scholarly journals Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer

2017 ◽  
Vol 18 (9) ◽  
Author(s):  
Ashwin N. Sridhar ◽  
Mohammed Abozaid ◽  
Prabhakar Rajan ◽  
Prasanna Sooriakumaran ◽  
Greg Shaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Techniques ◽  
Urinary Continence ◽  
Robot Assisted

Surgical techniques to optimise early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer

2017 ◽  
Vol 16 (6) ◽  
pp. e2379
Author(s):  
A.N. Sridhar ◽  
A. Mohammed ◽  
G. Mazzon ◽  
G. Busuttil ◽  
J. Thompson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Techniques ◽  
Urinary Continence ◽  
Robot Assisted

scholarly journals Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigenori Kakutani ◽  
Yuta Takeshima ◽  
Yuta Yamada ◽  
Tetsuya Fujimura ◽  
Shoichi Nagamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Radical Prostatectomy ◽  
Clinical Significance ◽  
Final Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Urinary Leakage ◽  
Postoperative Continence ◽  
The University

Abstract Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

scholarly journals Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)?

2019 ◽  
Author(s):  
Diwei Lin ◽  
Michael E O'Callaghan ◽  
Rowan David ◽  
Andrew Fuller ◽  
Richard Wells ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Short Form ◽  
High Volume ◽  
Urinary Continence ◽  
Resonance Imaging ◽  
Robot Assisted ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Radiotherapy Treatment

Abstract Purpose Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP).Methods We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score.Results The observed median MUL in this study was 14.6mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p=0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p=0.006). MUL was also associated with change in continence after surgery (β=1.22, p=0.002).Conclusions MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.

scholarly journals Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

2017 ◽  
Vol 12 (2) ◽  
pp. 45-9
Author(s):  
Khaled Ajib ◽  
Marc Zanaty ◽  
Mansour Alnazari ◽  
Emad Rajih ◽  
Pierre-Alain Hueber ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Time Points ◽  
Canadian Experience ◽  
Significant Difference ◽  
The Impact

Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP).Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (prostate- specific antigen [PSA]) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status.Results: Men who underwent SRT had a mean age, PSA, and time from radical prostatectomy (RP) to RT of 61.8 years (60.1‒63.6), 0.5 ng/ml (0.2‒0.8), and 458 days (307‒747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL, was observed in 89%, 93%, and 81%, at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months was 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3 (p=0.61). The mean SHIM score pre-SRT was comparable at all time points following treatment (p=0.86).Conclusions: In this unique Canadian experience, it appears that early SRT is highly effective for the treatment of BCR following RARP with little impact on urinary continence and potency outcomes.

scholarly journals Robotic radical prostatectomy in the 21 st century: evolution of experience

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Jesus Moreno Sierra
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Keywords Prostate Cancer ◽  
Novel Technologies ◽  
Open Radical Prostatectomy

The advent of novel technologies and surgical techniques has revolutionized urological surgery in recent years. Robot-assisted radical prostatectomy (RARP) has become the most widely used surgical approach for radical prostatectomy (RP) in the treatment of localized prostate cancer. However, the current available evidence on the benefit of RARP compared to open radical prostatectomy (ORP) is still under debate. Moreover, recent studies have proposed technical modifications of RARP to improve functional outcomes and postoperative quality of life of prostate cancer patients. The aim of this review was to summarize the current evidence on oncological, functional and perioperative outcomes of RARP, considering the results of our series of 408 RARP performed between October 2006 and February 2015 at Clínico San Carlos Hospital, and to provide a framework on the latest and most relevant updates on RARP surgical technique modifications. Keywords Prostate cancer; robot-assisted radical prostatectomy; oncological outcomes; functional outcomes; robotic surgical techniques.

