1
|
Beattie H, Subramanian T, Scudamore E, Middleton T, MacDonald C, Lindley R, Murthi G. Assessment of long-term quality of life, bowel and voiding function outcomes in patients with anorectal malformation at a single UK centre. Pediatr Surg Int 2024; 40:95. [PMID: 38565744 DOI: 10.1007/s00383-024-05684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
AIMS Assess long-term quality of life (QoL), bowel and voiding function in anorectal malformation (ARM) paediatric patients. METHOD Retrospective review of ARM patients between 2007 and 2020 was performed. QoL (all patients), bowel and voiding function (> 5 yo) were assessed using the paediatric quality of life inventory (PedsQL), paediatric incontinence and constipation score (PICS) and dysfunctional voiding scoring system (DVSS), respectively. RESULTS There were 122 patients (49% female, 85 > 5 yo) with ARM. Two had died, four refused, twenty-two were non-contactable, leaving ninety-four patients (65 > 5 yo) included. Mean age was 89 months (19-183), and follow-up was 86 months (13-183). Patients had significantly poorer scores for QoL, bowel and voiding function compared to published healthy controls. 57% had poor bowel function, 32% had poor voiding function and 38% required 'ancillary aids' to facilitate function. Patients using 'ancillary aids' for voiding function had a significantly lower QoL (parent: 62 vs 77; p = 0.01, patient: 66 vs 79; p = 0.05). Bowel continence was worse in those with high vs low ARM (13 vs 20, p = 0.004) and timely vs delayed diagnosis (17 vs 24, p = 0.04). CONCLUSION Patients with ARM have significantly worse QoL, bowel and voiding function than normal healthy controls. There is a need for long-term monitoring of function and further support for these children. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Harriet Beattie
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
- The Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - Thejasvi Subramanian
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Elizabeth Scudamore
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Thomas Middleton
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Caroline MacDonald
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Richard Lindley
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Govind Murthi
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK.
| |
Collapse
|
2
|
Nguyen K, McCormack L, Deans R, Nesbitt-Hawes E, Knapman B, Li F, Lim C, Abbott JA. A Prospective Study of Bladder Function Following Endometriosis Surgery With Up to Eight years Follow-up. J Minim Invasive Gynecol 2024; 31:205-212.e4. [PMID: 38042477 DOI: 10.1016/j.jmig.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
STUDY OBJECTIVE To assess long-term urinary function for women having laparoscopic surgery for endometriosis. DESIGN Institutional Review Board-approved nested cohort study within a larger randomized controlled trial assessing urinary function following any benign laparoscopy for gynecological presentations. SETTING Two tertiary-level university-affiliated hospitals. PATIENTS Women with histologically confirmed endometriosis within the randomized controlled trial between April 2012 and November 2019, where baseline urinary function was determined. INTERVENTIONS Women with histologically confirmed endometriosis were contacted between February and October 2020, and urinary function was re-assessed. MEASUREMENTS AND MAIN RESULTS Urinary function was assessed using validated questionnaires across the domains of filling, voiding, incontinence, and quality of life determined distant from surgery. Higher scores correlated with a greater severity of symptoms. From 518/711 (72.9%) women with histologically confirmed endometriosis, 289/518 (55.8%) consented to the nested study. At a mean of 50 months (range 12-103 months) post-operatively, 35 participants (12.1%) had sought treatment for bladder symptoms, and 81 participants (28.0%) reported at least one urinary tract infection since their index surgery. There was a significant worsening of symptoms for filling, voiding, incontinence, and quality of life pre-operative to post-operatively (2.27 vs 3.32, 0.93 vs 2.02, 1.06 vs 2.32, 0.83 vs 2.13 respectively, p <.001). There was no statistically significant difference in urinary questionnaire scores in participants with and without uterovesical endometriosis. There was no statistically significant difference in any parameter when comparing any revised American Society of Reproductive Medicine (rASM) stage of endometriosis. Participants who had post-operative urinary retention reported a higher mean voiding score than those who did not (3.24 vs 1.94, p = .017), while participants with post-operative urinary tract infection reported a higher mean frequency score than those who did not (5.17 vs 3.24, p = .016). CONCLUSION This study suggests a decline in urinary function over time following laparoscopic surgery for endometriosis that is not dependent on the severity or location of the disease.
Collapse
Affiliation(s)
- Kimberly Nguyen
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)..
| | - Lalla McCormack
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Rebecca Deans
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Erin Nesbitt-Hawes
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Blake Knapman
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Fiona Li
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Claire Lim
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| | - Jason A Abbott
- School of Clinical Medicine, UNSW Sydney, and Gynaecology Research and Clinical Evaluation (GRACE) Group, Sydney, New South Wales (all authors)
| |
Collapse
|
3
|
Dall CP, Mason JB, Choudhury E, Mora-Garijo B, Egan J, Hu JC, Kowalczyk KJ. Long-term outcomes of pelvic-fascia sparing robotic-assisted radical prostatectomy versus standard technique: Superior urinary function and quality of life without compromising oncologic efficacy in a single-surgeon series. Urol Oncol 2024; 42:67.e17-67.e24. [PMID: 38212151 DOI: 10.1016/j.urolonc.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Prostatic fascia-sparing robotic-assisted radical prostatectomy (PFS-RARP) has improved short-term postoperative continence compared to standard prostatectomy (S-RARP) but long-term differences remain unclear. MATERIALS AND METHODS One hundred two S-RARP followed by 239 PFS-RARPs were performed by a single surgeon. Univariate analyses were performed with t-test, χ2, Wilcoxon rank sum, Fisher exact, and analysis of variance (ANOVA). Regression models analyzed associates of EPIC-CP scores and oncologic outcomes. Cox proportional hazards modeling assessed postoperative continence. Primary outcomes included patient-reported urinary incontinence (UI) via EPIC-CP and continence rates. Secondary outcomes included EPIC-CP scores, positive surgical margins (PSM), and biochemical recurrence (BCR). Perioperative outcomes and time to continence were measured. RESULTS Median follow-up for PFS-RARP vs. S-RARP was 26 vs. 65 months. PFS-RARP demonstrated improved EPIC-CP UI and total scores at 24 months. On multivariate analysis, PFS-RARP was associated with improved EPIC-CP UI and total scores through 18 months, but not with PSM or BCR. PFS-RARP had a 39% and 66% reduced risk of incontinence using 0 and 0 to 1 pad-use definitions (HR 0.61, 95% CI 0.39 - 0.95; HR:0.34, 95% CI 0.16 - 0.76). Continence returned faster with PFS-RARP (0 PPD: 91.0 days vs. 261 days, P < 0.001; 0-1 PPD: 32.7 days vs. 171 days, P < 0.001). There were no differences in PSM (35% vs. 25%, P = 0.064). There were more anterior PSM in PFS-RARP vs. S-RARP (47% vs. 26% P = 0.035), but no differences in BCR (16% vs. 22% P = 0.241). CONCLUSIONS PFS-RARP improves continence and patient-reported QOL up to 24 months postoperatively without compromising oncologic outcomes.
Collapse
Affiliation(s)
- Christopher P Dall
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA.
| | - J Bradley Mason
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA
| | | | - Belen Mora-Garijo
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA
| | - Jillian Egan
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical Center, New York, NY, USA
| | - Keith J Kowalczyk
- Department of Urology, Medstar Georgetown University Hospital, Washington, DC, USA; Department of Urology, Medstar Washington Hospital Center, Washington, DC, USA; Georgetown University School of Medicine, Washington, DC, USA
| |
Collapse
|
4
|
Feng C, Li H, Ding Z, Zhao W. Comparison of postoperative urinary and sexual functions in men who underwent Denonvilliers' fascia preservation or intraoperative laparoscopic radical resection for rectal cancer: A meta-analysis of the Chinese population. Asian J Surg 2024:S1015-9584(24)00179-9. [PMID: 38302364 DOI: 10.1016/j.asjsur.2024.01.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/06/2024] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
Currently, colorectal cancer has the third highest incidence worldwide. As its incidence is increasing, focus on quality of life after laparoscopic radical resection for colorectal cancer has also increased. This study aimed to compare the effects of retention or resection of the Denonvilliers'fascia on urinary and sexual functions in men who underwent laparoscopic radical resection for rectal cancer. Relevant national and international literature databases, including China Knowledge Network, PubMed, Cochrane Library, and Excerpta Medica Database, were searched according to the established retrieval scheme. Review Manager 5.3 was used to analyze data, and the correct effect model was selected based on heterogeneity. In total, 22 studies involving 2255 patients were included in the meta-analysis. The studies were categorized into the experimental and control groups. The incidence of urinary dysfunction was lower in the experimental group than in the control group at 1 and 6 months postoperatively. In terms of sexual function, the experimental group had lower rates of erectile and ejaculatory dysfunctions than the control group at 1, 3, and 6 months and 1 year postoperatively. However, the experimental group had a longer operation time than the control group. No significant differences in incidence of postoperative complications, intra-operative blood loss, and number of lymph nodes dissections were observed between the two groups. Overall, laparoscopic radical resection for rectal cancer with preservation of the Denonvilliers' fascia has been proven effective in improving postoperative urinary and sexual functions in men without affecting the number of lymph nodes dissected and enhancing postoperative quality of life.
