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Yu K, Bu F, Jian T, Liu Z, Hu R, Chen S, Lu J. Urinary incontinence rehabilitation of after radical prostatectomy: a systematic review and network meta-analysis. Front Oncol 2024; 13:1307434. [PMID: 38584666 PMCID: PMC10996052 DOI: 10.3389/fonc.2023.1307434] [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: 10/04/2023] [Accepted: 12/27/2023] [Indexed: 04/09/2024] Open
Abstract
Purpose The aim of this study is to provide treatment for patients with urinary incontinence at different periods after radical prostatectomy. Methods The PubMed, Embase, Cochrane, and Web of Science were searched for all literature on the effectiveness on urinary control after radical prostate cancer between the date of database creation and 15 November 2023 and performed a quality assessment. A network meta-analysis was performed using RevMan 5.3 and Stata 17.0 software and evaluated using the surface under the cumulative ranking curve. Results The results of the network meta-analysis showed that pelvic floor muscle therapy including biofeedback with professional therapist-guided treatment demonstrated better results at 1 month to 6 months; electrical stimulation, biofeedback, and professional therapist guidance may be more effective at 3 months of treatment; professional therapist-guided recovery may be less effective at 6 months of treatment; and combined therapy demonstrated better results at 1 year of treatment. During the course of treatment, biofeedback with professional therapist-guided treatment may have significant therapeutic effects in the short term after surgery, but, in the long term, the combination of multiple treatments (pelvic floor muscle training+ routine care + biofeedback + professional therapist-guided treatment + electrical nerve stimulation therapy) may address cases of urinary incontinence that remain unrecovered long after surgery. Conclusion In general, all treatment methods improve the different stages of functional recovery of the pelvic floor muscles. However, in the long term, there are no significant differences between the treatments. Given the cost-effectiveness, pelvic floor muscle training + routine care + biofeedback + professional therapist-guided treatment + electrical nerve stimulation therapy within 3 months and pelvic floor muscle + routine care after 3 months may be a more economical option to treat urinary incontinence. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331797, identifier CRD42022331797.
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Affiliation(s)
- Kai Yu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Fan Bu
- Department of Plastic and Aesthetic Surgery, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Tengteng Jian
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Zejun Liu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Rui Hu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Sunmeng Chen
- Department of Urology, The First Hospital of Jilin University, Changchun, China
| | - Ji Lu
- Department of Urology, The First Hospital of Jilin University, Changchun, China
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Arikan Y, Eksi M, Tasci AI. Comparison of oncological and functional outcomes of perineoscopic radical prostatectomy and robot-assisted radical prostatectomy. Updates Surg 2023:10.1007/s13304-023-01453-3. [PMID: 36788157 DOI: 10.1007/s13304-023-01453-3] [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: 08/24/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
The aim of this study is to compare the functional, oncological, and complication outcomes of perineoscopic radical prostatectomy (PeRP) and robot-assisted radical prostatectomy (RARP) operations. Patients who underwent radical prostatectomy (RP) between October 2018 and June 2020 for localized prostate cancer (N0, < T3) were retrospectively screened. After the exclusion criteria, 56 patients who underwent PeRP and 67 patients who underwent RARP remained in the study. Demographic, perioperative, and postoperative data were collected. In functional outcomes, continence and potency status were compared at 1, 3, 6, and 12 months. The mean age of the patients was 61.3 ± 5.9 years in the PeRP group and 62.2 ± 5.7 years in the RARP group. No statistically significant differences were present between preoperative and postoperative values. Among the perioperative findings, the mean operation time was 90.4 ± 11.2 min for the PeRP group and 114.6 ± 14.7 min for the RARP group. The operation time was shorter in the PeRP group. The average hospital stay was 2 ± 0.6 days in the PeRP group and 2.3 ± 0.5 days in the RARP group. It was significantly shorter in the PeRP group. There is no statistically significant difference between the two groups in the oncological and functional results. PeRP is a surgical procedure safe in low-risk patients with medium-risk prostate cancer (PCa) who do not require lymph-node dissection. Moreover, PeRP minimizes the difficulties of perineal surgery.
