Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

Abstract

Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year.Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015.Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors.Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent.Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Erectile function after partial penectomy for penile cancer

“…Perhaps the preoperative evaluation of patients at a date very close to surgery represents the moment of greater anxiety and activity of the disease and, consequently, explains this result. Age was a significant predictor for worse sexual potency after surgery (24).…”

“…The length of the penis shaft was performed with the penis in a flaccid state, measured in centimeters using a rigid ruler from the pubic bone to the end of the shaft. The possible scores for the IIEF-5 range from 5 to 25, a score of 1-5 is awarded to each of the 5 questions, and ED was classified into five categories based on the scores: severe (5-7), moderate (8)(9)(10)(11), mild to moderate (12)(13)(14)(15)(16), mild (17)(18)(19)(20)(21), and no ED (22)(23)(24)(25). The patients answered the questionnaire only once, at least 3 months after surgery (range from 3 to 6 months).…”

Early return to continence and potency with use of dehydrated human umbilical cord graft at the time of robot‐assisted radical prostatectomy: A case study and analysis of relevant literature

“…The average time for continence recovery post‐RARP is 2.66 months and the average time to recovery of potency is 7.72 months 7 . However, multiple studies demonstrate that the mean time to continence and potency was significantly shorter in patients who were treated with dHACM and UC allografts at the time of prostatectomy as compared to a control group (Table 1).…”

Value of adding the apparent diffusion coefficient to capsular contact for the prediction of extracapsular extension in prostate cancer

“…Tumor-positive surgical margins have been associated with biochemical recurrence ( 24 ) , shorter disease-free (recurrence-free) survival, and the need for rescue therapies ( 25 ) . Although it is known that prostate cancer outcomes are highly dependent on the skills and experience of the attending urologist, thorough surgical planning also seems to be relevant ( 26 , 27 ) .…”