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Huang J, Dai X, Sun J, Fan Y, Guo C. Prediction models for urinary incontinence after robotic-assisted laparoscopic radical prostatectomy: a systematic review. J Robot Surg 2024; 18:249. [PMID: 38869689 DOI: 10.1007/s11701-024-02009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
Even though robotic-assisted laparoscopic radical prostatectomy (RARP) is superior to open surgery in reducing postoperative complications, 6-20% of patients still experience urinary incontinence (UI) after surgery. Therefore, many researchers have established predictive models for UI occurrence after RARP, but the predictive performance of these models is inconsistent. This study aims to systematically review and critically evaluate the published prediction models of UI risk for patients after RARP. We conducted a comprehensive literature search in the databases of PubMed, Cochrane Library, Web of Science, and Embase. Literature published from inception to March 20, 2024, which reported the development and/or validation of clinical prediction models for the occurrence of UI after RARP. We identified seven studies with eight models that met our inclusion criteria. Most of the studies used logistic regression models to predict the occurrence of UI after RARP. The most common predictors included age, body mass index, and nerve sparing procedure. The model performance ranged from poor to good, with the area under the receiver operating characteristic curves ranging from 0.64 to 0.98 in studies. All the studies have a high risk of bias. Despite their potential for predicting UI after RARP, clinical prediction models are restricted by their limited accuracy and high risk of bias. In the future, the study design should be improved, the potential predictors should be considered from larger and representative samples comprehensively, and high-quality risk prediction models should be established. And externally validating models performance to enhance their clinical accuracy and applicability.
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Affiliation(s)
- Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Xiaowei Dai
- Department of Reproductive Medicine Center, The Second Norman Bethune Hospital of Jilin University, Changchun, China
| | - Ji Sun
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Yi Fan
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Chuan Guo
- Department of Urology, Chengfei Hospital, Chengdu, China.
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2
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Visscher J, Hiwase M, Bonevski B, O'Callaghan M. The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2024; 27:222-229. [PMID: 37500786 DOI: 10.1038/s41391-023-00701-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Urinary and sexual dysfunction after radical prostatectomy remains a major cause of morbidity, despite widespread availability of pharmacological and rehabilitative treatments. Smoking is a modifiable risk factor known to correlate with erectile and urinary dysfunction and we hypothesise that smoking cessation may improve post-prostatectomy urinary and sexual function recovery. Our objective is to systematically evaluate literature describing the association of smoking status with urinary and sexual function in men following radical prostatectomy. METHODS In total, 310 unique records were identified through a systematic search of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and CENTRAL databases up to February 2023. Nine studies reported smoking status and post radical prostatectomy urinary and sexual function outcomes in men with localized prostate cancer. Risk of bias was assessed and meta-analysis included six studies. RESULTS Smokers had inferior erectile function after prostatectomy compared to non-smokers (OR 0.73, [95% CI 0.56-0.95]) during follow-up, while urinary incontinence was not statistically different between groups (OR 1.20, [95% CI 0.75-1.91]). Smoking cessation improved the EPIC-26 sexual domain score with 6.6 points on average [p = 0.03] to a clinically significant maximum of 12.5 points at 18-24 months. CONCLUSIONS Smoking is associated with impaired sexual function recovery after radical prostatectomy and quitting may improve sexual function >18 months. Current evidence shows no such association for urinary outcomes. Further studies are needed to corroborate findings.