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Affiliation(s)
- Yusuf Arikan
- Urology, Mus State Hospital, Saray Mah., Yeni Hastane Cad., No:1/A, Muş Merkez, Turkey.
| | - Mithat Eksi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh. Tevfik Saglam Cd. No:11 Bakirkoy, Istanbul, Turkey
| | - Ali Ihsan Tasci
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mh. Tevfik Saglam Cd. No:11 Bakirkoy, Istanbul, Turkey
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Moschovas MC, Brady I, Noel J, Zeinab MA, Kaviani A, Kaouk J, Crivellaro S, Joseph J, Mottrie A, Patel V. Contemporary techniques of da Vinci SP radical prostatectomy: multicentric collaboration and expert opinion. Int Braz J Urol 2022; 48:696-705. [PMID: 35363459 PMCID: PMC9306371 DOI: 10.1590/s1677-5538.ibju.2022.99.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The da Vinci SP robot consists of an innovative single port trocar that houses a flexible camera and three biarticulated arms, which minimizes the number of incisions to assess the surgical site, allowing a less invasive procedure. However, due to its recent release in the market, the current literature reporting SP-RARP is still restricted to a few centers. In this scenario, after performing a literature search with all available techniques of SP-RARP, our objective is to report a multicentric opinion of referral centers on different techniques to approach SP-RARP. Results The SP literature is provided by only a few centers due to the limited number of this new console in the market. Five different approaches are available: transperitoneal, extraperitoneal, Retzius-Sparing, transperineal and transvesical. None of the current studies describe long-term functional or oncological outcomes. However, all approaches had satisfactory operative performance with minimum complication rates. Conclusions Several techniques of SP-RARP have been reported in the literature. We performed a multicentric collaboration describing and illustrating the most challenging steps of this surgery. We believe that the details provided in this article are useful teaching material for new centers willing to adopt the SP technology.
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Affiliation(s)
- Marcio Covas Moschovas
- AdventHealth Global Robotics Institute (GRI), Celebration, USA.,University of Central Florida (UCF), Orlando, USA
| | - Isabella Brady
- AdventHealth Global Robotics Institute (GRI), Celebration, USA
| | - Jonathan Noel
- AdventHealth Global Robotics Institute (GRI), Celebration, USA
| | | | - Aaron Kaviani
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - Jihad Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, USA
| | | | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute (GRI), Celebration, USA.,University of Central Florida (UCF), Orlando, USA
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Iqbal MJ, Javed Z, Sadia H, Qureshi IA, Irshad A, Ahmed R, Malik K, Raza S, Abbas A, Pezzani R, Sharifi-Rad J. Clinical applications of artificial intelligence and machine learning in cancer diagnosis: looking into the future. Cancer Cell Int 2021; 21:270. [PMID: 34020642 PMCID: PMC8139146 DOI: 10.1186/s12935-021-01981-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is the use of mathematical algorithms to mimic human cognitive abilities and to address difficult healthcare challenges including complex biological abnormalities like cancer. The exponential growth of AI in the last decade is evidenced to be the potential platform for optimal decision-making by super-intelligence, where the human mind is limited to process huge data in a narrow time range. Cancer is a complex and multifaced disorder with thousands of genetic and epigenetic variations. AI-based algorithms hold great promise to pave the way to identify these genetic mutations and aberrant protein interactions at a very early stage. Modern biomedical research is also focused to bring AI technology to the clinics safely and ethically. AI-based assistance to pathologists and physicians could be the great leap forward towards prediction for disease risk, diagnosis, prognosis, and treatments. Clinical applications of AI and Machine Learning (ML) in cancer diagnosis and treatment are the future of medical guidance towards faster mapping of a new treatment for every individual. By using AI base system approach, researchers can collaborate in real-time and share knowledge digitally to potentially heal millions. In this review, we focused to present game-changing technology of the future in clinics, by connecting biology with Artificial Intelligence and explain how AI-based assistance help oncologist for precise treatment.
