scholarly journals Independent Factors Affecting Postoperative Short-Term Urinary Continence Recovery after Robot-Assisted Radical Prostatectomy

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Wen Deng ◽  
Ru Chen ◽  
Xian Jiang ◽  
Ping Zheng ◽  
Ke Zhu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Radical Prostatectomy ◽  
Surgical Approach ◽  
Prostate Volume ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Short Term ◽  
Patient Age ◽  
Transvesical Approach

Background. Our team had firstly applied the transvesical approach to robot-assisted radical prostatectomy (RARP) in patients afflicted with localized prostate cancer (PCa). The present study aims to present the postoperative recovery of urinary continence (UC) following the anterior, transvesical, and posterior approaches to RARP for localized PCa and evaluate the independent predictors to early UC recovery after RARP. Methods. Patients harboring localized PCa and receiving anterior, transvesical, and posterior approaches to RARP between January 2017 and June 2020 were enrolled in this analysis. Results on UC recovery were compared between these three approaches with the Kaplan–Meier method. All clinical and pathological variables were further analyzed via univariable and multivariable regression analysis to determine the independent factors contributing to short-term UC recovery after RARP. Results. A total of 135, 73, and 66 instances were included in the anterior, transvesical, and posterior groups, respectively. Over the postoperative follow-up period, both the transvesical and posterior approaches showed an advantage over the anterior approach in promoting postoperative UC recovery (both p values <0.001). Three months after surgery, 55 (40.7%), 4 (5.5%), and 5 (7.6%) patients failed to UC in the anterior, transvesical, and posterior groups, respectively. Patient age, preoperative PSA, prostate volume, biopsy Gleason score, surgical approach, extended lymph node dissection technique, nerve-sparing technique, and positive lymph node were related to UC status based on univariable analyses ( p < 0.05 ). Multivariable analysis results point patient age, prostate volume, surgical approach, and nerve-sparing technique as independent factors that affect postoperative UC recovery after RARP. Conclusions. The application of transvesical approach to RARP for localized PCa could obtain promising outcomes in terms of postoperative UC recovery. In addition, surgical strategies encompassing the nerve-sparing technique and the Retzius-sparing procedures, namely, the transvesical or posterior approach, during RARP could independently enable early achievement of postoperative continence.

scholarly journals Detrusorrhaphy during Robot-Assisted Radical Prostatectomy: Early Recovery of Urinary Continence and Surgical Technique

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Tae Young Shin ◽  
Yong Seong Lee
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Intraoperative Complications ◽  
Risk Groups ◽  
Catheter Removal ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Early Recovery ◽  
Open Radical Prostatectomy

Robot-assisted radical prostatectomy (RARP) has largely replaced open radical prostatectomy as the standard surgical treatment for prostate cancer. However, postoperative urinary incontinence still persists and has a significant impact on quality of life. We report the superior results of the detrusorrhaphy technique during RARP that helps achieve early continence. Our prospective study involved 95 consecutive patients who underwent RARP between March 2015 and May 2017; fifty patients underwent RARP using the new detrusorrhaphy technique (group 1) and 45 underwent standard RARP (group 2). The postoperative oncological and functional outcomes were compared between the two groups. The postoperative continence was assessed at 0 day, 1 week, 4 weeks, 8–12 weeks, and 6 months after catheter removal. Continence was defined as the use of no pad over a 24 h period. Mean operative time in groups 1 and 2 were 250 and 220 min, respectively. Intraoperative complications were not encountered in any patient. The continence rates after catheter removal in groups 1 and 2 were 68% and 0% at 0 day, 78% and 17.8% at 1 week, 86% and 64.4% at 4 weeks, 92% and 73.3% at 8–12 weeks, and 100% and 91.1% at 6 months, respectively. In the multivariate analysis, the nerve sparing technique, D’Amico risk groups, and prostate volume were involved in the early recovery of urinary continence. The detrusorrhaphy technique is simple, safe, and feasible, which helped achieve earlier continence. It showed significantly better outcomes than those achieved with the standard RARP technique in terms of urinary incontinence. Nevertheless, our findings need to be validated in further studies.