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Affiliation(s)
- Jordi Visscher
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Mrunal Hiwase
- Department of Surgery, Central Adelaide Health Network, Adelaide, SA, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael O'Callaghan
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Urology Unit, Adelaide, SA, Australia
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3
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Hutchison D, Zillioux J, Ali M, Farhi J, DeNovio A, Barquin D, Rapp DE. Predictors of urinary outcomes following robotic-assisted laparoscopic prostatectomy. BJUI COMPASS 2023; 4:722-728. [PMID: 37818018 PMCID: PMC10560616 DOI: 10.1002/bco2.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/04/2023] [Accepted: 04/16/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Incontinence and urgency are common after prostatectomy. The University of Virginia prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimise continence outcomes following robotic-assisted laparoscopic prostatectomy (RALP). Patients are prospectively evaluated by a Female Pelvic Medicine and Reconstructive Surgery specialist. This study assessed for predictors of 3- and 6-month stress urinary incontinence (SUI) and urgency symptom outcomes following RALP. Methods We performed a post hoc review of patients from our PFOP receiving a minimum of 6-month follow-up. Urinary symptoms are prospectively assessed using the validated International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) questionnaire and daily pad use (pads per day [PPD]). Primary study outcomes included ICIQ-MLUTS SUI and urgency domain scores and PPD. Multivariable linear regression was performed to identify variables associated with outcomes at 3 and 6 months postoperatively. Variables included patient, oncologic and surgical factors. Each variable was run in a separate model with pelvic floor muscle therapy and surgeon to reduce confounding and prevent overfitting. Results Forty men were included. In assessment of ICIQ-MLUTS SUI domain score, at 3 months, body mass index (BMI) was associated with worse scores, and at 6 months, BMI, hypertension and estimated blood loss (EBL) were associated with worse scores, whereas bilateral nerve-sparing technique was associated with better scores. For ICIQ-MLUTS Urgency domain score, at 3 months, preoperative use of benign prostatic hyperplasia (BPH) medication was associated with better scores. No covariates predicted 6-month ICIQ-MLUTS Urgency domain scores. For PPD use, at both 3 and 6 months, BMI was a positive predictor, while preoperative use of BPH medication was a negative predictor. Conclusion Increased BMI, EBL and hypertension are associated with worsened SUI outcomes following RALP, whereas bilateral nerve-sparing technique and preoperative BPH medication are associated with improved SUI outcomes. These data may inform patient counselling and help identify patients who may benefit from closer surveillance and earlier anti-incontinence intervention.
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Affiliation(s)
- Dylan Hutchison
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Marwan Ali
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jacques Farhi
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anthony DeNovio
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David Barquin
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David E. Rapp
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Huaqi Y, Zheng D, Yongkang M, Shiming Z, Zhenghui S, Zhiwei W, Congyu L, Qian L, Bingqi D, Mingkai Z, Chaoshuai Z, Jiangshan P, Tiejun Y. The significance of transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise in improving urinary continence after radical prostatectomy. Eur J Med Res 2023; 28:171. [PMID: 37179346 PMCID: PMC10182606 DOI: 10.1186/s40001-023-01133-3] [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: 09/13/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND To determine whether transrectal ultrasound and urologist_dually guided pelvic floor muscle exercise is associated with immediate, early and long-term urinary continence after radical prostatectomy. MATERIALS AND METHODS Data from 114 patients with localized prostate cancer (PC) who underwent RP at Henan Cancer Hospital from November 2018 to April 2021 were included in the retrospective study. Of the 114 patients, 50 patients in the observation group underwent transrectal ultrasound and urologist_dually guided PFME, and 64 patients in the control group underwent verbally_guided PFME. Contractile function of the external urinary sphincter was in the observation group was evaluated. The immediate, early and long-term urinary continence rates were assessed in both groups, and the factors affecting urinary continence were analyzed. RESULTS The urinary continence rate at 2 weeks and 1, 3, 6 and 12 months in the observation group after RP was significantly higher than that in the control group (52.0% vs. 29.7%, 70.0% vs. 39.1%, 82% vs. 57.8, 88% vs. 70.3%, 98.0 vs. 84.4%, p < 0.05). The contractile function of the external urinary sphincter was obviously correlated with urinary continence at multiple visits after RP, except for the 12-month visit. Transrectal ultrasound and urologist-dually guided PFME was verified to be an independent positive factor for urinary continence at 2 weeks and 1, 3, 6 and 12 months using logistic regression analysis. However, TURP was a negative factor for postoperative urinary continence at different times. CONCLUSIONS Transrectal ultrasound and urologist_dually guided PFME had a significant role in improving immediate, early and long-term urinary continence after RP and acted as an independent prognostic factor.
