urinary continence
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Nursing Open ◽  
2022 ◽  
Author(s):  
Myrta Kohler ◽  
Stefan Ott ◽  
Jeanette Mullis ◽  
Hanna Mayer ◽  
Jürg Kesselring ◽  
...  

2022 ◽  
Author(s):  
Yasukazu Nakanishi ◽  
Shunya Matsumoto ◽  
Naoya Okubo ◽  
Kenji Tanabe ◽  
Madoka Kataoka ◽  
...  

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.


2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Theodoros Karagiotis ◽  
Jorn H. Witt ◽  
Thomas Jankowski ◽  
Mikolaj Mendrek ◽  
Christian Wagner ◽  
...  

AbstractThe quality of life (QoL) of men with optimal outcomes after robot-assisted radical prostatectomy (RARP) is largely unexplored. Thus we assessed meaningful changes of QoL measured with the EORTC QLQ-C30 24 months after RARP according to postsurgical Cancer of the Prostate Risk Assessment score (CAPRA-S) and pentafecta criteria. 2871 prostate cancer (PCa) patients with completed EORTC QLQ-C30 were stratified according to CAPRA-S, pentafecta (erectile function recovery, urinary continence recovery, biochemical-recurrence-free survival (BFS), negative surgical margins) and 90-day Clavien–Dindo-complications (CDC) ≤ 3a. Multivariable logistic regression analyses (LRM) aimed to predict improvement of EORTC QoL. Mean preoperative QoL values did not significantly differ between CAPRA-S low- (LR) vs. high-risk (HR, 75.7 vs. 75.2; p = 0.7) and pentafecta vs. non-pentafecta groups (75.6 vs. 75.2; p = 0.6). After RARP, stable QoL rates for CAPRA-S LR vs. HR and pentafecta were 30, 26 and 30%, respectively. Corresponding improved QoL rates were 44, 32 and 47%. In LRM, CAPRA-S and pentafecta criteria were independent predictors of improved QoL. We conclude that most favourable combined outcomes after RARP might confer stable or even improved QoL but up to one third of patients might experience deterioration. This warrants further investigation how to capture the underlying cause and to address and potentially solve these perceived negative effects despite successful RARP.


2022 ◽  
Vol 48 (1) ◽  
pp. 122-130
Author(s):  
Thiago Camelo Mourão ◽  
Renato Almeida Rosa de Oliveira ◽  
Ricardo de Lima Favaretto ◽  
Thiago Borges Marques Santana ◽  
Carlos Alberto Ricetto Sacomani ◽  
...  

2021 ◽  
Author(s):  
Ori Haisraely ◽  
Yaacov Richard Lawrence ◽  
Ron Lewin ◽  
Orit Kaidar-Person ◽  
Ilana Weiss ◽  
...  

Abstract Purpose: To evaluate urinary continence and sexual potency following radical prostatectomy and adjuvant radiotherapy.Materials/Methods: Expanded Prostate Cancer Index Composite (EPIC) surveys of patients with localized prostate cancer treated with surgery followed by adjuvant/salvage pelvic radiotherapy (S+RT) were analyzed. A control cohort was primary radiotherapy (RT). Reverse "bifecta" was defined as a score less than 60 in both incontinence and sexual domains. Superior urinary function was defined as a score above 90. The clinically important difference was calculated using a distribution approach.Results: Surveys at least 1 year after treatment were available for 130 S+RT and 374 RT patients. For S+RT vs. RT, the mean urinary incontinence score was 68 [6.25 -100] versus 86.4 [CI-95 39.5-100] (p<0.001), confirming 6.5 points of clinically significant difference. The adjusted odds ratio for superior urinary function was 2.67 (1.7-4.1, p<0.001) for primary radiotherapy. The odds ratio of having both poor urinary and sexual performance (reverse " bifecta") was 0.29 in RT arm (0.14-0.58, p<0.001) when adjusted for age and Androgen Deprivation Therapy (ADT) , group risk stratification, comorbidities and smoking status.Conclusion: In this cross sectional study, Surgery with adjuvant/salvage RT was associated with significantly worse patient reported urinary continence outcomes at 1-year post treatment, lower odds of achieving perfect urinary continence and a threefold risk of reverse ‘bifecta’ with inferior urinary continence and sexual performance. Longitudinal studies of evolving toxicity are required to validate these findings. Patients referred for surgery with a high probability of requiring adjuvant or salvage radiotherapy should be informed regarding the potential composite toxicity of both surgery and radiotherapy.


