The effect of nerve-sparing surgery on patient-reported continence post-radical prostatectomy

Introduction: Urinary continence significantly affects quality of lifeafter radical prostatectomy (RP). The impact of nerve-sparing surgeryon continence is unclear from the current literature.Methods:We identified men with prostate cancer from the UniversityHealth Network Prostate Centre database who underwent RP.Preoperatively and at each postoperative visit, patients completedthe Patient-Oriented Prostate Utility Scale (PORPUS), a validatedpsychometric and health utility instrument. Incontinence was definedby a single questionnaire item. Patients with radiotherapy or lessthan 10 months follow-up were excluded. Chi-squared tests andANOVA were used to compare groups. Multivariable logisticregression was used to control for effects of nerve-sparing andother covariates.Results: Of the 253 eligible patients from 2003 to 2007, 159 patientshad bilateral nerve-sparing, 32 had unilateral nerve-sparing and62 had non-nerve-sparing surgery. Of these patients, 27%, 17%and 34%, respectively, were classified as incontinent at 1 year.These proportions were not significantly different between groups(p = 0.23). Multivariable logistic regression showed baseline urinarycontinence and urinary frequency to be significant predictorsof patient-reported continence at 1 year postoperatively, withodds ratios of 1.7 (95% confidence interval [CI] 1.1-2.9) and 1.5(95% CI 1.0-2.3), respectively.There was a significant difference in the proportion of PORPUSsexual function scores between nerve-sparing groups after excludingthose with baseline sexual dysfunction (p = 0.003). Similarly,health-related utility scores were different across groups (p < 0.001).Conclusion: Our results do not suggest a difference in 1-year patientreportedcontinence based on the type of nerve-sparing RP.However, baseline continence and urinary frequency were significantpredictors of continence at 1 year.Introduction : L’incontinence urinaire réduit grandement la qualitéde vie après une prostatectomie radicale (PR). Or, les donnéespubliées ne permettent pas d’établir l’impact sur la continenced’une intervention avec préservation des filets nerveux.Méthodologie : Des hommes atteints de cancer de la prostate etayant subi une PR ont été trouvés dans la base de données duUniversity Health Network Prostate Centre. Avant l’interventionet lors de chaque visite après celle-ci, les patients devaient utili -ser le questionnaire PORPUS d’auto-évaluation, un instrumentvalidé de psychométrie sur les troubles de la prostate et l’état desanté. Un seul point du questionnaire a trait à l’incontinence. Lespatients ayant reçu une radiothérapie ou dont le suivi était inférieurà 10 mois étaient exclus. Les groupes ont été comparés à l’aidede tests du chi carré et d’analyses ANOVA. Une analyse de régressionlogistique multivariée a permis de vérifier les effets de lapréservation des filets nerveux et d’autres covariables.Résultats : Sur les 253 patients admissibles traités entre 2003 et2007, 159 avaient subi une intervention bilatérale avec préservationdes filets nerveux, 32, une intervention unilatérale avec préservationdes filets nerveux et 62, une intervention sans préservationdes filets nerveux. De ces nombres, 27 %, 17 % et 34 %respectivement étaient considérés incontinents après un an. Laproportion de patients incontinents n’était pas significativementdifférente entre les groupes (p = 0,23). L’analyse de régressionlogistique multivariée a fait ressortir que la continence urinaire etla fréquence mictionnelle au départ étaient des facteurs de prédictionimportants de la continence évaluée par les patients unan après l’intervention, les rapports des risques étant respectivementde 1,7 (intervalle de confiance [IC] à 95 % : 1,1 à 2,9) et1,5 (IC à 95 % : 1,0 à 2,3).Une différence significative a été notée dans le taux de scoresPORPUS de dysfonction sexuelle entre les groupes ayant subi uneintervention avec préservation des filets nerveux, après exclusiondes patients présentant une dysfonction sexuelle au départ (p =0,003). De même, les scores concernant l’état de santé étaientdifférents d’un groupe à l’autre (p < 0,001).Conclusion : Nos résultats ne portent pas à croire à l’existence d’unedifférence sur le plan de la continence un an après l’interventionen fonction du type de PR avec préservation des filets nerveux.Cependant, la continence et la fréquence mictionnelle au départconstituent d’importants facteurs de prédiction de la continenceun an après l’intervention.

Download Full-text

The Impact of Catheter Removal Time on Urinary Continence and Overactive Bladder Symptoms After Robot-Assisted Radical Prostatectomy: A Retrospective Analysis of Consecutive 250 Cases From a Single Institution

10.21203/rs.3.rs-1032948/v1 ◽

2021 ◽

Author(s):

Han Hao ◽

Xu Chen ◽

Yue Liu ◽

Longmei Si ◽

Yuke Chen ◽

...