Collapse
Affiliation(s)
- Chenglei Feng
- Affiliated Hospital, Hangzhou Normal University, Hangzhou, China
| | - Hang Li
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Zujun Ding
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Wei Zhao
- Department of General Surgery, Longgang People's Hospital, Wengzhou, China.
| |
Collapse
|
5
|
Thompson D, Bensley JG, Tempo J, Ehdaie B, Carlsson S, Eastham J, Bolton D, Perera M, Papa N. Long-term Health-related Quality of Life in Patients on Active Surveillance for Prostate Cancer: A Systematic Review. Eur Urol Oncol 2023; 6:4-15. [PMID: 36156268 PMCID: PMC9908828 DOI: 10.1016/j.euo.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Active surveillance (AS) represents the preferred treatment option in patients with low-risk prostate cancer. Optimised patient selection has enabled more patients to be managed with AS for a longer time. Thus, there is growing interest in its effect on long-term quality of life compared with interventional management. OBJECTIVE To perform a systematic review evaluating the long-term patient-reported outcomes regarding mental health, and sexual and urinary function in patients on AS. EVIDENCE ACQUISITION We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We included series assessing validated patient-reported outcomes of health-related quality of life, and sexual and urinary function in AS patients followed up for at least 5 yr. EVIDENCE SYNTHESIS Our search yielded 1854 citations, including 19 papers involving 3643 patients on AS, 14 651 patients receiving surgery or radiotherapy, and 2478 controls without prostate cancer. In ten studies, major differences were observed in sexual and urinary symptoms between groups, such as better sexual function and fewer irritative urinary symptoms in patients on AS, though overall functional outcomes were comparable. In all studies, health-related quality of life for patients on AS was better than, or similar to, that for patients who had undergone surgery or radiotherapy and comparable with that for individuals without cancer. CONCLUSIONS We observed differences in specific functional outcomes between patients on AS and surgery or radiotherapy, ≥5 yr after treatment. Patients on AS reported good quality of life, similar to that in individuals without prostate cancer. AS should continue to be a recommended management strategy for appropriately selected patients. PATIENT SUMMARY Active surveillance is an accepted pathway for patients with low-risk localised prostate cancer. Previous literature has shown that it did not negatively affect short-term quality of life. This review finds that long-term quality of life for these patients is similar to that for people without prostate cancer.
Collapse
Affiliation(s)
- Daryl Thompson
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
| | - Jonathan G Bensley
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jake Tempo
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sigrid Carlsson
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Victoria, Australia; Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nathan Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
6
|
Miura H, Hatakeyama S, Tanaka T, Fujita N, Horiguchi H, Tanaka R, Noro D, Tokui N, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. Oncological and functional outcomes of female reproductive organ-sparing radical cystectomy and ileal neobladder construction. Urol Oncol 2022; 41:254.e17-254.e24. [PMID: 36513564 DOI: 10.1016/j.urolonc.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the oncological and urinary functional outcomes of reproductive organ-sparing radical cystectomy (ROS-RC) and U-shaped ileal neobladder construction in females compared with male patients. METHODS We retrospectively examined 357 patients (281 male and 76 female) with muscle-invasive bladder cancer who were treated with RC plus U-shaped ileal neobladder construction between May 1996 and July 2021. All female patients were treated with ROS-RC. We compared disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), and urinary functional outcomes between male and female patients. We evaluated the effect of gender on DFS, CSS, and OS. Furthermore, urinary functional outcomes were evaluated in 140 males and 48 females using a pressure-flow study at 3, 6, 9, and 12 months postoperatively. RESULTS Female patients were considerably older than male patients at the time of radical cystectomy. No significant difference was noted in the tumor stage preoperatively. The multivariable Cox regression analysis with an inverse probability treatment weighted model revealed that the female gender was not significantly related to DFS, CSS, and OS. Moreover, urinary functions at 12 months were not markedly different between males and females, except for the capacity of the neobladder, detrusor pressure, and maximum urethral closure pressure. CONCLUSIONS This study demonstrates that female patients with ROS-RC and U-shaped ileal neobladder construction did not significantly correlate with worse oncological outcomes. The combination of ROS-RC and U-shaped ileal neobladder construction might attain adequate urinary function without sacrificing oncologic outcomes.
Collapse
Affiliation(s)
- Hikari Miura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Toshikazu Tanaka
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryuma Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Noro
- Department of Urology, Mutsu General Hospital, Mutsu, Japan
| | - Noriko Tokui
- Department of Urology, Odate Municipal Hospital, Odate, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
7
|
Miura T, Sakamoto Y, Morohashi H, Suto A, Kubota S, Ichisawa A, Kuwata D, Yamada T, Tamba H, Matsumoto S, Hakamada K. Robotic surgery contributes to the preservation of bowel and urinary function after total mesorectal excision: comparisons with transanal and conventional laparoscopic surgery. BMC Surg 2022; 22:147. [PMID: 35449005 PMCID: PMC9026934 DOI: 10.1186/s12893-022-01596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determine whether robotic surgery is more effective than transanal and conventional laparoscopic surgery in preserving bowel and urinary function after total mesorectal excision (TME). METHODS Of 79 lower rectal cancer patients who underwent function-preserving TME between 2016 and 2020, 64 patients consented to a prospective questionnaire-based functional observation study (52 responded). At 6 months post-resection or ileostomy closure, Wexner, low anterior resection syndrome (LARS), modified fecal incontinence quality of life, and international prostate symptom scores were used to evaluate bowel and urinary function, comparing robotic surgery (RTME) with transanal (taTME) or conventional laparoscopic surgery (LTME). RESULTS RTME was performed in 35 patients (54.7%), taTME in 15 (23.4%), and LTME in 14 (21.9%). While preoperative bowel/urinary functions were similar in all three procedures, and the distance from the anal verge to tumor was almost the same, more hand-sewn anastomoses were performed and the anastomotic height from the anal verge was shorter in taTME than RTME. At 2 years post-resection, 8 patients (12.5%) had a permanent stoma; RTME showed a significantly lower rate of permanent stoma than taTME (2.9% vs. 40%, p < 0.01). Despite no significant difference, all bowel function assessments were better in RTME than in taTME or LTME. Major LARS was observed in all taTME and LTME cases, but only 78.8% of RTME. No clear difference arose between RTME and taTME in urinary function; urinary dysfunction was more severe in LTME than RTME (36.4% vs. 6.1%, p = 0.02). CONCLUSIONS In function-preserving TME for lower rectal cancer, robotic surgery was suggested to be more effective than transanal and conventional laparoscopic surgery in terms of bowel and urinary functions.