Safety and feasibility of salvage robot-assisted radical prostatectomy for recurrent prostate cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15171-e15171
Author(s):  
Andre Luis de Castro Abreu ◽  
Sanket Chauhan ◽  
Adrian Stuart Fairey ◽  
Ignacio Camacho ◽  
Alvin Goh ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Erectile Function ◽  
Cancer Control ◽  
Biochemical Failure ◽  
Perioperative Outcomes ◽  
Urinary Continence ◽  
Recurrent Prostate Cancer ◽  
Robot Assisted ◽  
Short Term

e15171 Background: The safety and feasibility of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer is unclear. Herein we report short-term cancer control, functional, and perioperative outcomes in a multi-institutional cohort. Methods: Between July 2007 and October 2011, 38 consecutive men underwent sRARP for recurrent prostate cancer at the University of Southern California (n=14) or Global Robotics Institute (n=24). Failed primary therapy was varied (external beam radiotherapy [EBRT; n=14]; interstitial brachytherapy [IBT; n=11]; EBRT + IBT [n=5]; high-intensity focused ultrasound [n=3]; cryoablation [n=3]; other [n=2]). The main outcomes were immediate biochemical failure (IBF), positive surgical margins (PSM), urinary continence and erectile function at 3 months, and complications within 90 days of surgery. Immediate biochemical failure was defined as a PSA > 0.2 ng/ml. Urinary continence was defined as the use of no pads and erectile function was defined as a SHIM score > 21. Complications were classified and graded using the Clavien system. Results: The median age was 68 years (50-83 years) and median preoperative PSA was 4.1 ng/ml (0.4-15.2 ng/ml). Preoperative biopsy Gleason score was ≤6 (n=7), 7 (n=18), and ≥8 (n=12). All procedures were completed without the need for open conversion. No patient experienced an intra-operative complication. Median estimated blood loss was 100 ml (30-300 ml) and operative time was 1.5 h (1-6h). Median length of hospital stay was 1 day (1-7 days). The median duration of urethral catheterization was 12 days (4-48 days). IBF occurred in 9 (29%) patients and PSM occurred in 7 (18%) patients. Urinary continence and erectile function occurred in 9 (34%) and 0 patients, respectively. One or more postoperative complications occurred in 12 (31%) patients. Low grade (I-II) and high grade (III-IV) complications occurred in 8 (21%) and 4 (10%) patients, respectively. No patient died. Conclusions: Salvage robot-assisted radical prostatectomy is safe and feasible. Short-term cancer control and perioperative morbidity were acceptable; however, functional recovery was poor. To date, this is the largest series worldwide.

scholarly journals A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 485-490 ◽  
Author(s):  
Tao Wang ◽  
Qunsuo Wang ◽  
Songtao Wang
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Meta Analysis ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Continence Rate

AbstractObjectiveTo evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.MethodsMeta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.ResultsThis meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P<0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).ConclusionAs an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.

scholarly journals Laparoscopic radical prostatectomy

2018 ◽  
Vol 6 (3) ◽  
pp. 57-72
Author(s):  
V. A. Perepechay ◽  
O. N. Vasiliev
Keyword(s):  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Surgical Techniques ◽  
Retention Mechanism ◽  
Medical Rehabilitation ◽  
Urinary Continence ◽  
Complex Mechanism ◽  
Robot Assisted ◽  
Urine Retention ◽  
The Social

Laparoscopic (including robot-assisted) radical prostatectomy has become an alternative to open radical retropubic surgery. The main surgical techniques for reducing the period of urinary incontinence after radical prostatectomy are aimed at preserving, reconstructing and strengthening the structures that provide a complex mechanism for urine retention, namely, the pubo-prostate-vesicular ligaments, bladder neck, Denonvilliers` fascia, in procuring the functional length of the urethra, etc. Despite advances in the study of urinary continence mechanism there exists a large number of problems that need to be discussed. Therefore, researchers continue to search for solutions to create an optimal technique that ensures the earliest possible of urine retention, which is one of the main tasks in the social and medical rehabilitation of a patient who has undergone radical prostatectomy. This article describes the main modern techniques and methods for performing radical laparoscopic prostatectomy, which are aimed at achieving the earliest possible recovery of the urine retention mechanism.

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