Keyword(s):

Radical Prostatectomy ◽

Overactive Bladder ◽

Catheter Removal ◽

Urinary Continence ◽

Removal Time ◽

Overactive Bladder Symptoms ◽

Significant Difference ◽

Bladder Symptoms ◽

The Impact ◽

Time Point

Abstract Background After radical prostatectomy, the optimal length of postoperative catheterization time remains to be determined. This study investigates the impact of catheter removal time on urinary continence and overactive bladder symptoms after robot-assisted radical prostatectomy (RARP).Methods Two hundred and fifty consecutive patients underwent RARP by a single surgeon between November 2020 and May 2021. Time to catheter removal was categorized into 7, 10, and ≥ 14 days. Continence was defined as no more than 1 pad used or no more than 20 grams of urine leakage per 24 hours. The patients' continence rates and overactive bladder symptom score (OABSS) were assessed at 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal.Results Overall, continence rates were 36% 48 hours after catheter removal, 55.6% 1 week, 74.8% 4 weeks, 98.4% 12 weeks, and 100% 24 weeks after catheter removal. The median time to regain continence was 1 week. After stratification according to catheterization time, no significant difference in continence rates was found between different groups at each time point after catheter removal. Longer catheterization was not an independent predictor of continence recovery (10 days: OR 0.985, 95% CI 0.689-1.409, p = 0.936; ≥14 days: OR 1.194, 95% CI 0.869-1.642, p = 0.274). The presence of diabetes was associated with worse continence outcomes (OR 1.535, 95% CI 1.105-2.132, p = 0.011). The mean OABSS of patients in the continent group were significantly lower than the incontinent group at 48 hours, 1 week, and 4 weeks after catheter removal. No significant difference in OABSS was found between different catheterization time groups at each time point after catheter removal.Conclusions Our results demonstrated that different catheterization time (7 days, 10 days, ≥14 days) is not associated with short-, intermediate-, long-term continence outcomes or overactive bladder symptoms.

Download Full-text

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

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.100 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 100-100 ◽

Cited By ~ 1

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.

Download Full-text

Toxicity in a multimodality approach of radical prostatectomy with radiation and hormonal therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.107 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 107-107

Author(s):

Stacy Loeb ◽

Meike Adam ◽

Pierre Tennstedt ◽

Wolfgang Huber ◽

Juergen Bernard ◽

...

Keyword(s):

Quality Of Life ◽

Radical Prostatectomy ◽

Sexual Function ◽

Hormonal Therapy ◽

Urinary Continence ◽

Urinary Function ◽

Bootstrap Analysis ◽

Patient Reported ◽

The Impact

107 Background: While the optimal use and timing of secondary therapy after radical prostatectomy remain controversial, there are limited data on the patient-reported outcomes following multimodality therapy. Our objective was to assess the impact of additional radiation and/or hormonal therapy on long-term urinary continence, quality of life and potency after radical prostatectomy. Methods: Among 13150 men treated by radical prostatectomy (RP) from 1992-2013, 905 underwent secondary radiation therapy (RP+RT), 407 received androgen deprivation therapy (RP+ADT) and 688 a combination of RT and ADT (RP+RT+ADT). Urinary function, sexual function and quality of life were evaluated annually using self-administrated validated questionnaires. Urinary function was assessed by the use of the number of pads in 24h (analyzed as 0 pads, safety only, 1-2, or ≥ 3 pads). Potency was defined as ≥ 3 points out of 5 on the question whether erections were hard enough for penetration. Quality of life was assessed using a score from 0-100%.The distribution of urinary function, sexual function and quality of life were plotted as a function of time after bootstrap analysis (n = 1000) of a propensity score matched cohort. Results: Urinary function. The distribution of 0 pads and 1 safety pad between patients with a) RP and RP+RT was 72.3% vs. 67.9% and 16.7% vs. 18.6%; b) between RP and RP+HT was 64.5% vs. 55.5% and 16.1% vs. 21.9%; c) between RP and RP+RT+ADT was 67.4% vs. 54.8% and 17.7% vs. 21.8% and d) between RP+RT and RP+RT+ADT was 64.5% vs. 55.5% and 16.1% vs. 21.9%. Potency. The distribution of potency between patients with a) RP and RP+RT was 62.9% vs. 40.0%; b) between RP and RP+HT was 59.1% vs. 29.3%; c) between RP and RP+RT+ADT was 57.4% vs. 24.0% and d) between RP+RT and RP+RT+ADT was 44.2% vs. 32.1%. Quality of life. The distribution of a score of 83.3%-100% between patients with a) RP and RP+RT was 67.9% vs. 57.4%; b) between RP and RP+HT was 57.8% vs. 41.7%; c) between RP and RP+RT+ADT was 59.3% vs. 48.2% and d) between RP+RT and RP+RT+ADT was 60.0% vs. 41.2%. Conclusions: Secondary therapy after radical prostatectomy has a negative influence on urinary function, potency and quality of life.

Download Full-text

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

Canadian Urological Association Journal ◽

10.5489/cuaj.4641 ◽

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.

Download Full-text

Predictors of early continence following robot-assisted radical prostatectomy

Canadian Urological Association Journal ◽

10.5489/cuaj.2086 ◽

2015 ◽

Vol 9 (1-2) ◽

pp. 93 ◽

Cited By ~ 27

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.

Download Full-text

Faculty of 1000 evaluation for Penile vibratory stimulation in the recovery of urinary continence and erectile function after nerve sparing radical prostatectomy: a randomized, controlled trial.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718145683.793487953 ◽

2013 ◽

Author(s):

Oliver Kayes

Keyword(s):

Randomized Controlled Trial ◽

Radical Prostatectomy ◽

Erectile Function ◽

Controlled Trial ◽

Urinary Continence ◽

Nerve Sparing ◽

Vibratory Stimulation ◽

Randomized Controlled ◽

Penile Vibratory Stimulation

Download Full-text

Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00315-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Åsa Kettis ◽

Hanna Fagerlind ◽

Jan-Erik Frödin ◽

Bengt Glimelius ◽

Lena Ring

Keyword(s):

Quality Of Life ◽

Clinical Practice ◽

Significant Difference ◽

Patient Reported ◽

Health Related Qol ◽

Health Related ◽

Secondary Outcomes ◽

The Impact ◽

Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

Download Full-text