Abstract
Purpose
We evaluated urinary continence in a series of consecutive patients who underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) to identify the preoperative predictors of the return to immediate urinary continence.
Methods
110 consecutive patients who underwent RS-RARP for clinically localized prostate cancer were retrospectively collected. Patients reported freedom from using safety pad (0 pad/day) within 7 days after removal of urinary catheter were defined as immediate urinary continent.
Results
A total of 85 patients (77.27%) were immediate urinary continent after RS-RARP. Patients with immediate urinary continence were significantly younger (66.92 ± 5.73 vs. 69.68 ± 4.99 years, p = 0.031) than those who were incontinent. Furthermore, the prostate volume was significantly smaller (30.90 vs. 44.60 ml, p = 0.001) and preoperative international prostate symptom score (IPSS) was significantly lower (Mild 76.5% vs. 24.0%, Moderate 20.0% vs. 32.0%, and Severe 3.5% vs. 44.0%, p = 0.000) in patients with immediate urinary continence compared with those who were not. On univariable regression analysis, patient’s age (OR 0.907, p = 0.035), prostate volume (OR 0.935, p = 0.000), moderate (OR 0.196, p = 0.007), and severe IPSS (OR 0.025, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence. On multivariable analysis, prostate volume (OR 0.955, p = 0.032) and severe preoperative IPSS (OR 0.044, p = 0.000) (compared with mild IPSS) were independent adverse predictors of immediate urinary continence after RS-RARP.
Conclusions
RS-RARP hastens the recovery of urinary continence after surgery. Prostate volume and severe preoperative IPSS were independent adverse predictors of the return to immediate urinary continence.
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References
Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. Cancer J Clin 66 (1):7–30. https://doi.org/10.3322/caac.21332
Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. Cancer J Clin 66(2):115–132. https://doi.org/10.3322/caac.21338
Bianco FJ Jr, Scardino PT, Eastham JA (2005) Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”). Urology 66(5):83–94. https://doi.org/10.1016/j.urology.2005.06.116
Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261. https://doi.org/10.1056/NEJMoa074311
Begg CB, Riedel ER, Bach PB, Kattan MW, Schrag D, Warren JL, Scardino PT (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346(15):1138–1144. https://doi.org/10.1056/NEJMsa011788
Barry MJ, Gallagher PM, Skinner JS, Fowler FJ Jr (2012) Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. J Clin Oncol 30(5):513–518. https://doi.org/10.1200/jco.2011.36.8621
Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A, Menon M, Montorsi F, Patel VR, Stolzenburg JU, Van der Poel H, Wilson TG, Zattoni F, Mottrie A (2012) Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 62(3):405–417. https://doi.org/10.1016/j.eururo.2012.05.045
Sridhar AN, Abozaid M, Rajan P, Sooriakumaran P, Shaw G, Nathan S, Kelly JD, Briggs TP (2017) Surgical techniques to optimize early urinary continence recovery post robot assisted radical prostatectomy for prostate cancer. Curr Urol Rep 18(9):71. https://doi.org/10.1007/s11934-017-0717-4
Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi AM (2010) A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol 58(3):457–461. https://doi.org/10.1016/j.eururo.2010.06.008
Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M, Ascione A, Gambacorta M, Bocciardi AM (2013) Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥ 1 year of follow-up. Eur Urol 64(6):974–980. https://doi.org/10.1016/j.eururo.2013.06.046
Dalela D, Jeong W, Prasad MA, Sood A, Abdollah F, Diaz M, Karabon P, Sammon J, Jamil M, Baize B, Simone A, Menon M (2017) A pragmatic randomized controlled trial examining the impact of the Retzius-sparing approach on early urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 72(5):677–685. https://doi.org/10.1016/j.eururo.2017.04.029
Menon M, Dalela D, Jamil M, Diaz M, Tallman C, Abdollah F, Sood A, Lehtola L, Miller D, Jeong W (2018) Functional Recovery, oncologic outcomes and postoperative complications after robot-assisted radical prostatectomy: an evidence-based analysis comparing the Retzius sparing and standard approaches. J Urol 199(5):1210–1217. https://doi.org/10.1016/j.juro.2017.11.115
Lim SK, Kim KH, Shin TY, Han WK, Chung BH, Hong SJ, Choi YD, Rha KH (2014) Retzius-sparing robot-assisted laparoscopic radical prostatectomy: combining the best of retropubic and perineal approaches. BJU Int 114(2):236–244. https://doi.org/10.1111/bju.12705
Heesakkers J, Farag F, Bauer RM, Sandhu J, De Ridder D, Stenzl A (2017) Pathophysiology and contributing factors in postprostatectomy incontinence: a review. Eur Urol 71(6):936–944. https://doi.org/10.1016/j.eururo.2016.09.031