Author(s):  
Ngoc Khanh Tran

TÓM TẮT Đặt vấn đề: Phẫu thuật cắt bỏ toàn bộ bàng quang được xem là phẫu thuật tiêu chuẩn đối với ung thư bàng quang xâm lấn. Tạo hình bàng quang mới từ hồi tràng, cũng như nạo vét hạch nhằm tránh di căn và nâng cao tỉ lệ sống sau 5 năm rất quan trọng. Bên cạnh đó, chất lượng cuộc sống của bệnh nhân sau phẫu thuật cũng rất đáng quan tâm. Mục tiêu: Đánh giá kết quả điều trị ung thư bàng quang xâm lấn lớp cơ bằng phẫu thuật cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt kết hợp nạo hạch chậu mở rộng và tạo hình bàng quang từ hồi tràng. Nội dung và phương pháp nghiên cứu: Nghiên cứu tiến cứu, mô tả lâm sàng không nhóm chứng 43 bệnh nhân nam được chẩn đoán ung thư bàng quang xâm lấn (cT2a - T4aN0M0), được phẫu thuật cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt, nạo hạch chậu mở rộng và tạo hình bàng quang mới từ hồi tràng từ tháng 1/2015 đến 12/2020 tại khoa ngoại Tổng hợp BVTW Huế. Kết quả: Thời gian phẫu thuật trung bình: 213,5 ± 29,7 phút. Lượng máu mất trung bình: 130 ± 90 ml. Lấy được 11,5 ± 4,5 hạch. Thời gian nằm viện trung bình: 17,12 ± 6,45 ngày. Tỷ lệ biến chứng sớm sau mổ 32,6%. Đa số bệnh nhân khi xuất viện đều tiểu được nhưng tia tiểu yếu, tiểu són, thể tích nước tiểu ít dưới 150 ml.Thể tích bàng quang tăng có ý nghĩa qua các lần tái khám (p < 0,05). Tỷ lệ kiểm soát tiểu tiện ban ngày: 97,2% sau 6 tháng. 1/43 tái phát tại miệng nối bàng quang - niệu đạo sau 4 tháng. 7 trường hợp tử vong do ung thư tiến triển. Kết luận: Cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt, nạo hạch chậu mở rộng và tạo hình bàng quang mới từ đoạn ruột non theo phương pháp Hautmann - Studer vẫn giải quyết triệt để vấn đề ung thư học, giảm khả năng tái phát di căn hạch, bệnh nhân vẫn còn khả năng tình dục và tiểu tự chủ sau mổ. ABSTRACT OUTCOMES OF INVASIVE BLADDER CANCER TREATED BY PROSTATE SPARING RADICAL CYSTECTOMY WITH EXTENDED PELVIC LYMPHADENECTOMY AND ORTHOTOPIC ILEAL NEOBLADDER Background: Radical cystectomy is considered a “gold standard” procedure to treat invasive bladder cancer. Orthotopic ileal neobladder after cystectomy as well as lymphadenectomy, which avoids metastasis and enhances postoperative 5 - years survival rate are important. Moreover, the quality of life after this kind of surgery is a great concern. Purpose: Evaluating results of treatment of invasive bladder cancer by prostate sparing radical cystectomy with extended pelvic lymphadenectomy and orthotopic ileal neobladder. Material and Method: Prospective and descriptive clinical study without a control group in 43 males who were diagnosed with invasive bladder cancer (cT2a - T4aN0M0), they underwent prostate sparing radical cystectomy with extended pelvic lymphadenectomy and orthotopic ileal neobladder, from 1/2015 to12/2020 at Department of General Surgery, Hue Central Hospital. Results: The operative time: 213,5 ± 29,7 min. The estimated blood loss: 130 ± 90 ml. The mean number of lympho nodes which is conducted lymphadenectomy: 11,5 ± 4,5. The length of hospital stay: 17,12 ± 6,45 days. Early complication rate: 32,6%. The majority of patients who were discharged from the hospital passed urine with urinary incontinence, weak urine stream and voided volume < 150ml. The volume of the neobladder increased with statistical significance through follow - up examinations (p < 0,05). The daytime continence rate was 97,2% after 6 months. 1/43 case recured at cystourethral anastomosis after 4 months. 7 cases dead due to cancer progression. Conclusion: Prostate sparing radical cystectomy with extended pelvic lymphadenectomy and Hautmann - Studer orthotopic ileal neobladderstill thoroughly solve oncologic issues, reduce the possibility of lymph node metastasis recurrence. The patient still has the sexual ability and urinary continence after this procedure. Keywords: Extended pelvis lymphadenectomy; invasive bladder cancer; radical cystectomy; orthotopic ileal neobladder.


