scholarly journals Long-term urinary functional outcome of vesicourethral anastomosis with bidirectional poliglecaprone (Monocryl®) vs. barbed polyglyconate suture (V-LocTM 180) in robot-assisted radical prostatectomy

2019 ◽  
Vol 14 (3) ◽  
Author(s):  
Emad Rajih ◽  
Malek Meskawi ◽  
Abdullah M. Alenizi ◽  
Kevin C. Zorn ◽  
Mansour Alnazari ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Single Layer ◽  
Barbed Suture ◽  
Urinary Continence ◽  
First Year ◽  
Robot Assisted ◽  
Monofilament Suture ◽  
Significant Difference ◽  
Vesicourethral Anastomosis ◽  
One Year

Introduction: We aimed to evaluate urinary continence recovery following robot-assisted radical prostatectomy (RARP) using monofilament poliglecaprone (Monocryl®) suture vs. barbed suture (V-LocTM 180) during vesicourethral anastomosis. Methods: In this prospective, observational cohort, data were collected on 322 consecutive patients. All patients underwent continuous, bidirectional, single-layer running anastomosis with either 3.0-monofilament suture (n=141) or 3.0 barbed suture (n=181). The primary outcome was continence recovery defined as time to 0 pad at one, three, six, 12, and 24 months following surgery. Results: Continence rates were significantly better with monofilament VUA at all followup time points up to one year. Median time to continence was one month vs. five months in the monofilament group vs. barbed group, respectively (p<0.001). Continence rates in monofilament suture vs. barbed group at one, three, six, 12, and 24 months were 56% vs. 26% (p<0.001), 73% vs. 36.4% (p<0.001), 84.4% vs. 60.2% (p<0.001), 90.8% vs. 71.9% (p<0.001), and 93.5% vs.87.1% (p=0.1), respectively. Anastomosis time was shorter in the barbed group, with a median of 23 vs. 30 utes (p<0.001). Patients anastomosed with Monocryl suture had smaller prostate weight (median 42.5 g vs. 50 g; p<0.001) and harbored less advanced disease (T2a‒c 76.6 vs. 74%; p=0.01) relative to patients treated with V-Loc 180 suture. However, in a multivariate Cox logistic regression analyses, independent predictors of continence recovery were suture type (hazard ratio [HR] 53; 95% confidence interval [CI] 0.41‒0.68; p=0.02] and prostate size (HR 0.99; 95% CI 0.98‒0.99; p<0.001). Conclusions: Barbed VUA contributed to delayed continence recovery compared to monofilament poliglecaprone suture during the first year post-RARP. However, no statistically significant difference was recorded at two years post-RARP. These results warrant special attention, especially with the widespread use of barbed suture in recent years.

scholarly journals Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiang-Nan Xu ◽  
Zhen-Yu Xu ◽  
Hu-Ming Yin
Keyword(s):  
Radical Prostatectomy ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Postoperative Continence ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P &lt; 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P &lt; 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P &lt; 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

scholarly journals The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes

2017 ◽  
Vol 12 (3) ◽  
pp. E121-5 ◽  
Author(s):  
Mansour Alnazari ◽  
Marc Zanaty ◽  
Khaled Ajib ◽  
Assaad El-Hakim ◽  
Kevin C. Zorn
Keyword(s):  
Risk Factors ◽  
Radical Prostatectomy ◽  
Urinary Retention ◽  
Catheter Removal ◽  
Urinary Continence ◽  
Median Lobe ◽  
Robot Assisted ◽  
Patient Counselling ◽  
Nerve Preservation ◽  
Significant Difference

Introduction: We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes.Methods: The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated.Results: The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months.Conclusions: While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

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 Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Wen Deng ◽  
Hao Jiang ◽  
Xiaoqiang Liu ◽  
Luyao Chen ◽  
Weipeng Liu ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Propensity Score ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Functional Scores

