Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States

Giudice, Francesco Del; Huang, Jianlin; Li, Shufeng; Sørensen, Simon Grund; Enemchukwu, Ekene; Maggi, Martina; Salciccia, Stefano; Russo, Giorgio Ivan; Crocetto, Felice; Pandolfo, Savio Domenico; Autorino, Riccardo; Krajewski, Wojciech; Crivellaro, Simone; Cacciamani, Giovanni; Bologna, Eugenio; Asero, Vincenzo; Scornajenghi, Carlo Maria; Moschini, Marco; D’Andrea, David; Brown, David R.; Chung, Benjamin I.

doi:10.1038/s41391-022-00558-x

Cited by 31 publications

(18 citation statements)

References 31 publications

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“…In patients with localized prostate cancer who received a RP, it was estimated that 3% of patients underwent at least one incontinence procedure during a median follow-up of 5 years. Among the treatment modalities for PPI, male slings were the most common incontinence procedure followed by an artificial urinary sphincter (AUS), which was the most expensive option [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Intraoperative factors including the surgical method, preservation of the neurovascular bundle, preservation of the bladder neck, and vesicoureteral anastomosis, were also well established to correlate with incontinence recovery [ 13 ]. Factors, such as older age, diabetes mellitus, prior radiation therapy, and a history of neurological comorbidities, had also been reported to be associated with an increased likelihood of incontinence after surgery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome

Shao

Kan

Chen

et al. 2023

JPM

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Purpose: Post-operative cystography has been used to predict the recovery of postprostatectomy urinary incontinence (PPI) in patients with localized prostate cancer. This study aimed to validate the predictive value of cystography for PPI and utilize a deep learning model to identify favorable and unfavorable features. Methods: Medical records and cystography images of patients who underwent robotic-assisted radical prostatectomy for localized prostate cancer were retrospectively reviewed. Specific cystography features, including anastomosis leakage, a downward bladder neck (BN), and the bladder neck angle, were analyzed for the prediction of PPI recovery. Favorable and unfavorable patterns were categorized based on the three cystography features. The deep learning model used for transfer learning was ResNet 50 and weights were trained on ImageNet. We used 5-fold cross-validation to reduce bias. After each fold, we used a test set to confirm the model’s performance. Result: A total of 170 consecutive patients were included; 31.2% experienced immediate urinary continence after surgery, while 93.5% achieved a pad-free status and 6.5% were still incontinent in the 24 weeks after surgery. We divided patients into a fast recovery group (≤4 weeks) and a slow recovery group (>4 weeks). Compared with the slow recovery group, the fast recovery group had a significantly lower anastomosis leakage rate, less of a downward bladder neck, and a larger bladder neck angle. Test data used to evaluate the model’s performance demonstrated an average 5-fold accuracy, sensitivity, and specificity of 93.75%, 87.5%, and 100%, respectively. Conclusions: Postoperative cystography features can predict PPI recovery in patients with localized prostate cancer. A deep-learning model can facilitate the identification process. Further validation and exploration are required for the future development of artificial intelligence (AI) in this field.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome

Shao

Kan

Chen

et al. 2023

JPM

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“…In patients with moderate/severe symptoms and no complications, medical therapy is indicated [ 1 , 15 , 16 , 17 , 18 ]. Even if is beyond the scope of this article to describe the various treatment options [ 19 , 20 ], it is evident that constant and close objective monitoring of LUTS symptoms and therapeutic follow-up is highly needed [ 21 , 22 , 23 , 24 , 25 ]. Our home assessment device surely permits us to reach these goals better than the office-based one by offering the potential to provide cost-effective, high-quality, and constantly up-to-date data allowing for clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

A Novel Low-Cost Uroflowmetry for Patient Telemonitoring

Pandolfo

Crauso

Aveta

et al. 2023

IJERPH

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Uroflowmetry (UF) is a crucial guideline-recommended tool for men with benign prostatic obstruction (BPO). Moreover, UF is a helpful decision-making tool for the management of patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). In the last few years, telemedicine and telehealth have increased exponentially as cost-effective treatment options for both patients and physicians. Telemedicine and telehealth have been well positioned during the COVID-19 pandemic to prevent healthcare system overload and to ensure adequate management of patients through screening, diagnosis, and follow-up at home. In the present manuscript, the main characteristics and performance of a novel and low-cost device for home-based UF have been analyzed. The simple weight-transducer method has been applied to perform UF. An inexpensive load cell connected to a 24 bit analogic digital converter (ADC) sends data to a cloud server via SIM card or home Wi-Fi. Data are processed and shown in graphics with both volume and flow rate as a function of time, allowing for measurement of average flow rate, maximum flow rate, voided volume, and voiding time. A numerical algorithm allows for filtering of the dynamic effect due to the urine gravity acceleration and for removing the funnel to simplify the home measurement procedure. Through an online platform, the physician can see and compare each UF data. The device’s reliability has been validated in a first laboratory setting and showed excellent performance. This approach based on domiciliary tests and an online platform can revolutionize the urologic clinic landscape by offering a constant patient cost-effective follow-up, eliminating the time wasted waiting in the office setting.

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“…Del Giudice et al assessed contemporary trends in postprostatectomy surgical SUI management in the United States by querying Optum's deidentified Clinformatics ® Data Mart Database between 2003-2017 (13). A total of 844 unique incontinence procedures were performed over the study period.…”

Section: Aus Vs Ms Utilizationmentioning

confidence: 99%

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

Desai¹,

Rozanski²

2023

Transl Androl Urol

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Surgery plays a crucial role in the definitive management of male stress urinary incontinence (SUI). The most utilized and well-studied surgical options include the artificial urinary sphincter (AUS) and the male sling (MS). The AUS has long been considered the "gold standard" and more versatile option in this space, showing effectiveness in mild, moderate, and severe SUI cases, whereas the MS is preferred in cases of mild to moderate SUI. Not surprisingly, and importantly, much of the published literature on male stress incontinence has focused on determining the "ideal" candidate for each procedure and identifying which clinical, device-specific, and patient factors play an important role in the objective and subjective success rates. There are, however, more granular, and sometimes debatable, topics to assess regarding the real-life practice patterns of male SUI surgery. The aim of this clinical practice review is to examine current trends of several of these topics including: AUS vs. MS utilization, the prevalence of outpatient procedures, 3.5 cm AUS cuff use, preoperative urine studies utilization, and intraoperative and postoperative antibiotics.As with many things in surgery, dogma rather than evidence-based medicine can significantly influence everyday clinical decision making. We seek to highlight which practice patterns in male SUI surgery are changing and/or being challenged and debated.

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Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States

Cited by 31 publications

References 31 publications

Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome

Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome

A Novel Low-Cost Uroflowmetry for Patient Telemonitoring

Changes and debates in male stress urinary incontinence surgery practice patterns: a contemporary review

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