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Affiliation(s)
- Yin Huaqi
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Du Zheng
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Ma Yongkang
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhao Shiming
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Sun Zhenghui
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Wang Zhiwei
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Li Congyu
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Li Qian
- Department of Ultrasound, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Dong Bingqi
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhu Mingkai
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Zhu Chaoshuai
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Peng Jiangshan
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China
| | - Yang Tiejun
- Department of Urology, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, No.127, Dong Ming Road, Zhengzhou, 450000, China.
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Chiu LW, Chen WC, Hsieh PF, Chen YH, Huang CP. Efficacy and Complications of the Re-Adjustable Male Sling System for Stress Urinary Incontinence after Radical Prostatectomy. J Clin Med 2022; 11:jcm11226764. [PMID: 36431241 PMCID: PMC9698314 DOI: 10.3390/jcm11226764] [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: 10/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the outcomes of re-adjustable male slings in pa-tients with postoperative stress urinary incontinence (SUI) following radical prostatectomy (RP). We retrospectively analyzed 18 patients with SUI following RP for prostate cancer, who were treated with re-adjustable male slings from January 2016 to December 2021. The clinical outcomes were evaluated based on daily pad usage and urodynamic studies, both preoperatively and post-operatively. The degree of SUI was categorized as either mild, moderate, or severe. Success was defined as no more pad use or significantly decreased pad use. Complications were classified ac-cording to the Clavien-Dindo system. The mean age of patients was 70.4 ± 5.9 years, and 61.1% of cases were diagnosed as locally advanced prostate cancer. Mild, moderate, and severe SUI were reported as 33.3%, 50.0%, and 16.7%, respectively. The average daily pad use after RP was 3.3 pads and there was a significant reduction in the number of daily pads used after the re-adjustable male sling procedure (3.3 vs. 1.3; p = 0.002). Overall, the operation was considered successful in 11 pa-tients (61.1%), 1 case showed improvement (5.6%), and it was considered unsuccessful in 6 patients (33.3%). Impressively, in the severe incontinence subgroup (three patients), one (33.3%) had im-provement and one (33.3%) had success. Transient perineal discomfort after the operation was the most common complaint. However, two patients had severe complications with bowel injury during sling implantation (Clavien-Dindo grade III). The re-adjustable male sling system was an efficient surgical treatment option for post-RP SUI, even in a locally advanced disease dominant population. One should pay attention to the complication of bowel perforation during surgery.
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Affiliation(s)
- Liang-Wei Chiu
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Wen-Chi Chen
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Chi-Ping Huang
- Department of Urology, China Medical University Hospital, Taichung 40447, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Correspondence:
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Baumann FT, Reimer N, Gockeln T, Reike A, Hallek M, Ricci C, Zopf EM, Schmid D, Taaffe D, Newton RU, Galvao DA, Leitzmann M. Supervised pelvic floor muscle exercise is more effective than unsupervised pelvic floor muscle exercise at improving urinary incontinence in prostate cancer patients following radical prostatectomy - a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5374-5385. [PMID: 34550846 DOI: 10.1080/09638288.2021.1937717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Urinary incontinence is one of the most clinically relevant side effects in the treatment of prostate cancer patients. The aim of this systematic review and meta-analysis was to analyze the specific exercise effects of supervised versus unsupervised pelvic floor muscle exercise (PFME) and exercise volume on urinary incontinence status after radical prostatectomy. METHODS A systematic data search was performed for studies published from January 2000 to December 2020 using the following databases: PubMed, Embase, SciSearch, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews and Effects. The review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A random-effects meta-analysis of urinary incontinence remission was performed. The relation between time since surgery and urinary incontinence remission was analyzed using a non-linear dose-response meta-analysis. RESULTS The meta-analysis included 20 randomized controlled trials involving 2188 men (n = 1105 in intervention groups; n = 1083 in control groups). PFME versus no PFME had a beneficial effect on urinary incontinence remission at 3 months, 3-6 months, and more than 6 months post-surgery, with risk differences ranging from 12 to 25%. These effects were particularly evident for higher volume, supervised PFME in the first 6 months post-surgery. Additional biofeedback therapy appeared to be beneficial but only during the first 3 months post-surgery. CONCLUSIONS There is good evidence that the supervised PFME causes a decrease in short-term urinary incontinence rates. Unsupervised PFME has similar effects as no PFME in postoperative urinary incontinence. PFME programs should be implemented as an early rehabilitative measure to improve postoperative short-term urinary incontinence in patients with prostate cancer.IMPLICATIONS FOR REHABILITATIONProstate cancer, surgery, and urinary incontinenceThe surgical treatment of prostate cancer often leads to urinary incontinence.Pelvic floor training leads to a significant improvement of this situation.Exercise therapy support is very important in this context and is even more effective than unsupported training.