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Affiliation(s)
- Muhammad Javed Iqbal
- Department of Biotechnology, Faculty of Sciences, University of Sialkot, Sialkot, Pakistan
| | - Zeeshan Javed
- Office for Research Innovation and Commercialization (ORIC), Lahore Garrison University, Sector-C, DHA Phase-VI, Lahore, Pakistan
| | - Haleema Sadia
- Department of Biotechnology, Balochistan University of Information Technology Engineering and Management Sciences (BUITEMS), Quetta, Pakistan
| | | | - Asma Irshad
- Department of Life Sciences, University of Management Sciences and Technology, Lahore, Pakistan
| | - Rais Ahmed
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Kausar Malik
- Center for Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - Shahid Raza
- Office for Research Innovation and Commercialization (ORIC), Lahore Garrison University, Sector-C, DHA Phase-VI, Lahore, Pakistan
| | - Asif Abbas
- Department of Biotechnology, Faculty of Sciences, University of Sialkot, Sialkot, Pakistan
| | - Raffaele Pezzani
- Dept. Medicine (DIMED), OU Endocrinology, University of Padova, via Ospedale 105, 35128 Padova, Italy
- AIROB, Associazione Italiana Per La Ricerca Oncologica Di Base, Padova, Italy
| | - Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador
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Minafra P, Carbonara U, Vitarelli A, Lucarelli G, Battaglia M, Ditonno P. Robotic radical perineal prostatectomy: tradition and evolution in the robotic era. Curr Opin Urol 2021; 31:11-17. [PMID: 33229862 DOI: 10.1097/mou.0000000000000830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To provide an updated review of robotic radical perineal prostatectomy (r-RPP) with emphasis on the recent advances in terms of surgical technique, outcomes, and new robotic platforms. RECENT FINDING The technological innovations in the urological field have been applied to radical prostatectomy with the aim of preserving important anatomical structures and reduce patients' morbidity and mortality. In recent years, robotic surgery contributed to resurge radical perineal prostatectomy. In 2014, the Cleveland Clinic group was the first to demonstrate the utility of a robotic approach in RPP. To date, the majority of the reported studies showed that r-RPP has noninferior perioperative, short-term oncological, and functional outcomes compared with the traditional robot-assisted radical prostatectomy (RARP). Given these benefits, r-RPP is a promising approach in selected patients, such as obese ones. Moreover, robotic perineal pelvic lymph node dissection performed through the same incision of r-RPP and the new Single-Port (SP) Robotic System represent further steps towards the overcoming of some intrinsic limitation of this surgical approach making this technique suitable for a larger number of patients with prostatic cancer. SUMMARY Overall, r-RPP represents a reliable and effective novel surgical technique. However, more studies with long-term follow-up are needed to clarify the advantages over RARP.
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Affiliation(s)
- Paolo Minafra
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, VCU Health, Richmond, Virginia, USA
| | - Antonio Vitarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation -Urology, Andrology, and Kidney Transplantation Unit, University of Bari 'Aldo Moro', Bari, Italy
- Urology Unit, National Cancer Institute IRCCS 'Giovanni Paolo II", Bari, Italy
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Bhat KRS, Raghunath SK, Srivatsa N, Tejus C, Vishruth K, Kumar RA. Outcomes of Minimally Invasive Radical Prostatectomy-a Contemporary Review. Indian J Surg Oncol 2020; 11:580-588. [PMID: 33299276 PMCID: PMC7714884 DOI: 10.1007/s13193-020-01125-3] [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: 01/03/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022] Open
Abstract
Prostatectomy has been widely accepted as a treatment option for prostate cancer and can be performed via an open, laparoscopic, and robotic approach. The outcomes following prostatectomy are primarily sub-grouped into oncological and functional outcomes. Oncological outcomes have been comparable in the above three surgical modalities. However, the robotic platform seems to have a better functional outcome compared to open prostatectomy. The data on the outcome of the laparoscopic approach is scarce and is not widely performed due to technical difficulty. With experience continence outcomes have reached a plateau in many robotic series, however, the potency outcome is the real Achilles tendon of this procedure. Many factors influence potency outcomes but the amount and quality of nerve-sparing is one factor that is under a surgeon's control and it improves with experience.