V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Yuji MAEDA ◽  
Toshimitsu MISAKI ◽  
Osamu UEKI ◽  
Tetsuyuki KUROKAWA ◽  
Yukinosuke OSHINOYA ◽  
...  
Keyword(s):  
Pilot Study ◽  
Radical Prostatectomy ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Early Recovery

Effect of adjuvant and salvage radiotherapy after radical prostatectomy on urinary continence.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 100-100 ◽  
Author(s):  
Meike Adam ◽  
Dominik Lanwehr ◽  
Philipp Wenzel ◽  
Markus Graefen ◽  
Uwe Michl ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Prostate Volume ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Continence Status ◽  
The Impact

100 Background: The clinical value of adjuvant (aRT) or salvage radiation (sRT) for patient treated with radical prostatectomy (RP) is currently controversially debated. In this study, we assessed the impact of aRT and sRT on long-term urinary continence. Methods: Overall, 15,901 patients who underwent RP in our center between 1992 and 2012 were analyzed. aRT within the first 6 months was performed in 734 (2.9%) patients, and sRT after 6 months in 1405 (8.8%) patients (median time 21.6 months), respectively. Continence rates were assessed annually after RP using a self-administrated questionnaire. Median follow-up was 48.4 months. Continence was defined as the use of no pads or one safety pad. Incontinence was categorized by the number of used pads. The impact of additional radiation therapy on continence results was analyzed by logistic regression analyses, the chi2-likelyhood test and propensity score matching. Results: In multivariate logistic regression analysis, adjusted for age, prostate volume, extend of nerve-sparing, year of surgery, the event of additive RT (OR=1.2, p=0.17) was not statistically relevant correlated with the long-term continence status whereas all other variables significantly correlated with urinary incontinence (p<0.01, each). The lacking correlation of RT and continence remained in a second logistic regression model, adjusted for tumor features (pT, pN, Gleason, PSA, margin-status). The timing of RT (aRT vs. sRT) was not statistically relevant correlated with the long-term continence status (OR=1.7, p=0.09; OR=1.2, p=0.5) In addition, a comparison of all patients received aRT with a propensity score based matched cohort of RP only patients (corrected for age, prostate volume, extend of nerve-sparing and year of surgery) revealed no statistical significant impact of RT on continence (p>0.05). In 248 patients, the continence status was available pre and post RT, again not showing a negative impact of RT (p>0.05). Conclusions: Additive radiation therapy after radical prostatectomy does not negatively affect urinary continence.

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 Association of surgeon and hospital volume with short-term outcomes after robot-assisted radical prostatectomy: Nationwide, population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253081
Author(s):  
Rebecka Arnsrud Godtman ◽  
Erik Persson ◽  
Walter Cazzaniga ◽  
Fredrik Sandin ◽  
Stefan Carlsson ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Hospital Volume ◽  
Population Based ◽  
Nerve Sparing ◽  
Surgical Volume ◽  
Robot Assisted ◽  
Short Term ◽  
Surgical Performance ◽  
Population Based Study ◽  
Wide Range

Background and objective Few studies have investigated the association between surgical volume and outcome of robot-assisted radical prostatectomy (RARP) in an unselected cohort. We sought to investigate the association between surgical volume with peri-operative and short-term outcomes in a nation-wide, population-based study group. Methods 9,810 RARP’s registered in the National Prostate Cancer Register of Sweden (2015–2018) were included. Associations between outcome and volume were analyzed with multivariable logistic regression including age, PSA-density, number of positive biopsy cores, cT stage, Gleason score, and extent of lymph node dissection. Results Surgeons and hospitals in the highest volume group compared to lowest group had shorter operative time; surgeon (OR 9.20, 95% CI 7.11–11.91), hospital (OR 2.16, 95% CI 1.53–3.06), less blood loss; surgeon (OR 2.58. 95% CI 2.07–3.21) hospital (no difference), more often nerve sparing intention; surgeon (OR 2.89, 95% CI 2.34–3.57), hospital (OR 2.02, 95% CI 1.66–2.44), negative margins; surgeon (OR 1.90, 95% CI 1.54–2.35), hospital (OR 1.28, 95% CI 1.07–1.53). There was wide range in outcome between hospitals and surgeons with similar volume that remained after adjustment. Conclusions High surgeon and hospital volume were associated with better outcomes. The range in outcome was wide in all volume groups, which indicates that factors besides volume are of importance. Registration of surgical performance is essential for quality control and improvement.