ObjectivesTo estimate the safety and efficiency of transvesical Retzius-sparing robot-assisted radical prostatectomy (T-RARP) compared with standard robot-assisted radical prostatectomy (S-RARP) for localized prostate cancer (PCa).Materials and Methods174 patients bearing localized PCa and undergoing T-RARP or S-RARP between October 2017 and January 2020 were retrospectively enrolled in our analysis. All potential baseline confounders were strictly restrained with propensity-score matching (PM) method (1: 1). Within the matched setting, the perioperative and functional outcomes were compared between the T-RARP and S-RARP groups, while the oncological results and functional recovery of the two arms were presented with Kaplan-Meier curves.ResultsFinally, 114 and 60 eligible patients harbouring localized PCa were identified in the S-RARP and T-RARP group, respectively. No significant differences between the two groups were found in all baseline characteristics after PM. Within the matched cohort, no case was converted to open surgery in either group. The T-RARP group was significantly related to a higher mean operative time (p = 0.001) and shorter median hospital stay length (p &lt; 0.001). There were not significant differences in the median estimated blood loss and specimen Gleason score between the two arms. The proportions of transfusion, pT3a disease, postoperative complication, and positive surgical margin in the T-RARP group were also comparable to that in the S-RARP group. The mean prostate-specific antigen and median erectile functional scores did not differ significantly between the two groups at postoperative 3 months and last follow-up. T-RARP vs. S-RARP had significantly improved urinary continence (UC) rates at the removal of catheter (p &lt; 0.001) and postoperative 3 months (p &lt; 0.001), but the significant difference between the two groups in UC recovery disappeared at last follow-up (p = 0.119). No significant difference in biochemical recurrence-free survival was observed following the two surgeries (p = 0.727).ConclusionsT-RARP by experienced hands was feasible for selected patients with clinically localized PCa, yielding significantly improved early return to UC and similar erectile functional preservation without compromising oncological control when compared with the standard approach.

scholarly journals Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy

2020 ◽  
Author(s):  
Xing Li ◽  
Huan Zhang ◽  
Zhuo Jia ◽  
Yunpeng Wang ◽  
Yong Song ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Radical Prostatectomy ◽  
Logistic Regression Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Significant Difference ◽  
Late Stages

Abstract Background: The robot-assisted radical prostatectomy (RARP) has been widely applied in recent years; however, only a few studies are reported about long-term urinary continence after surgery. The present study aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of urinary continence in patients with prostate cancer (PCa) undergoing RARP. Methods: This retrospective study included 650 patients treated with RARP with perioperative data and at least one year of follow-up from January 2009 to November 2017. Also, the preoperative, intraoperative, and postoperative parameters of the patients were analyzed. Continence was defined as no pad use. Early and late continence was defined as the return of urinary continence within 3 months and beyond 12 months post-surgery, respectively. CRs were examined from 1–48 months postoperatively. Logistic regression analysis evaluated the association between the predictive factors and urinary continence in the early and late stages. Results: No significant difference was detected in the CR from 12–48 months postoperatively (P=0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at 1 month. Nerve-sparing (NS) was a significant protective factor of urinary continence at 1, 3, and 6 months. Advanced age was an independent risk factor of urinary continence at 6, 12, and 24 months. Other variables were not statistically significant predictors of urinary continence. Conclusions: The current results demonstrated that CR gradually improved with time within 1 year and stabilized 1 year after the surgery. PLND, NS, and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperative identification of patients at high risk and counseling about postoperative expectations for urinary continence.

scholarly journals Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy

2019 ◽  
Author(s):  
Xing Li ◽  
Huan Zhang ◽  
Zhuo Jia ◽  
Yunpeng Wang ◽  
Yong Song ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Radical Prostatectomy ◽  
Logistic Regression Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
One Year ◽  
Late Stages

Abstract Background: Although the wide application of robot-assisted radical prostatectomy (RARP) in recent years, studies about long urinary continence were few. In this study, we aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of early and late urinary continence in patients with prostate cancer (PCa) undergoing RARP. Methods: This retrospective study included 650 patients treated with RARP who completed perioperative data and at least one year of follow-up from January 2009 to November 2017. We analyzed the preoperative, intraoperative, and postoperative parameters of the patients. Continence was defined as no pad use. CRs from one to 48 months postoperatively were examined. Logistic regression analysis was performed to evaluate the associations between the predictive factors and urinary continence in the early and late stages. Results: CRs of the patients at one, three, six, 12, 24, 36, and 48 months postoperatively were 40.62%, 60.92%, 71.38%, 78.77%, 79.96%, 79.51%, and 76.50%, respectively. There were no significant differences in CR from 12 to 48 months postoperatively (P=0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at one month. Nerve sparing (NS) was a significant protective factor of urinary continence at one, three and six months. Age was an independent risk factor of urinary continence at six, 12 and 24 months. Other variables were not statistically significant predictors. Conclusions: Our results demonstrated that CR gradually improved with time within one year and stabilized one year after the surgery. PLND, NS and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperatively identifying patients at high risk for urinary incontinence and counselling about postoperative expectations for urinary continence.

scholarly journals Novel method of knotless vesicourethral anastomosis during robot-assisted radical prostatectomy: feasibility study and early outcomes in 30 patients using the interlocked barbed unidirectional V-LOC180 suture