2021 ◽  
Vol 31 (06) ◽  
pp. 468-471
Author(s):  
Heiko Reutter ◽  
Gundela Holmdahl

AbstractBladder exstrophy-epispadias complex (BEEC) represents the severe end of the uro-rectal malformation spectrum and has profound impact on continence, sexual, and renal function. Treatment of BEEC is primarily surgical, and the main goals are safe closure of the abdominal wall, urinary continence while preserving renal function, and adequate cosmetic and functional genital reconstruction. Psychosocial and psychosexual outcomes and adequate health-related quality of life depend on long-term multidisciplinary care. The overall outcome is now considered very positive and affected individuals usually lead self-determined and independent lives with the desire to start their own families later in life. Certainty about the risk of recurrence and the provision of information about the current state of knowledge about the identified genetic causes with high penetrance will have an impact on family planning for healthy parents with an affected child and for affected individuals themselves. This review addresses this information and presents the current state of knowledge.


BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuwei Lu ◽  
Chang He ◽  
Sihong Zhang ◽  
Fan Yang ◽  
Zhuifeng Guo ◽  
...  

Abstract Background Radical prostatectomy (RP) is the primary treatment of localized prostate cancer. Immediate urinary incontinence post-RP was still common and depressing without specific reason. Methods A multicenter cohort of 154 consecutive patients from 2018 to 2020, who was diagnosed with localized prostate cancer underwent either modified mini-incision retropubic radical prostatectomy (Mmi-RRP) or laparoscopic radical prostatectomy (LRP) or robotic-assisted radical prostatectomy (RARP). Seventy-two patients with Denonvilliers’ fascia (DF) spared were included in DFS (Denonvilliers’ fascia sparing) group. Whereas eighty-two patients with DF completely or partially dissected were set as Group Control. The primary outcome was immediate continence (ImC). Continuous data and categorical data were analyzed with t-test and Chi-square test, respectively. Odds ratios (ORs) were calculated with logistic regression. Results Urinary continence of Group DFS was significantly better than that of Group Control at each time point within one year after operation. Incidence rate of continence in Group DFS and Group Control were 83.3% vs 13.4% (P < 0.01) for ImC, 90.3% vs 30.5% (P < 0.01) at 3 months, 91.7% vs 64.6% (P < 0.01) at 6 months, and 93.1% vs 80.5% (P = 0.02) at 1 year after operation, respectively. Positive surgical margin (PSM) showed no significant difference (20.8% vs 20.7%, P = 1.0). In multivariate analysis, DFS showed importance for ImC post RP (OR = 26.4, P < 0.01). Conclusions Denonvilliers’ fascia acted as the fulcrum and hammock for continence post RP. Preservation of DF contributed to better continence after RP without increase of PSM. Trail registration Our research was conducted retrospectively and approved by the ethical committees of Minhang Hospital, but not registered.


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