scholarly journals Significance of Postoperative Membranous Urethral Length and Position of Vesico-Urethral Anastomosis for Short Term Continence Recovery Following Robot-Assisted Laparoscopic Radical Prostatectomy

2022 ◽  
Author(s):  
Yasukazu Nakanishi ◽  
Shunya Matsumoto ◽  
Naoya Okubo ◽  
Kenji Tanabe ◽  
Madoka Kataoka ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Univariate Analysis ◽  
Operating Time ◽  
Laparoscopic Radical Prostatectomy ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Short Term ◽  
Recovery Rates ◽  
Patient Interview

Abstract Background We assess whether short term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with preoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). Methods Clinical variables including PVUA and pre- and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. Results Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (<25 kg/m2) (p = 0.040), longer preoperative MUL (≥9.5mm) (p = 0.013), longer postoperative MUL (≥9mm) (p <0.001), higher PVUA (<14.5mm) (p = 0.019) and shorter operating time (<170min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90 – 7.40, p <0.001) and higher PVUA (OR 2.02, 95% CI 1.07 – 3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into three groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% vs. 68.2% vs. 85.0% (p <0.001) at three months. Conclusions PVUA and postoperative MUL were significant factors for short term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.

scholarly journals Predictors of early continence following robot-assisted radical prostatectomy

2015 ◽  
Vol 9 (1-2) ◽  
pp. 93 ◽  
Author(s):  
Hugo Lavigueur-Blouin ◽  
Alina Camacho Noriega ◽  
Roger Valdivieso ◽  
Pierre-Alain Hueber ◽  
Marc Bienz ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Specific Antigen ◽  
Maximal Activity ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Prostate Weight ◽  
Increased Risk ◽  
Patient Reported

Introduction: Functional outcomes after robot-assisted radical prostatectomy (RARP) greatly influence patient quality of life. Data regarding predictors of early continence, especially 1 month following RARP, are limited. Previous reports mainly address immediate or 3-month postoperative continence rates. We examine preoperative predictors of pad-free continence recovery at the first follow-up visit 1 month after RARP.Methods: Between January 2007 and January 2013, preoperative and follow-up data were prospectively collected for 327 RARP patients operated on by 2 fellowship-trained surgeons (AEH and KCZ). Patient and operative characteristics included age, body mass index (BMI), staging, preoperative prostate-specific antigen (PSA), prostate weight, International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM) score and type of nervesparing performed. Continence was defined by 0-pad usage at 1 month follow-up. Univariate and multivariate logistic regression models were used to assess for predictors of early continence.Results: Overall, 44% of patients were pad-free 1 month post- RARP. In multivariate regression analysis, age (odds ratio [OR] 0.946, confidence interval [CI] 95%: 0.91, 0.98) and IPSS (OR: 0.953, CI 95%: 0.92, 0.99) were independent predictors of urinary continence 1 month following RARP. Other variables (BMI, staging, preoperative PSA, SHIM score, prostate weight and type of nerve-sparing) were not statistically significant predictors of early continence. Limitations of this study include missing data for comorbidities, patient use of pelvic floor exercises and patient maximal activity. Moreover, patient-reported continence using a 0-pad usage definition represents a semiquantitative and subjective measurement.Conclusion: In a broad population of patients who underwent RARP at our institution, 44% of patients were pad-free at 1 month. Age and IPSS were independent predictors of early continence after surgery. Men of advanced age and those with significant lower urinary tract symptoms prior to RARP should be counselled on the increased risk of urinary incontinence in the early stages.

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