Collapse
Affiliation(s)
- Takuya Miura
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Hajime Morohashi
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Akiko Suto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Shunsuke Kubota
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Aika Ichisawa
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Daisuke Kuwata
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Takahiro Yamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Hiroaki Tamba
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Shuntaro Matsumoto
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| |
Collapse
|
8
|
Lavallée E, Dovey Z, Pathak P, Dey L, Renström Koskela L, Hosseini A, Waingankar N, Mehrazin R, Sfakianos J, Hosseini A, Wiklund P. Functional and Oncological Outcomes of Female Pelvic Organ-preserving Robot-assisted Radical Cystectomy. EUR UROL SUPPL 2022; 36:34-40. [PMID: 35005650 DOI: 10.1016/j.euros.2021.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background For females undergoing cystectomy and urinary diversion, decreases in sexual and urinary functions can have a significant impact on quality of life. Pelvic organ-preserving (POP) radical cystectomy (RC) has been proposed as an approach to improve postoperative functional outcomes. Objective To evaluate postoperative functional outcomes of a robotic approach for female POP RC with intracorporeal urinary diversion. Design setting and participants This was a multicenter retrospective study evaluating sexual, urinary, and oncological outcomes for sexually active females undergoing POP robot-assisted RC for ≤T2 bladder cancer. Exclusion criteria included multifocal, trigonal, or locally advanced tumors. Surgical procedure We describe a step-by-step technique for POP robot-assisted RC with intracorporeal urinary diversion. Measurements The primary outcome of the study was evaluation of sexual and urinary functions following surgery. Oncological outcomes were evaluated as a secondary endpoint. Results and limitations Our study included 23 females who underwent POP robot-assisted RC between 2008 and 2020 with intracorporeal neobladder (87%) or ileal conduit (13%) reconstruction. The median follow-up was 20 mo. A postoperative sexual function questionnaire was completed by 15 patients (65%). Of those, 13 (87%) resumed sexual activity at a median of 6 mo after surgery. Of the patients with a neobladder, 14 (70%) achieved daytime continence and 16 (80%) achieved nighttime continence. Cancer-specific and overall survival were both 91%. The results are limited by their retrospective nature. Conclusions POP robot-assisted RC with orthotopic neobladder allows a majority of female patients to return to sexual activity after surgery. This approach should be considered for selected sexually active women. Patient summary We evaluated 23 women with bladder cancer who underwent surgical removal of the bladder with preservation of their reproductive organs. Following this surgery, a majority of patients resumed sexual activity. For selected patients, this technique can be performed without compromising cancer control.
Collapse
|
9
|
Li K, He X, Zheng Y. An Optimal Surgical Plane for Laparoscopic Functional Total Mesorectal Excision in Rectal Cancer. J Gastrointest Surg 2021; 25:2726-2727. [PMID: 34109532 DOI: 10.1007/s11605-021-05035-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraoperative damage of pelvic autonomic nerves is the primary reason for postoperative sexual and urinary dysfunction after rectal cancer surgery,1,2 especially in patients with low rectal cancer. In the present study, we developed the nerve plane as a novel concept in rectal cancer surgery, which served as a landmark for better preservation of pelvic autonomic nerves in standardized total mesorectal excision (TME) surgery. The nerves never exist alone, and are always surrounded by tiny capillaries and adipose tissue, which are covered by a thin layer of membranous tissue, leading to a continuous plane, which we defined as the nerve plane. The nerve plane could be preserved from thermal damage, ischemic injury, nerve stretching, and chemical factors produced by local inflammatory effects. We also found loose connective tissue (the first gap) between the proper fascial of the rectum and the nerve plane, which was also a natural avascular holy's plane. Using the concept of nerve plane, the proposed functional TME procedure could help surgeons to better protect pelvic autonomic nerves from injury. Herein, we present a brief video to describe the technical aspects of a laparoscopic functional TME in rectal cancer surgery. METHODS Fifty-eight consecutive male patients without preoperative sexual and urinary dysfunction underwent laparoscopic functional TME surgery for histologically confirmed adenocarcinoma at our hospital since 2018. The present study was approved by the institutional review board of the Renmin Hospital of Wuhan University (2018-X-08), and written informed consent was obtained from all patients. Urinary and sexual function was evaluated using the international prostatic symptom score (IPSS)3 and the 5-item version of International Index of Erectile Function (IIEF-5)4 questionnaires, respectively, which are internationally recognized as well-structured and reliable questionnaires to evaluate urinary and sexual function. Moderate-to-severe urinary dysfunction was defined as IPSS score >8 points,2 while erectile dysfunction was defined as IIEF-5 score ≤ 11points.5 The laparoscopic functional TME procedure shown in the video is described as follows. First, the incision line was marked on the peritoneum from the lower edge of the duodenum to the pelvic entrance with an electric hook using a medium approach. The holy's plane was divided into five structures by enforcing traction and anti-traction, which included fascia propria of the rectum, the loose areolar connective tissue over the nerve plane (the first gap), the nerve plane, the loose areolar connective tissue below the nerve plane (the second gap), and the Gerota's fascia or the presacral fascia. Second, dissection over the nerve plane was performed from the lower edge of the duodenum to the pelvic entrance. Superior hypogastric plexus nerve plane, abdominal aortic plexus nerve plane, and inferior mesenteric plexus nerve plane were clearly displayed. Dissection was continued in this way, and the left and right hypogastric nerve planes were also preserved. Finally, the pelvic cavity was entered, and posterior dissection was continued downward to the Waldeyer fascia. We selected to go over the Waldeyer fascia along the nerve plane instead of transecting it to enter the superior levator space, thereby some small nerves such as efferent branches of hypogastric nerves in this area were protected from injury. The lateral pelvic dissection was continued over the pelvic plexus nerve plane, anterior pelvic dissection was continued, and the Denonvillier's interfascial space was entered between the anterior layer and the posterior layer of Denonvilliers' fascia. The left and right neurovascular bundles (NVB) were avoided and not intentionally exposed during the operation, thereby protecting them from injury. Although some steps of the procedure are displayed very close to the anatomical landmarks, patience and higher-resolution laparoscopic equipment are needed for surgeons to find the nerve plane. For less experienced surgeons, we suggest that the harmonic with the "hot" blade should be as far away from the nerves as possible during the radical resection of tumor. After the rectum was dissected, superior hypogastric plexus nerve plane, abdominal aortic plexus nerve plane, inferior mesenteric plexus nerve plane, hypogastric nerve plane, pelvic plexus nerve plane, left ureter, and genital vessels were displayed and completely preserved. The intraoperative nerve plane and mesorectum of the postoperative specimen were intact and smooth. RESULTS The median age of patients was 53 years, with a body mass index (BMI) of 24.0 kg/m2. The median total operation time was 198 min (range 128-248 min). The median volume of blood loss was 30 ml (range 10-50 ml). The median number of retrieved lymph nodes was 31 (range 13-65). No patient showed postoperative moderate-to-severe urinary dysfunction at 6 months. The incidence of postoperative erectile dysfunction was 5.17% (3/58) at 12 months. No patient was lost during 1-year of follow-up. CONCLUSION Nerve plane is an optimal surgical landmark for laparoscopic functional total mesorectal excision in rectal cancer. It provides a superior surgical technique for pelvic autonomic nerve protection.
Collapse
Affiliation(s)
- Kai Li
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
| | - Xiaobo He
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
| | - Yongbin Zheng
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China.
| |
Collapse
|
10
|
Dior UP, Reddington C, Cheng C, Levin G, Healey M. Urinary Function after Surgery for Deep Endometriosis: A Prospective Study. J Minim Invasive Gynecol 2021; 29:308-316.e2. [PMID: 34469822 DOI: 10.1016/j.jmig.2021.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To compare urinary function before and after surgery in patients undergoing laparoscopy for deep endometriosis and to measure the rate of postoperative deterioration in urinary function after surgery. DESIGN Prospective questionnaire-based observational cohort study. SETTING Tertiary university-affiliated hospital. PATIENTS Included were 149 women who underwent surgery for deep endometriosis. INTERVENTIONS Participants completed the international consultation on incontinence female lower urinary tract symptoms long-form questionnaire before surgery and 6 weeks, 6 months, and 12 months after surgery. MEASUREMENTS AND MAIN RESULTS Bladder filling, voiding, and urinary incontinence summary scores were compared before and after surgery with mixed-effects linear regression analysis (correlated observations). Individual domains comprising the summary scores and their bother scores were also compared before and after surgery. Filling score at 6 weeks (3.7 ± 2.6), 6 months (3.2 ± 2.2), and 12 months (3.4 ± 2.2) improved from presurgery scores (4.2 ± 2.6) (p-value for the difference between before and after surgery: p <.001, p = .009, and p = .02 for 6 weeks, 6 months, and 12 months, respectively). No change was observed after surgery in bladder voiding score. Incontinence score improved at 6 weeks after surgery (presurgery and 6-week scores: 2.5 ± 3.3 and 1.6 ± 2.2, respectively, p <.001) but not thereafter. Patients with low preoperative summary scores had higher summary scores (worse function) after surgery, and patients with high preoperative scores had lower summary scores (improved function) after surgery. CONCLUSION Urinary function improved after laparoscopy for deep endometriosis. Greatest improvement was found in patients with worse preoperative function, whereas postoperative deterioration in urinary function was found for patients with initially normal function. More research is needed to better identify the subpopulations in whom surgical intervention provides symptomatic benefit or deterioration.