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Affiliation(s)
| | - S. K. Raghunath
- Trustwell Hospital, No 5, J C Road, Bangalore, 560002 India
- HCG Hospital, Bengaluru, Karnataka India
| | | | - C. Tejus
- HCG Hospital, Bengaluru, Karnataka India
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Chang Y, Xu W, Lu X, Zhou Y, Ji M, Xiao YT, Sun Y, Ren S. Robotic Perineal Radical Prostatectomy: Initial Experience with the da Vinci Si Robotic System. Urol Int 2020; 104:710-715. [PMID: 32289797 DOI: 10.1159/000505557] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the feasibility and surgical technique of robotic perineal radical prostatectomy (RPRP). MATERIALS AND METHODS We retrospectively analyzed 6 consecutive patients diagnosed with prostate cancer from December 2018 to May 2019 who underwent RPRP at our center. Perioperative outcomes were recorded for safety and feasibility analysis. RESULTS Six patients successfully underwent RPRP with no conversion to open procedures. Operative time was 140 (interquartile range [IQR] 123.75-148.75) min, console time was 70 (IQR 62.5-70) min, with an estimated blood loss of 125 (IQR 100-187.5) mL. Patients were discharged 2 days postoperatively (IQR range 1-3) with pelvic drainages removed. The Foley catheter was removed 2 weeks after surgery. Postoperative pathology revealed 5 patients with locally advanced disease (apical margin-positive prostate cancer [pT3a]bNx). Two patients had a positive surgical margin (33.3%). No complications of Clavien grade 3 and above were recorded; 1 patient had a delay in wound-healing of 1 week. Postoperative continence was achieved for 2 patients immediately after Foley catheter removal, 2 recovered 1-month postoperatively, and 1 recovered within 3 months, and 1 still had mild incontinence at the latest follow-up 1-month postoperatively. CONCLUSION RPRP is a safe and feasible alternative for the transperitoneal route in selected patients. Further investigation is required to assess its oncological and quality-of-life results.
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Affiliation(s)
- Yifan Chang
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Weidong Xu
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiaojun Lu
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yi Zhou
- Department of Anesthesiology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Ji
- Department of Urology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | - Yu-Tian Xiao
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shancheng Ren
- Department of Urology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China,
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Liu S, Hemal A. Techniques of robotic radical prostatectomy for the management of prostate cancer: which one, when and why. Transl Androl Urol 2020; 9:906-918. [PMID: 32420206 PMCID: PMC7214982 DOI: 10.21037/tau.2019.09.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The advent of robotic assistance in surgery has completely revolutionized the surgical management of prostate cancer. It enables precise dissection and reconstruction in order to maximize oncological and functional outcomes. In many parts of the world, robot-assisted laparoscopic radical prostatectomy has evolved to become the surgical standard of care for localized disease, including in appropriately selected patients with high risk prostate cancer. Its role has also been expanded to encompass cytoreductive prostatectomy and salvage radical prostatectomy. As surgical expertise grows with robotic assistance, several novel and non-radical approaches have been developed to further mitigate treatment side effects. Patient characteristics, disease factors and surgeon expertise are important metrics for consideration when selecting the most appropriate technique for any given patient.
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Affiliation(s)
- Shuo Liu
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Ashok Hemal
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Garisto J, Bertolo R, Wilson CA, Kaouk J. The evolution and resurgence of perineal prostatectomy in the robotic surgical era. World J Urol 2019; 38:821-828. [PMID: 31811370 DOI: 10.1007/s00345-019-03004-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To review the recent advances in terms of surgical technique and new robotic platforms applied to radical perineal prostatectomy (RPP). METHODS A literature review was performed focusing on original articles on perineal prostatectomy searching via Medline/Pubmed and Embase. The entire spectrum was covered such as development of surgical technique including pelvic lymphadenectomy, adoption of novel surgical platforms, learning curve and future directions. RESULTS Surgical removal of the prostate plays a significant role on the treatment of localized prostate cancer (PCa). RPP was the first surgical approach described for radical prostatectomy. This technique declined in popularity secondary to the development of the retropubic approach. Recently, the appearance of novel robotic technology has generated renewed interest in the perineal approach. CONCLUSION There has been a recent resurgence on the interest of radical perineal prostatectomy for the treatment of localized PCa driven by the advent of new robotic surgical technologies into the field. Future studies are needed to better determine the learning curve of the perineal approach and its current role in the treatment of prostate cancer.
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Affiliation(s)
- Juan Garisto
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA
| | - Riccardo Bertolo
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA
| | - Clark A Wilson
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA
| | - Jihad Kaouk
- Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA.
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