2013 ◽  
Vol 5 (3) ◽  
pp. 188
Author(s):  
Kevin C. Zorn ◽  
Hugues Widmer ◽  
Jean-Baptiste Lattouf ◽  
Dan Liberman ◽  
Naeem Bhojani ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Barbed Suture ◽  
Knot Tying ◽  
Robot Assisted ◽  
Suture Tension ◽  
Vesicourethral Anastomosis ◽  
Watertight Closure ◽  
The Right ◽  
Cas A ◽  
Posterior Reconstruction

Purpose: Our purpose was to describe the safety and feasibility ofa running posterior reconstruction (PR) integrated with continuousvesicourethral anastomosis (VUA) using a novel self-cinchingunidirectional barbed suture in robot-assisted radical prostatectomy(RARP).Methods: Between March and October 2010, 30 consecutivepatients with organ-confined prostate cancer underwent RARP byan experienced single surgeon (KCZ). Upon completion of radicalprostatectomy, urinary reconstruction was carried out using2 knotless, interlocked 6-inches 3-0 V-Loc-180 suture. The lefttail of the suture was initially used for PR (starting at 5-o’clockand ran to re-approximate the retrotrigonal layer to the rectourethralis)followed by left-sided VUA (from 6- to 12-o’clock), whilethe right-sided suture completed the right-sided VUA. Assuranceof watertight closure with an intraoperative 300 cc saline visualcystogram was performed in all cases prior to case completion.Perioperative outcomes and 30-day complications were recorded.Results: All anastamoses were performed without assistance andwithout knot tying. Median time for nurse setup and urinary reconstructionwas 40 seconds (interquartile range [IQR] 25-60) and14.6 min (IQR 10-18), respectively. The need to readjust suturetension or place Lapra-Ty clips (Ethicon Endo-Surgery, Cincinnati,OH) to establish watertight closure was observed in 2 cases (7%).No patient had clinical urinary leak and there was no urinary retentionafter catheter removal on mean postoperative day 5 (IQR 4-6).Conclusions: Our clinical experience with a novel technique usingthe interlocked V-Loc suture during RARP for both PR and anastomosisappears to be safe and efficient. Using the barbed sutureprevents slippage and eliminates the need for bedside assistanceto maintain suture tension or knot tying, thus assuring watertighttissue closure.Objectif : Notre but était de décrire l’innocuité et la faisabilitéd’une reconstruction postérieure (RP) intégrée à une anastomosevésico-urétrale continue à l’aide de la nouvelle technique de sutureavec fils barbelés unidirectionnels et ancrage automatique aprèsprostatectomie radicale assistée par robot (PRAR).Méthodologie : Entre mars et octobre 2010, 30 patients consécutifsatteints d’un cancer de la prostate confiné à la glande ont subi unePRAR effectuée par un chirurgien expérimenté (KCZ). Après laprostatectomie radicale, une reconstruction urinaire a été entrepriseà l’aide de 2 sutures 3-0 de 6 pouces sans noeud par le dispositifV-Loc 180. L’extension gauche de la suture a d’abord été utiliséepour la PR (en commençant à 5 heures et en poursuivant pourrapprocher la couche rétrotrigonale du muscle recto-urétral) etsuivie d’une anatostomose vésico-urétrale du côté gauche (de 6 à12 heures), alors que la partie droite de la suture a permis de terminerl’anastomose vésico-urétrale droite. Une fermeture hermétiquepar cystogramme visuel intraopératoire avec 300 mL de solutionsalée dans tous les cas a été réalisée avant la fin de l’intervention.Les résultats peropératoires et les complications émergeant pendantles 30 jours suivants ont été consignés.Résultats : Toutes les anastomoses ont été effectuées sans aide etsans noeud. Le temps médian pour la préparation par l’infirmièreet la reconstruction urinaire était de 40 secondes (écart interquartile[EIQ] 25-60) et de 14,6 minutes (EIQ 10-18), respectivement.Dans 2 cas (7%), on a eu besoin de rajuster la tension des pointsde suture ou de placer des agrafes LapraTy (Ethicon Endo-Surgery,Cincinnati, OH) pour assurer une fermeture hermétique. Aucunpatient n’a présenté de fuite urinaire clinique ni aucune rétentionurinaire après le retrait du cathéter en moyenne 5 jours aprèsl’opération (EIQ 4-6).Conclusions : Selon notre expérience clinique, cette nouvelle techniquede fermeture de plaie par le dispositif V-Loc pour une PRARavec anastomose semble sans danger et efficace. L’usage des fils barbelés empêche le glissement et élimine le besoin d’aide afind’assurer la bonne tension des points de suture ou de noeuds, etassure une fermeture hermétique des tissus.

Sign in / Sign up

Export Citation Format

Share Document