Collapse
Affiliation(s)
- Uri P Dior
- From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia; Endometriosis Centre, Hadassah-Hebrew University Medical Centre (Drs. Levin and Dior), Jerusalem, Israel.
| | - Charlotte Reddington
- From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia
| | - Claudia Cheng
- From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne (Drs. Cheng and Healey), Melbourne, Victoria, Australia
| | - Gabriel Levin
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre (Drs. Levin and Dior), Jerusalem, Israel
| | - Martin Healey
- From the Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital (Drs. Dior, Reddington, Cheng, and Healey), Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne (Drs. Cheng and Healey), Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Declemy A, Haddad R, Chesnel C, Charlanes A, Le Breton F, Sheikh Ismael S, Amarenco G. Prevalence of comorbidities in multiple sclerosis patients with neurogenic bladder. Prog Urol 2021; 31:732-738. [PMID: 33941463 DOI: 10.1016/j.purol.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/11/2020] [Accepted: 10/30/2020] [Indexed: 01/22/2023]
Abstract
AIMS The aim of this study was to define the prevalence of comorbidities among multiple sclerosis patients with lower urinary tract symptoms. METHODS A retrospective study of data collected prospectively from January 2000 to March 2016 was carried out using a database. Comorbidities were divided into several classes according to the International Classification of Diseases (ICD-10). RESULTS One hundred and fifty-five patients were included. All had a neurogenic bladder with 150 (96%) overactive bladder. EDSS score was≥6 in 44 patients (28%). Comorbidities were present in 79 (50,9%) and the most frequent ones were cardiovascular (14,2%), endocrinological (10,3%), urological (8,4%), abdominal (7,7%). Overweight (BMI≥25) was observed in 63 (40%). A strict relationship was found for BMI and stress urinary incontinence (P<0.001) as well as voiding dysfunction (P=0.003) without significant association for BMI and overactive bladder. CONCLUSION Prevalence of comorbidities is important in MS (more than 50%). A significant association is found between overweight, stress urinary incontinence and voiding dysfunction. Knowledge of these comorbidities in MS is important since the presence of these urinary symptoms not related to neurogenic bladder must lead to a specific treatment. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- A Declemy
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France.
| | - R Haddad
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - C Chesnel
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - A Charlanes
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - F Le Breton
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - S Sheikh Ismael
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| | - G Amarenco
- GREEN GRC-01 UPMC (Group of clinical REsEarch in Neuro-urology), Sorbonne University, Paris, France; Department of Neuro-urology, Tenon Hospital, APHP, Paris, France
| |
Collapse
|
12
|
Torrijo I, Balciscueta Z, Tabet J, Martín MC, López M, Uribe N. Prospective study of urinary function and analysis of risk factors after rectal cancer surgery. Tech Coloproctol 2021; 25:727-737. [PMID: 33811298 DOI: 10.1007/s10151-021-02445-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Alterations in urinary function are complications of rectal cancer surgery. The aim of this study was to prospectively analyze the changes in urinary function in patients operated on for rectal cancer, and to identify risk factors that may have an impact on the deterioration of postoperative urinary function. METHODS A prospective study of urinary function in rectal cancer patients who had elective oncological resection with curative intention at the Arnau de Vilanova Hospital in Valencia, Spain, from January 2017 to March 2019. The evaluation of urinary function was performed using the International Prostate Symptom Score (IPSS) preoperatively, at 6 and 12 months after surgery. Predictive factors of urinary dysfunction were identified by univariate and multivariate analysis. RESULTS Ninety-four patients were enrolled in the study. Eighty-seven of them completed all the follow-up assessments (48 men and 39 women, mean age 65.74 ± 10.95 years,). The mean IPSS was 7.96 ± 7.59 preoperatively, 9.01 ± 6.81 at 6 months, and 8.63 ± 5.59 at 12 months, without statistically significant differences. There were no differences in IPSS between males and females. Preoperative urinary dysfunction was 39% and at 12 months, a deterioration occurred in 23 patients (26.4%). IPSS analysis of symptoms showed a statistically significant worsening of nocturia at 6 months (p = 0.002) and 1 year after surgery (p = 0.037) in women. American Society of Anesthesiologists (ASA) class (OR: 11, [95% CI2.4-53]; p = 0.010), surgical difficulty (OR: 4.5, [95% CI 1-19]; p = 0.027) and anastomotic leakage (OR: 14, [95% CI 1.6-117]; p = 0.010), were identified as independent risk factors for deterioration of urinary function after surgery. CONCLUSIONS Our study showed worsening urinary dysfunction after rectal cancer surgery in 26.4% of the patients. However, there were no statistically significant differences in mean IPSS scores at the three assessment times (preoperatively, 6 months, 12 months). ASA class, surgical difficulty, and anastomotic leakage may predict postoperative deterioration.
Collapse
Affiliation(s)
- I Torrijo
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain.
| | - Z Balciscueta
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - J Tabet
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M C Martín
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M López
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - N Uribe
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| |
Collapse
|
13
|
Panaiyadiyan S, Nayyar BU, Nayyar R, Kumar N, Seth A, Kumar R, Singh P, Nayak B, Kumar M. Impact of vesicovaginal fistula repair on urinary and sexual function: patient-reported outcomes over long-term follow-up. Int Urogynecol J 2021; 32:2521-2528. [PMID: 33420796 DOI: 10.1007/s00192-020-04648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS While the anatomical closure rates of vesicovaginal fistula (VVF) following transabdominal (TA) and transvaginal (TV) repairs seem comparable, studies comparing urinary and sexual outcomes following successful repair are lacking. We aimed to report patient-reported outcomes on sexual and urinary functions after long-term follow-up with successful repair. METHODS We retrospectively reviewed 81 women who had successful VVF repair at our institute. Pre-, intra- and post-operative details were retrieved from electronic data software. Patient-reported sexual and urinary function outcomes were assessed using the Female Sexual Function Index (FSFI) questionnaire and International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF), respectively, at last follow-up. We also compared such outcomes among TA and TV repairs. RESULTS Of 81 women, 28 (34.6%) had TA and 53 (65.4%) had TV repairs. Mean age was 37.5 years and mean fistula diameter was 12.9 mm. The most common aetiology was hysterectomy. Thirty-three patients (40.7%) had previous failed repairs. At a mean follow-up of 29.8 months, 24 (34.3%) women had sexual dysfunction and 15 (18.5%) women experienced urinary dysfunction. The TA and TV groups had comparable mean FSFI scores (28.7 ± 6.1 vs. 30.9 ± 5.2, p = 0.13) and ICIQ-SF scores (0.7 ± 1.7 vs. 0.5 ± 1.4, p = 0.59). In multivariate analysis, fistula size and site were significant predictors of urinary dysfunction whereas multiparity was the most significant predictor of sexual dysfunction. CONCLUSIONS Sexual and urinary dysfunction is found in a considerable number of women after VVF repair. However, our data suggest comparable long-term sexual and continence outcomes between TA and TV repairs.