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Affiliation(s)
- Freerk T Baumann
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Nadine Reimer
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Theresa Gockeln
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Alexandra Reike
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - Christian Ricci
- Centre of Excellence for Nutrition, Nutritional Epidemiology and Biostatistics, North West University South Africa, Potchefstroom, South Africa
| | - Eva M Zopf
- Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Department Melbourne, Australian Catholic University, Melbourne, Australia
| | - Daniela Schmid
- Division for Quantitative Methods in Public Heallth and Health Services Research, Private University of Health Sciences Medical Informatics and Technology, Hall, Austria
| | - Dennis Taaffe
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Daniel A Galvao
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Michael Leitzmann
- Faculty of Medicine, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Kesch C, Heidegger I, Kasivisvanathan V, Kretschmer A, Marra G, Preisser F, Tilki D, Tsaur I, Valerio M, van den Bergh RCN, Fankhauser CD, Zattoni F, Gandaglia G. Radical Prostatectomy: Sequelae in the Course of Time. Front Surg 2021; 8:684088. [PMID: 34124138 PMCID: PMC8193923 DOI: 10.3389/fsurg.2021.684088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Radical prostatectomy (RP) is a frequent treatment for men suffering from localized prostate cancer (PCa). Whilst offering a high chance for cure, it does not come without a significant impact on health-related quality of life. Herein we review the common adverse effects RP may have over the course of time. Methods: A collaborative narrative review was performed with the identification of the principal studies on the topic. The search was executed by a relevant term search on PubMed from 2010 to February 2021. Results: Rates of major complications in patients undergoing RP are generally low. The main adverse effects are erectile dysfunction varying from 11 to 87% and urinary incontinence varying from 0 to 87% with a peak in functional decline shortly after surgery, and dependent on definitions. Different less frequent side effects also need to be taken into account. The highest rate of recovery is seen within the first year after RP, but even long-term improvements are possible. Nevertheless, for some men these adverse effects are long lasting and different, less frequent side effects also need to be taken into account. Despite many technical advances over the last two decades no surgical approach can be clearly favored when looking at long-term outcome, as surgical volume and experience as well as individual patient characteristics are still the most influential variables. Conclusions: The frequency of erectile function and urinary continence side effects after RP, and the trajectory of recovery, need to be taken into account when counseling patients about their treatment options for prostate cancer.
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Affiliation(s)
- Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
- Department of Urology, University College London Hospital, London, United Kingdom
| | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Lausanne, Switzerland
| | | | | | - Fabio Zattoni
- Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele, Milan, Italy
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8
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Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020; 9:3036-3048. [PMID: 33457277 PMCID: PMC7807332 DOI: 10.21037/tau.2020.03.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients’ quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Urkmez A, Ranasinghe W, Davis JW. Surgical techniques to improve continence recovery after robot-assisted radical prostatectomy. Transl Androl Urol 2020. [PMID: 33457277 DOI: 10.21037/tau.2020.03.36)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Radical prostatectomy directly affects urinary continence dynamics with incontinence being a major factor in patients' quality of life, social and psychological status. In order to help maintain continence after robot-assisted radical prostatectomy (RARP), a number of surgical techniques have been described. In the present narrative review, we summarize the surgical techniques that have been applied during RARP and their effects on incontinence rates and time to continence recovery.
