Study Type – Therapy (outcomes)
Level of Evidence 2c
What's known on the subject? and What does the study add?
In addition to a higher prevalence and biological aggressiveness of prostate cancer, African‐Americans tend towards narrower pelvises than Caucasians resulting in a potentially more difficult surgical dissection doing radical prostatectomy and increased positive surgical margins. In this study, there was no difference in urinary or sexual HRQL or overall satisfaction between African‐Americans and Caucasians 2 years after radical prostatectomy, suggesting that the potential technical challenges of a narrower pelvis do not translate into poorer outcomes for African‐Americans.
OBJECTIVE
To determine if any differences exist in postoperative health‐related quality‐of‐life (HRQL) outcomes, e.g. erectile function and continence, after radical prostatectomy (RP) in African‐American (AA) vs Caucasian‐American (CA) men.
PATIENTS AND METHODS
Between October 2000 and July 2008, 1338 CA and 56 AA men underwent open RP by a single surgeon and signed informed consent to participate in a prospective longitudinal outcomes study.
The American Urological Association Symptom Score (AUA‐SS) and University of California, Los Angeles, Prostate Cancer Index (UCLA‐PCI) and a global assessment of satisfaction were self‐administered at baseline and after RP 24 months.
Urinary, sexual, and satisfaction outcomes were compared at 24 months.
RESULTS
AA men had significantly higher rates of hypertension and diabetes.
There were no other significant baseline differences in age, co‐morbidities, body mass index, phosphodiesterase type 5 inhibitor use, preoperative prostate‐specific antigen level, AUA‐SS, and UCLA‐PCI scores.
There were no differences in the percentage of men undergoing nerve‐sparing procedures, estimated blood loss, transfusion rates, or complication rates between the groups.
At 24 months after RP the mean UCLA‐PCI urinary and sexual function and bother scores and global satisfaction scores were similar between the groups.
CONCLUSION
AA and CA men experience no significant differences in urinary and sexual HRQL or overall satisfaction after open RP when performed by a single experienced surgeon.
Mixed urinary incontinence is a commonly encountered condition for urologists, urogynecologists, and primary care providers. In this review, we discuss the approach to the evaluation and management of patients with simultaneous stress and urgency urinary incontinence. The available evidence for treatment modalities in the setting of mixed urinary incontinence is presented, and we discuss our treatment algorithm for this common but challenging clinical scenario. An accurate assessment of stress and urge symptoms and their relative impact on quality of life help guide the management plan, appropriate counseling, and appropriate appraisal of patient expectations for treatment.
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