Collapse
Affiliation(s)
- Sridhar Panaiyadiyan
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Bharti Uppal Nayyar
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Neeraj Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manoj Kumar
- Department of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| |
Collapse
|
14
|
Kang SB, Cho JR, Jeong SY, Oh JH, Ahn S, Choi S, Kim DW, Lee BH, Youk EG, Park SC, Heo SC, Lee DS, Ryoo SB, Park JW, Park HC, Lee SM, Kang SI, Kim MH, Oh HK, Shin R, Kim MJ, Lee KH, Kim YH, Kim JS, Lee KW, Lee HS, Kim HJ, Park YS, Sohn DK, Park KJ. Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study. Lancet Reg Health West Pac 2020; 6:100087. [PMID: 34327411 PMCID: PMC8315365 DOI: 10.1016/j.lanwpc.2020.100087] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 12/20/2022]
Abstract
Background The long-term effects of radical resection on quality of life may influence the treatment selection. The objective of this study was to determine whether abdominoperineal resection has a better effect on the quality of life than sphincter preservation surgery at 3 years after surgery Methods This prospective, cohort study included patients who underwent radical resection for low rectal cancer. The primary outcomes were European Organisation for Research and Treatment of Cancer QLQ-C30 and CR38 quality of life scores 3 years after surgery, which were compared with linear generalised estimating equations, after adjustment for baseline values, a time effect, and an interaction effect between time and treatment. The secondary outcomes included sexual-urinary functions and oncological outcomes. The study was registered with ClinicalTrials.gov (NCT01461525). Findings Between December 2011 and August 2016, 342 patients were enrolled: 268 (78•4%) underwent sphincter preservation surgery and 74 (21•6%) underwent abdominoperineal resection. The global quality of life scores did not differ between sphincter preservation surgery and abdominoperineal resection groups (adjusted mean difference, 4•2 points on a 100-point scale; 95% confidence interval [CI], −1•3 to 9•7, p = 0•1316). Abdominoperineal resection was associated with a worse body image (9•8 points; 95% CI, 2•9 to 16•6, p = 0•0052), micturition symptoms (−8•0 points; 95% CI, -14•1 to −1•8, p = 0•0108), male sexual problems (−19•9 points; 95% CI, -33•1 to -6•7, p = 0•0032), less confidence in getting and maintaining an erection in males (0•5 points on a 5-point scale; 95% CI, 0•1 to 0•8, p = 0•0155), and worse urinary symptoms (−5•4 points on a 35-point scale; 95% CI, −8•0 to −2•7, p < 0•0001). The 5-year overall survival was worse with abdominoperineal resection in unadjusted (92•2% vs 80•9%; difference 11•3%, hazard ratio 2•38; 95% CI, 1•27 to 4•46, p = 0•0052), but did not differ after adjustment. Interpretation In this long-term prospective study, abdominoperineal resection failed to meet the superiority to sphincter preservation surgery in terms of quality of life. Although the global quality of life scores did not differ between groups, this study suggests that sphincter preservation surgery can be an acceptable alternative to abdominoperineal resection for low rectal cancer, offering a better quality of life and sexual-urinary functions, with no increased oncological risk even after 3 years. Funding Seoul National University Bundang Hospital, Korea
Collapse
Affiliation(s)
- Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Jung Rae Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Seung-Yong Jeong
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea (S Choi is currently at Korea University College of Medicine, Seoul, Korea)
| | - Sunkyu Choi
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea (S Choi is currently at Korea University College of Medicine, Seoul, Korea)
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Bong Hwa Lee
- Department of Surgery, Hallym University College of Medicine, Hallym University Hospital, Anyang, Korea (BH Lee is currently at Clean Seoul Clinic, Seoul, Korea; HC Park is currently at the National Cancer Center, Goyang, Korea)
| | - Eui Gon Youk
- Department of Surgery, Daehang Hospital, Seoul, Korea (EG Youk is currently at Good-Jang Hospital, Seoul, Korea)
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Doo-Seok Lee
- Department of Surgery, Daehang Hospital, Seoul, Korea (EG Youk is currently at Good-Jang Hospital, Seoul, Korea)
| | - Seung-Bum Ryoo
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Park
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyoung-Chul Park
- Department of Surgery, Hallym University College of Medicine, Hallym University Hospital, Anyang, Korea (BH Lee is currently at Clean Seoul Clinic, Seoul, Korea; HC Park is currently at the National Cancer Center, Goyang, Korea)
| | - Sung-Min Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Sung Il Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Min Hyun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S-M Lee is currently at Kyungpook National Univeristy Chilgok Hospital, Daegu, Korea; SI Kang is currently at Yeungnam University Medical Center, Daegu, Korea)
| | - Rumi Shin
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Min Jung Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Gastroenterology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyu Joo Park
- Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | | |
Collapse
|
15
|
Abstract
Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.
Collapse
Affiliation(s)
- Meghan Davis
- Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA. https://twitter.com/MeghanFDavis1
| | - Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA. https://twitter.com/JillianEganMD
| | - Shawn Marhamati
- Austin Hospital, Department of Urology, 145 Studley Rd, Heidelberg VIC 3084, Australia
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, Milano 20162, Italy
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, 3800 Reservoir Road Northwest, Washington, DC 20007, USA.
| |
Collapse
|
16
|
Egan J, Marhamati S, Carvalho FLF, Davis M, O'Neill J, Lee H, Lynch JH, Hankins RA, Hu JC, Kowalczyk KJ. Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. Eur Urol 2020; 79:839-857. [PMID: 32536488 DOI: 10.1016/j.eururo.2020.05.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to improve continence. However, questions remain regarding feasibility and generalizability of technique and outcomes. OBJECTIVE To compare the outcomes of 140 consecutive standard robot-assisted radical prostatectomy (S-RARP) versus RS-RARP. DESIGN, SETTING, AND PARTICIPANTS A total of 70 S-RARPs were performed followed by 70 RS-RARPs. Demographic, pathologic, and functional outcomes were compared preoperatively and through 12 mo. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) was used to compare functional outcomes. Logistic and linear regression analyses were utilized to analyze variables associated with EPIC-CP urinary incontinence and overall quality of life (QOL) scores, and oncologic outcomes. Cox regression analysis was used to analyze incontinence at 12 mo. SURGICAL PROCEDURE RS-RARP versus S-RARP. MEASUREMENTS Patient and tumor characteristics (age, body mass index, prostate-specific antigen, Charlson Comorbidity Index, Gleason group, clinical stage, and Prostate Imaging Reporting and Data System score), perioperative outcomes (console time, estimated blood loss, postoperative complications, and length of stay), oncologic outcomes (positive surgical margin [PSM], and biochemical recurrence), overall and 12-mo continence rates (zero pads and zero to one safety pad), time to continence, potency (erection sufficient for sexual activity), EPIC-CP urinary incontinence, sexual function, and overall QOL scores. RESULTS AND LIMITATIONS Median follow-up for S-RARP versus RS-RARP was 46.3 versus 12.3 mo. RS-RARP versus S-RARP had improved overall continence rates at total follow-up (95.7% vs 85.7%, p = 0.042) and 12-mo follow-up (97.6% vs 81.4%, p = 0.002), and faster return to continence (zero to one safety pad, 44 vs 131 d, p < 0.001). RS-RARP EPIC-CP urinary incontinence and overall QOL scores remained significantly better at 12 mo. There were no differences in overall PSM rates, although RS-RARP had lower rates of nonfocal PSMs. There were no differences in sexual function. In multivariate analysis, RS-RARP was significantly associated with improved 12-mo EPIC-CP urinary incontinence and improved QOL scores, but was not associated with PSM or biochemical recurrence. Limitations include retrospective study design and unequal follow-up; however, significantly better RS-RARP continence at 12 mo is striking despite fewer patients attaining 12-mo follow-up. CONCLUSIONS RS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL. PATIENT SUMMARY Retzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control.
Collapse
Affiliation(s)
- Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shawn Marhamati
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Filipe L F Carvalho
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Meghan Davis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John O'Neill
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Harry Lee
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John H Lynch
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ryan A Hankins
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.