Walz J, Epstein JI, Ganzer R, Graefen M, Guazzoni G, Kaouk J, Menon M, Mottrie A, Myers RP, Patel V, Tewari A, Villers A, Artibani W (2016) A critical analysis of the current knowledge of surgical anatomy of the prostate related to optimisation of cancer control and preservation of continence and erection in candidates for radical prostatectomy: an update. Eur Urol 70(2):301–311. https://doi.org/10.1016/j.eururo.2016.01.026
Walz J, Burnett AL, Costello AJ, Eastham JA, Graefen M, Guillonneau B, Menon M, Montorsi F, Myers RP, Rocco B, Villers A (2010) A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy. Eur Urol 57(2):179–192. https://doi.org/10.1016/j.eururo.2009.11.009
Chang LW, Hung SC, Hu JC, Chiu KY (2018) Retzius-sparing robotic-assisted radical prostatectomy associated with less bladder neck descent and better early continence outcome. Anticancer Res 38(1):345–351. https://doi.org/10.21873/anticanres.12228
Sayyid RK, Simpson WG, Lu C, Terris MK, Klaassen Z, Madi R (2017) Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: a safe surgical technique with superior continence outcomes. J Endourol 31(12):1244–1250. https://doi.org/10.1089/end.2017.0490
Lee S, Yoon CJ, Park HJ, Lee JZ, Ha HK (2013) The surgical procedure is the most important factor affecting continence recovery after laparoscopic radical prostatectomy. World J Men’s Health 31(2):163–169. https://doi.org/10.5534/wjmh.2013.31.2.163
Santok GD, Abdel Raheem A, Kim LH, Chang K, Lum TG, Chung BH, Choi YD, Rha KH (2017) Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size. BJU Int 119(1):135–141. https://doi.org/10.1111/bju.13632
Galfano A, Panarello D, Secco S, Di Trapani D, Barbieri M, Napoli G, Strada E, Petralia G, Bocciardi AM (2018) Does prostate volume have an impact on the functional and oncological results of Retzius-sparing robot-assisted radical prostatectomy? Minerva Urol Nefrol 70(4):408–413. https://doi.org/10.23736/S0393-2249.18.03069-2
Konety BR, Sadetsky N, Carroll PR (2007) Recovery of urinary continence following radical prostatectomy: the impact of prostate volume—analysis of data from the CaPSURE database. J Urol 177(4):1423–1425. https://doi.org/10.1016/j.juro.2006.11.089 discussion 1425–1426.
Boczko J, Erturk E, Golijanin D, Madeb R, Patel H, Joseph JV (2007) Impact of prostate size in robot-assisted radical prostatectomy. J Endourol 21(2):184–188. https://doi.org/10.1089/end.2006.0163
Nguyen L, Jhaveri J, Tewari A (2008) Surgical technique to overcome anatomical shortcoming: balancing post-prostatectomy continence outcomes of urethral sphincter lengths on preoperative magnetic resonance imaging. J Urol 179(5):1907–1911. https://doi.org/10.1016/j.juro.2008.01.036
Paparel P, Akin O, Sandhu JS, Otero JR, Serio AM, Scardino PT, Hricak H, Guillonneau B (2009) Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol 55(3):629–637. https://doi.org/10.1016/j.eururo.2008.08.057
Nyarangi-Dix JN, Radtke JP, Hadaschik B, Pahernik S, Hohenfellner M (2013) Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial. J Urol 189(3):891–898. https://doi.org/10.1016/j.juro.2012.09.082
Friedlander DF, Alemozaffar M, Hevelone ND, Lipsitz SR, Hu JC (2012) Stepwise description and outcomes of bladder neck sparing during robot-assisted laparoscopic radical prostatectomy. J Urol 188(5):1754–1760. https://doi.org/10.1016/j.juro.2012.07.045
Shikanov S, Desai V, Razmaria A, Zagaja GP, Shalhav AL (2010) Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery. J Urol 183(5):1803–1807. https://doi.org/10.1016/j.juro.2010.01.016
Lavigueur-Blouin H, Noriega AC, Valdivieso R, Hueber PA, Bienz M, Alhathal N, Latour M, Trinh QD, El-Hakim A, Zorn KC (2015) Predictors of early continence following robot-assisted radical prostatectomy. Can Urol Assoc J 9(1–2):e93–e97. https://doi.org/10.5489/cuaj.2086
Acknowledgements
This study was supported by grants from the National Natural Science Foundation of China (81772710, 81602232, 81572519), Natural Science Foundation of Jiangsu Province (BK20150112, BK20150097), Nan**g Medical Science and technique Development Foundation (QRX17128), and Nan**g Health Distinguished Youth Fund (JQX16025).
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All procedures performed in studies were approved by the Ethics Committee of the Drum Tower Hospital, Medical School of Nan**g University, with a waiver of written informed consent given the retrospective nature of this study.
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Qin, H., Qiu, X., Ma, H. et al. Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case–control study. Int Urol Nephrol 51, 825–830 (2019). https://doi.org/10.1007/s11255-018-02071-4
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DOI: https://doi.org/10.1007/s11255-018-02071-4