Prostate cancer detection rate in patients with repeated extended 21-sample needle biopsy

Abstract

test and the Incontinence Quality of Life questionnaire were completed preoperatively and at 3 and 6 months postoperatively. Results: The median age at the procedure was 63.3 years (range 44.7-74.7). The mean preoperative and 6-month postoperative patient-reported pad use was 4.52 and 1.04, respectively (2-tailed t test, P = .0009). The 24-hour pad test, performed preoperatively and at 6 months postoperatively, yielded a pad weight of 779.3 and 67.6 g, respectively (P = .03). The Valsalva leak point pressure improved significantly (P = .032), but the detrusor voiding pressure, postvoid residual urine volume, and maximal and average flow rates remained relatively unchanged. At 3 and 6 months postoperatively, the Incontinence Quality of Life scores had improved significantly compared with the preoperative scores (P < .01). Conclusions: These results are encouraging, because this series has demonstrated a significant improvement in patient-reported pad use, 24-hour pad test weights, and Valsalva leak point pressure without signs of obstruction. The improvement in incontinence was accompanied without any changes in the other voiding parameters and with significant improvement in the quality-of-life measures. Ongoing studies with longer follow-up are pending to compare their results with these promising early results. Editorial CommentThe authors present urodynamic data supporting the concept that the transobturator sling achieves continence by means other than compression. Original reports from developers of the sling (1) supported the concept that it achieved continence by lengthening of the membranous urethra. The current article does not shed light on whether that is indeed the mechanism but it does show that pressure-flows studies are not consistent with obstruction. Curiously, 2 of 13 patients had to perform intermittent catheterization postoperatively for urinary retention lasting up to 2 weeks. It would be interesting to know whether the urodynamic outcomes of these 2 patients were any different from the rest. With only 13 patients and large standard deviations around the variables of interest, the study is underpowered to test anything but an enormous difference in voiding parameters; however, with pre-and post-op flow rates and pressures so close to each other it is hard to believe the findings would be clinically significantly different even with a larger cohort. While the findings deserve to be validated by other centers, the conclusions remain important. Reference 1. Rehder P, Gozzi C: Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy.