Analysis of Complications Development Predictors after Radical Prostatectomy

Introduction: The standard treatment for prostate cancer is radical prostatectomy (RP). This surgical technique results in typical complications such as intraoperative blood loss, urethral strictures (vesicourethral anastomosis), urinary incontinence, erectile dysfunction, lymphocele, and the ureter or rectum injury. The study aims to analyze the development of complications after radical prostatectomy. Materials and methods: The article presents a retrospective analysis of clinical cases with an established diagnosis of prostate cancer from 2012 to 2018 in Irkutsk, Russian Federation. During this period, 52 patients met the study criteria. A multivariate analysis established Non-Nerve-sparing RRP (OR-0.9; 95% CI-1.9; -0.07; p=0.035) as a significant incontinence predictor after 2 years. Results: Multivariate analysis also established previous transurethral operations as a significant predictor of the vesicourethral anastomosis stricture (OR 6.09; 95% CI 0.71; 11.4; p=0.026), which indicates a six times risk of developing a vesicourethral anastomosis stricture if the patient already had one or more transurethral surgery. Obesity (OR 0.12; 95% CI 0.03; 0.21; p = 0.008), diabetes (OR 2.3; 95% CI 0.45; 4.2; p = 0.015) and coagulopathy (OR 3.1; 95% CI 0.5; 5.7; p = 0.019) became independent predictors of lymphocele development. Conclusions: The study revealed some new information on the possible predictors of such complications as urinary incontinence in the late period, the lymphocele, and stricture of the vesicourethral anastomosis. Some of the results require further study and confirmation.

Трансректальное ультразвуковое исследование простатэктомического ложа

В настоящее время радикальная простатэктомия выполняется трети пациентов с локализованным раком предстательной железы. Это диктует необходимость стандартизации технологического и описательного протоколов трансректального ультразвукового исследования в соответствии с адекватными временными затратами на данное исследование. Подробное описание ультразвуковой картины и сохранение изображений окажут существенную помощь при оценке простатэктомического ложа в динамике, позволяя избежать большого количества ложно-положительных результатов диагностики локальных рецидивов рака предстательной железы. Трактовка данных трансректального ультразвукового исследования простатэктомического ложа должна основываться не только на особенностях ультразвуковой картины и оценке ее динамики, но и на клинико-лабораторных данных (как минимум, наличие или отсутствие биохимического рецидива). При необходимости трансректальное ультразвуковое исследование простатэктомического ложа может использоваться при пункционной биопсии для выбора участковмишеней и наведения при различных вариантах магнитно-резонансного и ультразвукового совмещения (фьюжен). Ключевые слова: трансректальное ультразвуковое исследование, радикальная простатэктомия, цистоуретральный (везикоуретральный) анастомоз, простатэктомическое ложе, рак предстательной железы, transrectal ultrasound, radical prostatectomy, vesicourethral anastomosis, prostatectomy bed, prostate cancer

Effect of a novel technique of posterior reconstruction of pubourethralis on ‘early’ return of continence after robot assisted radical prostatectomy (RARP): A comparative study

Objective: To study the effect of a novel technique of posterior reconstruction of pubourethralis on early return of continence after robot assisted radical prostatectomy (RARP). Materials and methods: The study included 206 patients of organ confined prostate cancer managed at our centre between March 2014 and December 2018.The patients were randomly distributed into two comparable groups with respect to age, height, weight and BMI, with 100 patients in control and 106 patients in study group. After standard excision of the specimen, the posterior reconstruction in the form of Rocco stitch was done in control group while in addition to Rocco stitch pubourethralis was approximated posteriorly in midline at the proposed site of vesicourethral anastomosis in study group. Continence was defined as the need to use 0–1 pad in 24 h. The data was collected on day 0, 3, 7, 15, 30, 90 and 180 after removal of catheter. Results: At day zero, 3,7, 15, 30, 90 and 180 days after catheter removal continence rates (⩽1 pad usage per day) were observed to be 18.8% versus 0%, 22.6% versus 0%, 50.9% versus 5%, 72.6% versus 20%, 84.9 versus 32%, 97.1% versus 83%, and 97.1% versus 91% in the study and control group respectively. Conclusion: Despite small number of patients in this study the results with respect to early return of continence are encouraging in the reconstruction group and there by in favour of this technique .Furthermore the technique is easily reproducible and may be seen as one more additional step to be applied in order to enhance the recovery of continence after RARP. However it is necessary to further validate the efficacy of this procedure through multicenteric controlled trials.

Pre- and Postoperative Parameters on Magnetic Resonance Imaging Predict Continence Recovery after Laparoscopic Radical prostatectomy

Background: To evaluate the association between pre- and postoperative parameters on magnetic resonance imaging (MRI) and continence recovery after laparoscopic radical prostatectomy (LRP). Methods: 73 patients who underwent LRP were retrospectively reviewed. Demographic characteristics, clinicopathologic outcomes and several MRI parameters before and after surgery were evaluated. Continence was defined as no pad per day. Early continence recovery was defined as continence recovery within 3 months. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery. Cox proportional-hazards regression analyses were performed to identify independent predictors of continence recovery after LRP.Results: Patients with smaller prostatic volume, shorter intravesical prostatic protrusion length (IPPL), longer preoperative membranous urethral length (MUL), lower MUL-removal rate, triangular vesicourethral anastomosis (VUA) and neurovascular bundle sparing experienced a faster continence recovery (All, p < 0.05). Multivariate analyses revealed IPPL (hazard ratio [HR]: 0.94, p = 0.044), preoperative MUL (HR: 1.10, p = 0.032), MUL-removal rate (HR: 0.91, p = 0.007) and shape of VUA (square vs. triangle, HR: 2.30, p = 0.012) were independent predictors of continence recovery after LRP.Conclusion: IPPL, preoperative MUL, MUL-removal rate and shape of VUA were promising parameters on MRI for predicting continence recovery after LRP.