| |
Collapse
|
17
|
Deng WH, Zheng YB, Tong SL, Cao FY, He XB, Xiao K, Song D, Yang YJ. [Efficiency analysis on functional protection of nerve plane-oriented laparoscopic total mesorectal excision]. Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22:1144-1151. [PMID: 31874530 DOI: 10.3760/cma.j.issn.1671-0274.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Using previous total mesorectal excision with pelvic autonomic nerve preservation (PANP+TME) and simple total mesorectal excision (TME) without emphasis on retained nerves as control, we explore the advantages of nerve plane-oriented laparoscopic total mesorectal excision (NPO+LTME) on urinary and sexual function. Methods: A retrospective cohort study was carried out. Case inclusion criteria: (1) male patients with pathologically confirmed middle and low rectal adenocarcinoma (4 to 11 cm from the anus); (2) stage T1-2tumor; (3) normal sexual life before operation. Exclusion criteria: (1) no pathological diagnosis before surgery; (2) local recurrence or distant metastasis; (3) preoperative neoadjuvant chemoradiotherapy; (4) opensurgery and laparoscopic surgery conversionto open; (5) no follow-up data. According to the above criteria, clinical data of 173 male patients with low and middle rectal adenocarcinoma who underwent radical operation for laparoscopic rectal cancer from July 2003 to July 2018 at the Department of Gastrointestinal Surgery, Wuhan University People's Hospital were collected. According to different surgical methods, patients were divided into TME group (58 cases), PANP+TME group (63 cases) and NPO+LTME group (52 cases). There were no significant differences in the baseline data including age, body mass index and pathological examination between the 3 groups (all P>0.05). The nerve plane referred to the nerve, the adipose tissue, the extremely finecapillaries around the nerve with overlying fine membranous tissue. NPO+LTME referred to the process of laparoscopic TME guided by the nerve plane, performing in the loose connective tissue between the nerve plane and the rectal properfascia, in order to ensure the integrity of the nerve plane, and maximally protect the patient's urinary and reproductive functions. The operation time, intraoperative blood loss, urinary catheter removal time, urinary function grading, postoperative first erection time, and erectile function and ejaculation function were observed and compared among the 3 groups at 3- and 6-month after operation. Results: In the NPO+LTME group, the PANP+TME group and the TME group, the operation time was (181.9±24.5) minutes, (176.7±29.2) minutes and (137.7±16.2) minutes, respectively (F=54.868, P<0.001); the intraoperative blood lost was (6.0±1.4) ml, (6.5±1.8) ml and (12.8±4.6) ml, respectively (F=95.016, P<0.001); the time to postoperative removal of the catheter was (2.4±1.1) days, (3.7 ±1.7) days and (6.5±2.4) days, respectively (F=79.409, P<0.001); the first postoperative erection time was (1.6±0.6) days, (8.9±2.7) days and (15.9±6.8) days (F=177.677, P<0.001), respectively, whose differences were all statistically significant (all P<0.01). In comparison of urinary function grading, the proportion of grade I (normal function, no urinary dysfunction) in the NPO+LTME, the ANP+TME group and the TME group was 84.1% (53/63), 39.7% (23/58) and 19.2% (10/52), respectively, and the difference was statistically significant (H=52.915, P<0.001). At postoperative 3- and 6-month, proportion of patients with grade I erectile function (normal erectile function) was 77.8% (49/63) and 85.7% (54/63), 44.8% (26/58) and 53.4% (31/58), 28.8% (15/52) and 48.1% (25/52) in the NPO+LTME group, the PANP+TME group, and the TME group, respectively. The differences were statistically significant (H=91.709, P<0.001; H=79.692, P<0.001). The proportion of patients with grade I ejaculation function (with ejaculation, no abnormalities in routine semen examination before and after surgery) at 3- and 6-month after surgery in the NPO+LTME group, the PANP+TME group and the TME group was 82.5% (52/63) and 87.3% (55/63), 53.4% (31/58) and 60.3% (35/58), 28.8% (15/52) and 46.1% (24/52), respectively. The differences were statistically significant as well (H=86.543, P<0.001; H=78.667, P<0.001). Patients in the NPO+LTME group had no grade III erections and ejaculation disorders. Conclusion: The surgical procedure of NPO+LTME can promote the recovery of postoperative neurological function and preserve urination and sexual function better.
Collapse
Affiliation(s)
- W H Deng
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Jolivet M, Trilling B, Sage PY, Boussat B, Girard E, Faucheron JL. Prospective evaluation of functional outcomes after laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease in consecutive male patients. Tech Coloproctol 2019; 24:33-40. [PMID: 31820191 DOI: 10.1007/s10151-019-02123-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, there has been no consensus concerning the vascular approach during sigmoid colectomy for diverticular disease. The aim of this study was to determine the functional impact of elective laparoscopic sigmoidectomy performed with high ligation of the inferior mesenteric artery for diverticulitis in consecutive male patients. METHODS Twenty-five consecutive patients of median age 53 years were enrolled in a prospective single-centre pilot study at a tertiary teaching hospital. Main outcome measures were functional results. Patients were asked to complete standardized, validated questionnaires to evaluate preoperative and 6 months postoperative bowel symptomatology (Jorge-Wexner Incontinence Score and KESS score), urinary function (IPSS), and sexual function (IIEF). Secondary outcomes were surgical data, morbidity, and quality of life (SF-36). RESULTS There were no significant differences between preoperative and 6 months postoperative total scores for bowel symptomatology, urinary function, and sexual function. There were no perioperative deaths. The morbidity rate was 12% including three minor and no major events. Quality of life demonstrated statistically better general health (p < 0.01) and better medical status over the prior 4 weeks at 6 months after surgery, compared to baseline. This single-centre prospective study has a limited number of patients, relatively short follow-up time, and includes only male patients. CONCLUSION Laparoscopic sigmoidectomy with high tie of the inferior mesenteric artery for diverticular disease does not induce functional disorders at 6 months after surgery. The benefit of the operation for quality of life is even greater for general health and medical status.
Collapse
Affiliation(s)
- M Jolivet
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - B Trilling
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - P-Y Sage
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
| | - B Boussat
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
- Quality of Care Unit, Department of Community Health Sciences and the O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - E Girard
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - J-L Faucheron
- Department of Colorectal Surgery, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex, France.
- University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, 38000, Grenoble, France.
| |
Collapse
|
19
|
Chang W, Wei Y, Ren L, Jian M, Chen Y, Chen J, Liu T, Huang W, Peng S, Xu J. Short-term and long-term outcomes of robotic rectal surgery-from the real word data of 1145 consecutive cases in China. Surg Endosc 2019; 34:4079-4088. [PMID: 31602514 PMCID: PMC7395014 DOI: 10.1007/s00464-019-07170-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022]
Abstract
Background Due to a limited patient sample size, substantial data on robotic rectal resection (RRR) is lacking. Here, we reported a large consecutive cases from the real word data to assess the safety and efficacy of RRR. Methods From September 2010 to June 2017, a total of 1145 consecutive RRR procedures were performed in patients with stage I–IV disease. We conducted an analysis based on information from a prospectively designed database to evaluate surgical outcomes, urogenital function, and long-term oncological outcomes. Results Of three types of RRR performed, 227 (24.2%) were abdominoperineal resections, 865 (75.5%) were anterior resections, and 3 (0.3%) were Hartmann. Conversion to an open procedure occurred in 5.9% of patients. The overall positive circumferential margin rate was 1.3%. Surgical complication rate and mortality were 16.2% and 0.8% within 30 days of surgery, respectively. Mean hospital stay after surgery and hospital cost were 6.3 ± 2.9 days and 10442.5 ± 3321.5 US dollars, respectively. Risk factors for surgical complications included male gender, tumor location (mid-low rectum), combined organ resection, and clinical T category (cT3–4). Urinary function and general sexual satisfaction decreased significantly 1 month after surgery for both sexes. Subsequently, both parameters increased progressively, and the values 1 year after surgery were comparable to those measured before surgery. At a median follow-up of 34.6 months, local recurrence and distant metastases occurred in 2.3% and 21.1% of patients, respectively. Conclusions Robotic rectal resection was safe with preserved urogenital function and arrived equivalent oncological outcomes in a nonselected group of patients with rectal cancer.
Collapse
Affiliation(s)
- Wenju Chang
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.,Shanghai Engineering Research Cancer of Colorectal Cancer Minimally Invasive (17DZ2252600), Shanghai, China
| | - Ye Wei
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.,Shanghai Engineering Research Cancer of Colorectal Cancer Minimally Invasive (17DZ2252600), Shanghai, China
| | - Li Ren
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.,Shanghai Engineering Research Cancer of Colorectal Cancer Minimally Invasive (17DZ2252600), Shanghai, China
| | - Mi Jian
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Yijiao Chen
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Jingwen Chen
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Tianyu Liu
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Wenbai Huang
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China.,Shanghai Engineering Research Cancer of Colorectal Cancer Minimally Invasive (17DZ2252600), Shanghai, China
| | - Shangjin Peng
- Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, China
| | - Jianmin Xu
- Colorectal Cancer Center; Department of General Surgery; Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China. .,Shanghai Engineering Research Cancer of Colorectal Cancer Minimally Invasive (17DZ2252600), Shanghai, China.
