Retropubic TFS Minisling for Postprostatectomy Male Incontinence: First Report

<b><i>Hypothesis:</i></b> A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. <b><i>Methods:</i></b> The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vectors around the PPL, with digital support for the PPL rectally and cadaveric testing with a tissue fixation system (TFS) minisling, and finally, 22 cases of postprostatectomy incontinence were addressed only with retropubic insertion of a 7-mm TFS sling between the bladder neck and perineal membrane to reinforce the PPL. <b><i>Results:</i></b> On ultrasound testing, 3 urethral closure muscles were confirmed to act reflexively around the PPL to close the urethra distally and at the bladder neck. A finger was inserted rectally, pressed against the symphysis only on one side of the urethra at the origin of the PPL that controlled urine loss on coughing. The mean pre-op pad loss was 3.8 pads at 9 months; the mean post-op loss was 0.7 pads; 13/22 (59%) patients were 100% improved; 7/22 (31%) improved &#x3e;50% but &#x3c;100%; 2/22 (9.1%) improved &#x3c;50%. <b><i>Conclusions:</i></b> The 7-mm-wide TFS minisling is the first retropubic minisling for postprostatectomy urinary incontinence. It differs significantly from transobturator male operations surgically and in modus operandi. As in the female, reconstruction of the PPL alone was sufficient to cure/improve SUI, suggesting that preservation of the PPL is of critical importance during retropubic radical prostatectomy.

Denonvilliers’ fascia acts as the fulcrum and hammock for continence after radical prostatectomy

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.

Denonvilliers’ Fascia Acts as the Fulcrum and Hammock for Continence After Radical Prostatectomy

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 DF spared were included in DFS 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<0.001) for ImC, 90.3% vs 30.5% (P<0.001) at 3months, 91.7% vs 64.6% (P<0.001) at 6months, and 93.1% vs 80.5% (P=0.023) at 1year after operation, respectively. Positive surgical margin (PSM) showed no significant difference (20.8% vs 20.7%, P=0.988). In multivariate analysis, DFS showed importance for ImC post RP (OR=26.418, P<0.001).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.

Localized Prostate Cancer, Retropubic Radical Prostatectomy: Surgical Complications, Single Centre Study.

Background: For organ-confined disease in carcinoma of prostate the primary curative procedure that is well identified is the retro pubic radical prostatectomy. Objective: To assess the complications related to surgery of prostate after open retro pubic radical prostatectomy. Materials and Methods: Retropubic radical prostatectomy was performed in 75 subjects suffering from localized cancer of prostate in last 05 years, at the urology department. Open retropubic radical prostatectomy procedure represented by Walsh as a classic method was adapted. Disease progression and caliber of life indices like potency and urinary continence were noted during the follow up. Result: There were total 75 patients in current study. Mean age of patients was 63.3 years. Out of 75 patients, 70 were married and 05 patients were unmarried, 25 were from urban areas, while 50 were from rural area, 35 were educated and 45 were uneducated, 05 patients had positive family history for prostatic malignancy, while 70 patients had no family history of prostatic carcinoma. Out of 75 patients, 63, 65 and 69 patients were continent, at 10, 06 and 12 months; however, 05, 04 and 04 had stress incontinence at 10, 06 and 12 months; and 07, 03 and 01 had mixed incontinence urge and stress at 06 and 12 months; 05, 03 and 01 had total incontinence at 06 and 12 months. Subjects with incontinence are trained exercises concerned with pelvic floor. Conclusion: The retro-pubic thorough prostatectomy is the typical management of early cancer of prostate and a number of complications are associated with this technique of surgery. It had a vertical knowledge curl. Large figure of patients and improvement in techniques are needed to attain the perfect outcomes. Keywords: Carcinoma, prostate, radical, prostatectomy.

Prostate cancer testicular metastasis: Are they underestimated? Case report and analysis of the literature

Introduction: We aim to present a rare case of a patient who developed a late testicular metastasis of PCa after radical prostatectomy. Case description: A 78 years old man presenting for left testicular swelling slowly increasing of size over the last 2 months. He underwent a retropubic radical prostatectomy and extended bilateral lymphadenectomy in 2007 for prostatic adenocarcinoma. At the time of the presentation the last PSA was 0.91 ng/mL. The patient underwent a standard left orchifunicolectomy in April 2019 without intra- or perioperative complications. The pathological analysis showed a testicular metastasis of acinar adenocarcinoma. Conclusions: In conclusion, testicular metastasis from PCa are uncommon conditions. PSA evaluation and physical examination of all sites of metastasis and accurate evaluation of all signs/symptoms during the clinical visit remains crucial to the diagnosis of recurrence.