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Affiliation(s)
- Ahmet Urkmez
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weranja Ranasinghe
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Daily Pad Usage Versus the International Consultation on Incontinence Questionnaire Short Form for Continence Assessment Following Radical Prostatectomy. Int Neurourol J 2020; 24:156-162. [PMID: 32615678 PMCID: PMC7332826 DOI: 10.5213/inj.1938116.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Continence assessment is an essential component of follow-up after radical prostatectomy (RP). Several methods exist to assess the severity of urinary incontinence (UI). Our study examined the relationship and degree of agreement between International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores and the number of pads used in a 24-hour period in the assessment of UI following RP. Methods Continence was prospectively assessed in 746 men from a Spanish urology clinic 12 months after RP using the ICIQ-SF and pad usage. The relationship between ICIQ-SF scores and pad usage was assessed using Spearman rank correlation coefficients. The Jonckheere-Terpstra trend test was used to determine whether the ICIQ-SF score and the component question scores increased with increasing pad usage. The Bonferroni-corrected pairwise Wilcoxon rank-sum test was used to determine which pairs of pad usage levels differed. The weighted kappa was used to evaluate the agreement between pad usage levels and ICIQ-SF questions. Results The continence rate was 82% using the “no pad usage” definition of continence versus 78% using the definition of an ICIQ-SF score of 0 (P<0.001). Strong positive correlations were observed between the number of pads and the ICIQ-SF total and component question scores (rs>0.85, P<0.001). The ICIQ-SF total and component question scores increased significantly with increasing pad usage (P<0.001). The ICIQ-SF scores (P<0.018) for all pairs of pad usage levels (0, 1, 2, or 3 or more) differed significantly. The agreement between the ICIQ-SF leakage amount question and pad usage was very good (rs=0.861, P<0.001). Conclusions At 12 months post-RP, 24-hour pad usage was closely correlated with ICIQ-SF, although the continence rate differed depending on the definition used. Higher levels of pad usage were associated with higher questionnaire scores, more leakage, and poor quality of life (interference with everyday life).
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11
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Toia B, Leung LY, Saigal R, Solomon E, Malde S, Taylor C, Sahai A, Hamid R, Seth JH, Sharma D, Greenwell TJ, Ockrim JL. Is pre-operative urodynamic bladder function the true predictor of outcome of male sling for post prostatectomy incontinence? World J Urol 2020; 39:1227-1232. [PMID: 32506387 PMCID: PMC8124059 DOI: 10.1007/s00345-020-03288-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/28/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate pre-operative urodynamic parameters in male sling patients to ascertain whether this might better predict surgical outcomes and facilitate patient selection. METHODS We performed a retrospective, case notes and video-urodynamics, review of men who underwent AdVanceXP male sling in three London hospitals between 2012 and 2019. Urodynamics were performed in all centres, while retrograde leak point pressure (RLPP) was performed in one centre. RESULTS Successful outcome was seen in 99/130 (76%) of men who required one pad or less per day. The dry rate was 51%. Pad usage was linked to worse surgical outcomes, mean 2.6 (range 1-6.5) for success vs 3.6 (range 1-10) although the ranges were wide (p = 0.002). 24 h pad weight also reached statistical significance (p = 0.05), with a mean of 181 g for success group versus 475 g for the non-successful group. The incidence of DO in the non-successful group was significantly higher than in successful group (55% versus 29%, p = 0.0009). Bladder capacity less than 250 ml was also associated with worse outcomes (p = 0.003). Reduced compliance was not correlated with outcomes (31% for success groups vs 45% for non-successful group, p = 0.15). Preoperative RLPP was performed in 60/130 patients but did not independently reach statistical significance (p = 0.25). CONCLUSION Urodynamic parameters related to bladder function-detrusor overactivity and reduced maximum cystometric capacity predict male sling outcomes and may help in patient selection for male sling (or sphincter) surgery; whereas urodynamic parameters of sphincter incompetency (RLPP) were not predictive. Further larger scale studies are required to confirm these findings.
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Affiliation(s)
- Bogdan Toia
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK. .,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK.