| |
Collapse
|
20
|
Shah TT, Peters M, Miah S, Eldred-Evans D, Yap T, Hosking-Jervis F, Dudderidge T, Hindley RG, McCracken S, Greene D, Nigam R, Valerio M, Winkler M, Virdi J, Arya M, Ahmed HU, Minhas S. Assessment of Return to Baseline Urinary and Sexual Function Following Primary Focal Cryotherapy for Nonmetastatic Prostate Cancer. Eur Urol Focus 2019; 7:301-308. [PMID: 31590961 DOI: 10.1016/j.euf.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/11/2019] [Accepted: 09/04/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The oncological outcomes in men with clinically significant prostate cancer following focal cryotherapy are promising, although functional outcomes are under-reported. OBJECTIVE To determine the impact of focal cryotherapy on urinary and sexual function, specifically assessing return to baseline function. DESIGN, SETTING, AND PARTICIPANTS Between October 2013 and November 2016, 58 of 122 men who underwent focal cryotherapy for predominantly anterior clinically significant localised prostate cancer within a prospective registry returned patient-reported outcome measure questionnaires, which included International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-15) questionnaires. INTERVENTION Standard cryotherapy procedure using either the SeedNet or the Visual-ICE cryotherapy system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was return to baseline function of IPSS score and IIEF erectile function (EF) subdomain. Cumulative incidence and Cox-regression analyses were performed. RESULTS AND LIMITATIONS Probability of returning to baseline IPSS function was 78% at 12 mo and 87% at both 18 and 24 mo, with recovery seen up to 18 mo. For IIEF (EF domain), the probability of returning to baseline function was 85% at 12 mo and 89% at both 18 and 24 mo, with recovery seen up to 18 mo. Only the preoperative IIEF-EF score was associated with a poor outcome (hazard ratio 0.96, 95% confidence interval 0.93-0.999, p = 0.04). The main limitation was that only half of the patients returned their questionnaires. CONCLUSIONS In men undergoing primary focal cryotherapy, there is a high degree of preservation of urinary and erectile function with return to baseline function occurring from 3 mo and continuing up to 18 mo after focal cryotherapy. PATIENT SUMMARY In men who underwent focal cryotherapy for prostate cancer, approximately nine in 10 returned to their baseline urinary and sexual function. Keeping in mind that level 1 evidence and long-term data are still needed, in men who wish to preserve urinary and sexual function, focal cryotherapy may be considered an alternative treatment option to radical therapy.
Collapse
Affiliation(s)
- Taimur T Shah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK.
| | - Max Peters
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Saiful Miah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tet Yap
- Department of Urology, Guy's Hospital, Great Maze Pond, London, UK
| | - Feargus Hosking-Jervis
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Stuart McCracken
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Damian Greene
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Raj Nigam
- Department of Urology, Royal Surrey County Hospital NHS Trust, UK
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mathias Winkler
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
21
|
Luca F, Craigg DK, Senthil M, Selleck MJ, Babcock BD, Reeves ME, Garberoglio CA. Sexual and urinary outcomes in robotic rectal surgery: review of the literature and technical considerations. Updates Surg 2018; 70:415-421. [PMID: 30120743 DOI: 10.1007/s13304-018-0581-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/05/2018] [Indexed: 12/31/2022]
Abstract
Several studies have reported high rates of urogenital dysfunction after open and laparoscopic surgery for rectal cancer. Robotic surgery has several features that could facilitate identification and preservation of autonomic nerves. This manuscript aims to summarize the literature regarding urogenital function after robotic rectal cancer surgery and focus on technical aspects of nerve-sparing total mesorectal excision. Comprehensive searches were conducted through online databases. Selection criteria included: original articles assessing urinary and sexual function after robotic surgery of males and/or females with standardized questionnaires. A total of 16 articles were included in the review. Seven of the nine cohort studies evaluating male sexual function showed earlier recovery or better outcomes in patients operated with robotic techniques. Two studies did not find any statistically significant difference. Three out of four case series found no difference in sexual function scores measured preoperatively and after 1 year. Female sexual function was assessed in seven studies: two case series show no deterioration of at 1 year. Three comparative studies showed no difference between robotic and laparoscopic groups. Two randomized control trials showed different results in terms of male and female sexual functions with better preservation at 1 year in the robotic group in one and no difference in another. Urinary functions assessed in males and/or females in the 16 studies showed no statistically significant differences at long-term follow-up. At present, there is no evidence of superiority of robotic surgery for performing nerve-sparing rectal cancer surgery.
Collapse
Affiliation(s)
- Fabrizio Luca
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA.
| | - Danielle K Craigg
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA
| | - Matthew J Selleck
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA
| | - Blake D Babcock
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA
| | - Mark E Reeves
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA
| | - Carlos A Garberoglio
- Division of Surgical Oncology, Department of Surgery, Loma Linda University, 11175 Campus Street, 21111, Loma Linda, CA, 92350, USA
| |
Collapse
|
22
|
Avulova S, Chang SS. Role and Indications of Organ-Sparing "Radical" Cystectomy: The Importance of Careful Patient Selection and Counseling. Urol Clin North Am 2018; 45:199-214. [PMID: 29650136 DOI: 10.1016/j.ucl.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Organ-sparing cystectomy remains an operation for a highly selected patient population that can offer similar oncologic outcomes but improved sexual function in men and women. Occult prostate cancer in men may occur even with screening but the majority is of clinical insignificance. Paramount to patient selection are oncologic concerns, but preoperative sexual function, age, performance status, and postoperative expectations must also be evaluated during patient selection. Improved diagnostic and surveillance tools may facilitate and improve patient selection in the future.
Collapse
Affiliation(s)
- Svetlana Avulova
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA.
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37203, USA
| |
Collapse
|
23
|
Wan X, Zheng D, Liu C, Xu H, Xie M, Zhou J, Yao HJ, Wang Z. A Comparative study of two types of organ-sparing surgeries for early stage penile cancer: Wide local excision vs partial penectomy. Eur J Surg Oncol 2018; 44:1425-1431. [PMID: 29656798 DOI: 10.1016/j.ejso.2018.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Till date, there have been few reports of comparative studies on the outcomes of these different treatment modalities. In this study, we have aimed to comparatively evaluate the quality-of-life parameters, including sexual function, urinary function, and health-related quality of life (HRQOL), in patients with early stage penile cancers who underwent two different organ-sparing surgeries. MATERIAL AND METHODS From March 2012 to March 2015, we enrolled 15 patients with early stage penile cancers who underwent either wide local excision or partial penectomy as organ-sparing surgical treatments. We assessed their sexual and urinary functions and their HRQOL, using the International Index of Erectile Function (IIEF-15), Self-Esteem and Relationship (SEAR), and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires and urodynamic determinations, and comparatively analyzed the outcomes of these patients who underwent either type of surgery. RESULTS All patients who underwent these two types of surgeries experienced satisfactory outcomes. The patients who underwent wide local excision performed relatively better, in terms of their sexual functions, urinary functions, and HRQOL, but no statistically significant differences were observed in the data collected via the IIEF-15, SEAR, EDITS, and EORTC-QLQ-C30 questionnaires and urodynamic determinations (p > 0.05), except in the data corresponding to the orgasmic function (p = 0.033). CONCLUSION Both types of organ-sparing surgeries assessed in this study achieved good outcomes, in terms of the aesthetics, sexual functions, urinary functions, and HRQOL in patients, without compromising the therapeutic effects of these surgeries. However, the observed decreases in orgasmic function will need to be addressed further.
Collapse
Affiliation(s)
- Xiang Wan
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Dachao Zheng
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Chong Liu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Minkai Xie
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Juan Zhou
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China
| | - Hai-Jun Yao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China.
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China.
| |
Collapse
|
24
|
Hashine K, Kakuda T, Iuchi S, Hosokawa T, Ninomiya I. Prospective longitudinal outcomes of quality of life after laparoscopic radical prostatectomy compared with retropubic radical prostatectomy. Health Qual Life Outcomes 2018; 16:7. [PMID: 29304808 PMCID: PMC5756410 DOI: 10.1186/s12955-017-0835-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background There have been few reports on health-related quality of life (HRQOL) after laparoscopic radical prostatectomy (LRP) in Japanese patients. The aim of this study is to assess changes in HRQOL during 36 months after LRP compared with retropubic radical prostatectomy (RRP). Methods The subjects were 105 consecutive patients treated with LRP between 2011 and 2012. HRQOL was evaluated using the International Prostate Symptom Score (IPSS), Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and Expanded Prostate Cancer Index Composite (EPIC) at baseline and 1, 3, 6, 12 and 36 months after surgery. These results were compared with data for 107 consecutive patients treated with RRP between 2005 and 2007. The comparison between LRP and RRP was examined at every time point by Mann-Whitney U-test and chi-square test. Multiple linear regression analysis was used to identify independent factors related to the urinary domain in EPIC. Results The IPSS change was similar in both groups. The LRP group had a better SF-8 mental component summary score at baseline and a better SF-8 physical component summary score at 1 month after surgery. In EPIC, urinary function and bother were worse after LRP, but improved at 12 months and did not differ significantly from those after RRP; however, these factors then worsened again at 36 months after LRP. Urinary incontinence was also worse at 36 months after LRP, compared to RRP. In patients treated with nerve-sparing surgery, urinary function and urinary incontinence were similar and good at 12 and 36 months in both groups. Bowel function and bother, and sexual function and bother were similar in both groups and showed no changes from 12 to 36 months. Age and salvage radiotherapy were independent predictors of incontinence (daily use of two or more pads) in multivariate analysis. Surgical procedure was not an independent factor for incontinence, but incontinence defined as use of one pad or more was associated with the surgical procedure. Conclusions Urinary function and bother at 36 months were worse after LRP than after RRP. Age, salvage radiotherapy and surgical procedure were associated with urinary incontinence after 36 months.
