit, Fondazione PTV Policlinico Tor Vergata, 00133 Rome, Italy
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, 52100 Arezzo, Italy
| | - Filippo Annino
- Urology Unit, Azienda USL Toscana Sud-Est, San Donato Hospital, 52100 Arezzo, Italy
| | - Gaia Colalillo
- Urology Unit, Fondazione PTV Policlinico Tor Vergata, 00133 Rome, Italy
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, 33074 Bordeaux, France
| | - Thierry Piechaud
- Unit of Urology, Clinique Saint-Augustin, 33074 Bordeaux, France
| | - Alessandro Mauriello
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Filippo Borri
- Anatomic Pathology, Azienda USL Toscana Sud-Est, San Donato Hospital, 52100 Arezzo, Italy
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Nunez Bragayrac LA, Hussein AA, Attwood K, Pop E, James G, Osei J, Murekeysoni C, Kauffman EC. Feasibility and continence outcomes of extended prostatic urethral preservation during robot-assisted radical prostatectomy. Prostate Cancer Prostatic Dis 2019; 23:286-294. [PMID: 31700145 DOI: 10.1038/s41391-019-0173-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prostatic urethra is conventionally resected during robot-assisted radical prostatectomy (RARP). We describe the technical feasibility and urinary continence outcomes of extended prostatic urethral preservation (EPUP) during RARP. METHODS A single surgeon at a National Comprehensive Cancer Network institute performed 48 consecutive RARP operations using EPUP from March 2014 to March 2016, during which time 177 conventional non-EPUP RARP operations were performed by other surgeons. Prior to this period, the EPUP surgeon had performed 17 non-EPUP RARP operations over 15 months. Total intracorporeal urethral length (IUL) preserved during EPUP was measured intraoperatively. Associations of EPUP and IUL with continence recovery rates and/or times were tested in Fisher's exact and log rank univariate analyses and Cox logistic regression multivariable analyses. RESULTS Median IUL preserved during EPUP was 4.0 cm (range 2.5-6.0 cm), and urethral dissections typically spanned the prostatic apex to mid-gland or base. Seven-week continence rates were significantly higher with versus without EPUP. EPUP patient rates of using 0 or 0-1 pads per day immediately after catheter removal were 19% and 35%, respectively. These rates increased significantly (53% and 76%, respectively), as did the IUL preserved (median 5.0 cm), among more recent EPUP patients (n = 17), which suggested a learning curve. In multivariable analyses including all patients, an EPUP approach was an independent predictor of faster continence recovery. In multivariable analyses of the EPUP subset, a longer IUL preserved was independently associated with faster continence recovery. No EPUP patient had a urethral fossa positive margin, and apical positive margins were similarly infrequent among EPUP and non-EPUP patients. CONCLUSIONS EPUP is technically feasible during RARP and associated with faster continence recovery. Future investigation into the generalizability of these findings and the oncologic safety of EPUP is warranted.
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Affiliation(s)
| | - Ahmed A Hussein
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elena Pop
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Gaybrielle James
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jennifer Osei
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Eric C Kauffman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. .,Department of Cancer Genetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
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Huang HC, Jiang YH, Lin VCH, Tsai YC, Kuo HC. Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy – Bladder neck level and urodynamic parameters. J Formos Med Assoc 2019; 118:237-243. [DOI: 10.1016/j.jfma.2018.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/28/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022] Open
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Impact of Obesity on Long-Term Urinary Incontinence after Radical Prostatectomy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8279523. [PMID: 29850573 PMCID: PMC5903323 DOI: 10.1155/2018/8279523] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/11/2018] [Accepted: 02/28/2018] [Indexed: 12/31/2022]
Abstract
Obesity is a known risk factor for prostate cancer progression and may contribute to poor treatment outcomes. However, little is known concerning the relationship between obesity (body mass index [BMI] ⩾ 30) and the urinary incontinence (UI) of patients after radical prostatectomy (RP). The goal of this study was to focus on the prevalence and duration of UI after RP with specific attention to the BMI. Subsequently, trials were identified in a literature search of PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting BMI, study characteristics, and outcome data including the relationship between BMI and urinary incontinence data were included. Finally, four studies comprising 6 trials with 2890 participants were included. The results showed that obesity increased UI risk at 12 months in patients who underwent robotic-assisted laparoscopic radical prostatectomy (RLRP) (odds ratio [OR] 2.43, 95% confidence interval [CI] [1.21, 4.88], P = 0.01). When stratified by the surgical methods, the pooled results showed that obesity increased UI risk at 24 months in patients who underwent RLRP (OR 2.00, 95% CI [1.57, 2.56], P < 0.001). However, in patients who underwent laparoscopic radical prostatectomy (LRP), the pooled results showed that obesity does not increase UI risk at 24 months (OR 1.13, 95% CI [0.74, 1.72], P = 0.58). This is the first study to include obesity as the primary independent variable. Outcomes indicate that obesity (BMI ≥ 30) may increase the UI risk at 12 and 24 months after RLRP. Well-designed randomized controlled trials with strict control of confounders are needed to make results comparable.
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Song W, Kim CK, Park BK, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy. Can Urol Assoc J 2017; 11:E93-E99. [PMID: 28360954 DOI: 10.5489/cuaj.4035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP). METHODS Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months. RESULTS Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01-1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16-9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17-7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85-19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24-13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL. CONCLUSIONS Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.
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Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Kwan Park
- Department of Radiology and Centre for Imaging Science, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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Vessel-sparing radiation and functional anatomy-based preservation for erectile function after prostate radiotherapy. Lancet Oncol 2016; 17:e198-208. [DOI: 10.1016/s1470-2045(16)00063-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/06/2016] [Accepted: 01/21/2016] [Indexed: 12/14/2022]
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Hamada A, Razdan S, Etafy MH, Fagin R, Razdan S. Early Return of Continence in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy Using Modified Maximal Urethral Length Preservation Technique. J Endourol 2014; 28:930-8. [DOI: 10.1089/end.2013.0794] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alaa Hamada
- Department of Urology, Jackson South Hospital, Miami, Florida
| | | | | | | | - Sanjay Razdan
- Department of Urology, Herbert Wertheim Florida International University College of Medicine, Jackson South Hospital, Miami, Florida
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Lee CH, Ha HK. Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy. Int J Urol 2014; 21:653-6. [DOI: 10.1111/iju.12419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Chan Ho Lee
- Department of Urology; Pusan National University School of Medicine
- Medical Research Institute; Pusan National University Hospital; Busan Korea
| | - Hong Koo Ha
- Department of Urology; Pusan National University School of Medicine
- Medical Research Institute; Pusan National University Hospital; Busan Korea
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Anatomic and technical considerations for optimizing recovery of urinary function during robotic-assisted radical prostatectomy. Curr Opin Urol 2013; 23:78-87. [DOI: 10.1097/mou.0b013e32835b0ae5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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