| | - Lap Yan Leung
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Raveen Saigal
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Eskinder Solomon
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Claire Taylor
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Arun Sahai
- Guy's and St Thomas' NHS Foundation Trust, King's College London, London, SE1 9RT, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jai H Seth
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Davendra Sharma
- St George's University Hospital, Blackshaw Rd., Tooting, London, SW17 0QT, UK
| | - Tamsin J Greenwell
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
| | - Jeremy L Ockrim
- University College London, Gower St, Bloomsbury, London, WC1E 6BT, UK.,Department of Urology, University College London Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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Averbeck MA, Marcelissen T, Anding R, Rahnama'i MS, Sahai A, Tubaro A. How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S119-S126. [PMID: 31821626 DOI: 10.1002/nau.23972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023]
Abstract
AIMS To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). METHODS This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" RESULTS Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. CONCLUSIONS Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
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Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Mohammad S Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University 2nd School of Medicine, Sant Andrea Hospital, Rome, Italy
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13
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Effect of Bladder Neck Preservation on Long-Term Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2019; 8:jcm8122068. [PMID: 31771310 PMCID: PMC6947283 DOI: 10.3390/jcm8122068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to evaluate the effect of bladder neck preservation (BNP) on long-term urinary continence after robot-assisted laparoscopic prostatectomy (RALP). We systematically searched the PubMed, Embase, and Cochrane Library databases to identify studies that assessed the difference in urinary continence and oncologic outcomes between patients who underwent RALP with BNP and those who underwent RALP without BNP. Four trials (1880 cases with BNP, 727 controls without BNP) were considered suitable for meta-analysis. BNP was associated with significantly better urinary continence outcomes at 3–4 months (odds ratio (OR), 2.88; 95% confidence interval (CI), 1.52–5.48; p = 0.001), 12 months (OR, 2.03; 95% CI, 1.10–3.74; p = 0.02), and 24 months (OR, 3.23; 95% CI, 1.13–9.20; p = 0.03) after RALP. There was no difference in the rate of overall positive surgical margin (PSM) (OR, 1.00; 95% CI, 0.72–1.39; p = 0.99) and that of PSM at the prostate base (OR, 0.49; 95% CI, 0.21–1.13; p = 0.09) between the two groups. The BNP technique during RALP leads to early return of urinary continence and long-term urinary continence without compromising the oncologic outcomes.
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Schmid FA, Wettstein MS, Kessler TM, Hermanns T, Boss A, Hötker AM, Eberli D. Contrast media kinetics in multiparametric magnetic resonance imaging before radical prostatectomy predicts the probability of postoperative incontinence. World J Urol 2019; 38:1741-1748. [DOI: 10.1007/s00345-019-02952-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/05/2019] [Indexed: 01/28/2023] Open
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15
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Ma BL, Yao L, Fan Y, Wang Y, Meng YS, Zhang Q, He ZS, Jin J, Zhou LQ. Short-term benefit of neoadjuvant hormone therapy in patients with localized high-risk or limited progressive prostate cancer. Cancer Manag Res 2019; 11:4143-4151. [PMID: 31190986 PMCID: PMC6522651 DOI: 10.2147/cmar.s196378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: Radical surgery is the preferred method for local high-risk and limited progressive prostate cancer in the routine clinical setting. However, current guidelines do not recommend neoadjuvant hormone therapy (NHT). Opinions regarding NHT vary among individual clinicians. According to the experience gained at our center, we explored the benefits of NHT for patients with prostate cancer during the perioperative period in this study. Methods: In this retrospective study, we explored the perioperative benefits of NHT among 189 patients with local high-risk or limited progressive prostate cancer who underwent radical prostatectomy and divided them into two groups: the NHT group and the non-NHT group. The NHT regimens were a gonadotropin-releasing hormone (GnRH) agonist alone (3.75/11.25 mg of leuprolide or 3.6/10.8 mg of goserelin acetate), an androgen receptor antagonist (ARA) alone, or a combination of the two. The duration of treatment was <3 months, 3 to 6 months, or >6 months. Results: We found that NHT could reduce the surgery time and intraoperative hemorrhage, thus reducing the difficulty of surgery; NHT could also improve the postoperative recovery of patients. However, it did not reduce the stage of prostate cancer or positive surgical margin rate. Conclusions: Neoadjuvant therapy is optional for some patients. We believe that NHT will improve the overall prognosis of patients as progress continues in the medical field in the future.
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Affiliation(s)
- Bing-Lei Ma
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Lin Yao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Yu Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Yi-Sen Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Qian Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Zhi-Song He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Jie Jin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Beijing, People’s Republic of China
- Beijing Key Laboratory of Urogenital Diseases (male), Molecular Diagnosis and Treatment Center, Beijing, People’s Republic of China
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