Anatomical predictors of long‐term urinary incontinence after robot‐assisted laparoscopic prostatectomy: A systematic review

Calahorro, C. Muñoz; García‐Sánchez, Carmen; García-Ramos, Juan Braulio; Rodríguez-Pérez, Antonio; Medina-López, R.A.

doi:10.1002/nau.24652

Cited by 11 publications

(11 citation statements)

References 24 publications

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“…The negative correlation between postoperative urethral length and incontinence severity agrees with reports of a shorter membranous urethra in incontinent men pre‐ 20 and postprostatectomy. 26 Although plausible that shorter urethral length could impact SUS function and underpin an assumption that length is the principal determinant of incontinence, the absence of correlation between SUS and urethral length measures suggests an independent contribution. It is notable that urethral length report here are longer than those reported earlier 20 (~20 mm vs. ~13 mm).…”

Section: Discussionmentioning

confidence: 99%

The relationship between pre‐ and postprostatectomy measures of pelvic floor muscle function and development of early incontinence after surgery

Stafford

Doorbar‐Baptist²,

Hodges

2022

Neurourology and Urodynamics

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Aims: The aim of this study is to investigate (i) whether pelvic floor muscle (PFM) shortening can be enhanced by provision of training focused on striated urethral sphincter (SUS) with feedback before prostatectomy, (ii) whether PFM shortening during voluntary efforts and coughing before and after prostatectomy differs between men who do and do not report symptoms of urinary incontinence 1 month after prostatectomy, and (iii) the relationship between severity of incontinence after prostatectomy and features of pelvic floor function (muscle shortening) and urethral length before and after prostatectomy.Methods: Sixty men referred for preoperative PFM training before radical prostatectomy participated. The International Continence Society Male Short Form questionnaire was used to quantify continence status. Transperineal ultrasound (US) imaging was used to record pelvic displacements related to activation of striated urethral sphincter, bulbocavernosus (BC) and puborectalis muscles during cough, "natural" voluntary contraction following pamphlet instruction, and trained voluntary contraction after formal physiotherapist instruction including US feedback. Results: Pelvic floor displacements following training differed between continent and incontinent men; continent participants demonstrated increased SUS shortening after training (compared with "natural"), but no difference was observed between trained and "natural" contractions for incontinent participants. Motion at ano-rectal junction during cough was reduced following surgery, but voluntary and involuntary activation of SUS or BC was not consistently affected by surgery.Conclusions: Participants' capacity to improve function of the SUS with training appears related to postprostatectomy continence outcome.

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Section: Discussionmentioning

confidence: 99%

The relationship between pre‐ and postprostatectomy measures of pelvic floor muscle function and development of early incontinence after surgery

Stafford

Doorbar‐Baptist²,

Hodges

2022

Neurourology and Urodynamics

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“…Older age of the patient, non-sparing neurovascular resection and stricture of the anastomosis are risk factors for PPI [ 2 ]. Additionally, the preoperative length of the membranous urethra evaluated by magnetic resonance imaging can predict the risk of developing PPI [ 3 ].…”

Section: Post-prostatectomy Incontinence (Ppi) Treatment Optionsmentioning

confidence: 99%

Update on Adjustable Trans-Obturator Male System (ATOMS) for Male Incontinence after Prostate Cancer Surgery

et al. 2023

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(1) Background: The adjustable trans-obturator male system (ATOMS) is a surgical device developed to treat post-prostatectomy incontinence (PPI) after prostate cancer treatment. We review the current literature on this anti-incontinence device with the intention of assessing the effectiveness, safety and duration of the silicone-covered scrotal port (SSP) ATOMS, the only generation of the device that is currently available. (2) Material and Methods: Non-systematic literature review is performed. Forty-eight full-text articles are assessed for eligibility. Case reports, expert opinions or commentaries without specific data reported (n = 6), studies with patients who underwent intervention before 2014 (IP or SP ATOMS; n = 10), and studies with incontinence after transurethral resection of the prostate (TUR-P; n = 2) are excluded for analysis. Thirty studies with SSP ATOMS are included in a qualitative synthesis that incorporates systematic reviews (n = 3), articles partially overlapping with other previously published studies (e.g., follow-up or series updates; n = 9), and studies focusing on specific populations (n = 8). Only articles revealing outcomes of SSP ATOMS were included in the quantitative synthesis of results (n = 10). (3) Results: the pooled data of 1515 patients from the 10 studies with SSP ATOMS confirmed very satisfactory results with this device after adjustment: dry rate: 63–82%, improved rate: 85–100%, complication rate: 7–33%, device infection rate: 2.7–6.2% and explant rate: 0–19%. The durability of the device is reassuring, with 89% of devices in place 5 years after implantation. (4) Conclusion: Despite the absence of randomized controlled studies, the literature findings confirm results of SSP ATOMS appear equivalent to those of artificial urinary sphincters (AUSs) in terms of continence, satisfaction and complications, but with a lower rate of revision in the long-term. A prospective study identified that patients with daily pad test results <900 mL and a Male Stress Incontinence Grading Scale (MSIGS) of not 4 (i.e., early and persistent stream or urine loss) are the best candidates. Future studies centered on the elder population at higher risk of impaired cognitive ability and in patients including radiation as prostate cancer treatment are needed.

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“…We read with great interest the systematic review by Muñoz-Calahorro et al published in Neurourology and Urodynamics assessing the role of anatomical features in predicting postprostatectomy incontinence in patients submitted to robotic-assisted radical prostatectomy (RARP). 1 We commend the authors for their analysis, which inevitably highlights the numerous limitations of the literature on this topic, underlining a mediocre level of scientific evidence. 2 We respectfully suggest that the abstract, and the final message of the article, is misleading because it completely ignores the importance of a proper patient counseling based on multiple aspects.…”

Section: Sirmentioning

confidence: 99%