Collapse
Affiliation(s)
- Katsuyoshi Hashine
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan.
| | - Toshio Kakuda
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| | - Shunsuke Iuchi
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| | - Tadanori Hosokawa
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| | - Iku Ninomiya
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| |
Collapse
|
25
|
Wang C, Song Z, Li S, Tai S. Extended nursing for the recovery of urinary functions and quality of life after robot-assisted laparoscopic radical prostatectomy: a randomized controlled trial. Support Care Cancer 2017; 26:1553-1560. [PMID: 29196816 PMCID: PMC5876261 DOI: 10.1007/s00520-017-3988-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022]
Abstract
Purpose The purpose of this work is to explore the effects of continuing nursing care intervention on postoperative urinary control and quality of life among patients with prostate cancer. Methods This was a single-center, parallel, and randomized controlled trial that was carried out at the Department of Urology, the First Affiliated Hospital of Anhui Medical University, China. The participants underwent robot-assisted laparoscopic radical prostatectomy (RARP) between October 2014 and April 2016. The patients were randomized to the experimental and control groups (n=37/group). Patients in the control group received routine nursing care, while patients in the experimental group received continuing nursing care. During the 6-month follow-up, each patient was invited at the hospital discharge and at 1, 3, and 6 months to fill the ICI-Q-SF and SF-36 questionnaires. Results The scores of urinary incontinence were improved in the intervention group compared with controls at 3 and 6 months after discharge (both P < 0.01). The scores of quality of life in the experimental group were significantly higher than control group at 1, 3, and 6 months (all P < 0.01). Adverse events were mild or moderate in intensity and were resolved in all patients. All adverse events were related to RARP. Conclusions Continuing nursing care intervention had significant beneficial effects on urinary functions and quality of life in patients with prostate cancer after RARP. This approach warrants to be promoted in the clinical setting.
Collapse
Affiliation(s)
- Chunxia Wang
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhen Song
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Siheng Li
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sheng Tai
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
26
|
Huang M, Lin J, Yu X, Chen S, Kang L, Deng Y, Zheng J, Luo Y, Wang L, Lan P, Wang J. Erectile and urinary function in men with rectal cancer treated by neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy alone: a randomized trial report. Int J Colorectal Dis 2016; 31:1349-57. [PMID: 27270480 DOI: 10.1007/s00384-016-2605-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim was to evaluate erectile and urinary function of male patients with rectal cancer treated by neoadjuvant (NA) chemoradiotherapy (CRT) or NA chemotherapy only. METHODS In this prospective randomized trial (ClinicalTrials.gov NCT01211210; "FOWARC"), we included 102 men who received NA therapy for stage II-III rectal cancer between January 2011 and June 2013. Before surgery, patients received either NA mFOLFOX6 chemotherapy with radiation (RCS group, n = 54) or NA mFOLFOX6 chemotherapy alone (CS group, n = 48). Erectile and urinary dysfunctions were assessed with the five-item International Index of Erectile Function (IIEF-5) scale and the International Prostatic Symptom Score (IPSS), respectively. Questionnaires were completed at baseline and at 3, 6, and 12 months (t0-t3, respectively) after surgery. RESULTS At t3, mean IIEF-5 score was significant higher in the CS group (15.3 ± 5.5) than in the RCS group (12.6 ± 5.7; P < 0.05). And score difference was statistically higher in RCS group compared with CS group at t2 and t3, especially t3 (9.3 ± 5.5 vs. 6.1 ± 5.1, P < 0.01). Univariate analysis of the RCS group's IIEF-5 scores associated age, stoma, location, and tumor size to erectile dysfunction. However, mean IPSS scores did not differ between the two groups at any point. CONCLUSIONS Compared with the CS group, erectile and urinary functions were significantly affected by NA CRT. Age, stoma, tumor location, and tumor size were also correlated with erectile dysfunction in the RCS group.
Collapse
Affiliation(s)
- Meijin Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China.
| | - Jinxin Lin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China
| | - Xihu Yu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China
| | - Shen Chen
- Department of Gynaecology and Obstetrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, People's Republic of China
| | - Liang Kang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, People's Republic of China
| | - Jian Zheng
- Department of Radiation Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, People's Republic of China
| | - Yanxin Luo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China
| | - Lei Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China
| | - Ping Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China
| | - Jianping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, People's Republic of China.
| |
Collapse
|
27
|
Ozeki S, Maeda K, Hanai T, Masumori K, Katsuno H, Takahashi H. Effects of robotic rectal surgery on sexual and urinary functions in male patients. Surg Today. 2016;46:491-500. [PMID: 26198896 DOI: 10.1007/s00595-015-1217-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSES This study prospectively assessed the sexual and urinary functions, as well as factors influencing these functions, in patients who underwent open or robotic surgery for rectal cancer. METHODS Forty-five consecutive male patients who underwent rectal resection for rectal cancer were prospectively enrolled in this study. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF; sexual function) and the International Prostate Symptom Score (IPSS; urinary function) before and at 3, 6, and 12 months after surgery. RESULTS Fifteen patients who underwent robotic surgery and 22 who underwent open surgery were finally analyzed in this study. The total IIEF score and the individual score items did not change at 3, 6 or, 12 months after open or robotic surgery compared with the preoperative values. However, a univariate analysis revealed that age affected the urinary function 12 months after surgery, while both univariate and multivariate analyses revealed that postoperative complications affected the sexual function 12 months after surgery. CONCLUSIONS In this non-randomized comparison, the postoperative sexual and urinary functions were comparable between patients who underwent open rectal surgery and those who underwent robotic rectal surgery. Postoperative complications were a risk factor for sexual dysfunction, while age was a risk factor for urinary dysfunction.
Collapse
|
28
|
Resnick MJ, Barocas DA, Morgans AK, Phillips SE, Koyama T, Albertsen PC, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hoffman KE, Hoffman RM, Kaplan SH, McCollum D, Paddock LE, Stanford JL, Stroup AM, Wu XC, Penson DF. The Evolution of Self-Reported Urinary and Sexual Dysfunction over the Last Two Decades: Implications for Comparative Effectiveness Research. Eur Urol 2015; 67:1019-25. [PMID: 25174325 DOI: 10.1016/j.eururo.2014.08.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/14/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time. OBJECTIVE To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart. DESIGN, SETTING, AND PARTICIPANTS Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies. RESULTS AND LIMITATIONS The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39-2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68-3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding. CONCLUSIONS Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations. PATIENT SUMMARY Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research.
Collapse
|
29
|
Noh JY, Han DH, Yoon JA, Kim MH, Kim SE, Ko IG, Kim KH, Kim CJ, Cho S. Circadian rhythms in urinary functions: possible roles of circadian clocks? Int Neurourol J 2011; 15:64-73. [PMID: 21811695 DOI: 10.5213/inj.2011.15.2.64] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 06/20/2011] [Indexed: 12/12/2022] Open
Abstract
Circadian clocks are the endogenous oscillators that harmonize a variety of physiological processes within the body. Although many urinary functions exhibit clear daily or circadian variation in diurnal humans and nocturnal rodents, the precise mechanisms of these variations are as yet unclear. In this review, we briefly introduce circadian clocks and their organization in mammals. We then summarize known daily or circadian variations in urinary function. Importantly, recent findings by others as well as results obtained by us suggest an active role of circadian clock genes in various urinary functions. Finally, we discuss possible research avenues for the circadian control of urinary function.
Collapse
|