De novo overactive bladder after robot‐assisted laparoscopic radical prostatectomy

Matsukawa, Yoshihisa; Yoshino, Yashushi; Ishida, Susumu; Fujita, Takashi; Majima, Tsuyoshi; Funahashi, Yasuhito; Sassa, Naoto; Kato, Masashi; Gotoh, Momokazu

doi:10.1002/nau.23556

Cited by 30 publications

(29 citation statements)

References 27 publications

(34 reference statements)

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“…Actually, some studies have reported the presence of postoperative DO after RP. 20,21 The postoperative BOO index in the DU group was also significantly decreased compared with the non-DU group. The BOO index is defined as PdetQmax minus two times Qmax.…”

Section: Discussionmentioning

confidence: 85%

Prevalence and predictors of postoperative detrusor underactivity after robot‐assisted radical prostatectomy: A prospective observational study

et al. 2021

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To identify the prevalence and predictors of postoperative detrusor underactivity during the early postoperative period after robot-assisted radical prostatectomy. Methods: We carried out a prospective observational study of 64 patients scheduled for robot-assisted radical prostatectomy using urodynamic study before and 1 month after robot-assisted radical prostatectomy. Detrusor underactivity was defined as maximum flow rate ≤15 mL/s and detrusor pressure at maximum flow rate ≤25 cmH 2 O during voiding. Incidences of pre-and postoperative detrusor underactivity were assessed, and predictors of postoperative detrusor underactivity were determined using uni-and multivariate logistic regression analyses. Factors comprised patient characteristics (age, prostate weight etc.), operative factors (surgical duration, nerve sparing etc.) and preoperative urodynamic study parameters (maximum flow rate, bladder contractile index etc.). Results: Pre-and postoperative detrusor underactivity at 1 month after robot-assisted radical prostatectomy were detected in one patient (1.6%) and 24 patients (37.5%), respectively. Univariate analysis selected preoperative maximum flow rate (P = 0.02), detrusor pressure at maximum flow rate (P = 0.04) and bladder contractile index (P < 0.01) as predictors of postoperative detrusor underactivity (odds ratio 0.83, 0.97 and 0.94, respectively). On multivariate analyses, only preoperative bladder contractile index was associated with postoperative detrusor underactivity (P < 0.01; odds ratio 0.94). A cut-off of 102.8 offered optimal accuracy in receiver operating characteristic analysis. Patient characteristics and operative factors were not significantly associated with postoperative detrusor underactivity. Conclusions: A comparatively high prevalence of postoperative detrusor underactivity is observed in patients at 1 month after robot-assisted radical prostatectomy. Patients with preoperative low bladder contractile index have a higher probability of developing early postoperative detrusor underactivity after robot-assisted radical prostatectomy.

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Section: Discussionmentioning

confidence: 85%

Prevalence and predictors of postoperative detrusor underactivity after robot‐assisted radical prostatectomy: A prospective observational study

et al. 2021

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“…UPP were measured twice at each time, and the average maximum urethral closing pressure (MUCP) was obtained. RARP was carried out via the transperitoneal approach with six ports using the da Vinci S system (Intuitive Surgical) as previously reported 7 …”

Section: Methodsmentioning

confidence: 99%

“…RARP was carried out via the transperitoneal approach with six ports using the da Vinci S system (Intuitive Surgical) as previously reported. 7 To evaluate predictive factors for low preoperative urethral function, we analyzed the association between preoperative MUCP and the following factors: age, body mass index, American Society of Anaesthesiologists physical status, history of diabetes mellitus and hypertension, prostate volume, international prostate symptom score (IPSS), erectile function domain scores using the International Index of Erectile Function 15 (IIEF15) (question 1 + 2 + 3 + 4 + 5 + 15), and current medication use, such as calcium channel blockers, α-adrenoceptor blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors. Prostate volume was measured using abdominal ultrasound.…”

Section: Study Amentioning

confidence: 99%

Urodynamic evaluation before and after to RARP to identify pre and intraoperative factors affecting postoperative continence

Majima

Matsukawa

Funahashi

et al. 2021

Neurourology and Urodynamics

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Aims To investigate factors contributing to pre and postoperative urethral function in male patients who underwent robot‐assisted radical prostatectomy (RARP) using the urethral pressure profile (UPP). Methods Study A A total of 313 patients who underwent RARP between April 2013 and March 2015 were prospectively investigated. UPP was performed preoperatively in all patients. Correlation and multiple regression analyses were performed to investigate predictive factors for low preoperative maximum urethral closure pressure (MUCP). Study B To validate the predictive factors for low preoperative MUCP obtained in Study A, 755 patients who underwent RARP between May 2010 and October 2017 were retrospectively examined. Relationships between the time to pad‐free status and the following factors were investigated: number of predictive factors, nerve‐sparing surgery, and vesicourethral anastomosis (VUA) methods (barbed vs. nonbarbed suture). Results Study A A total of 187 patients were enrolled. Multivariate analysis revealed that older age, large prostate volume, low erectile function domain scores in International Index Erectile Function 15, and use of calcium channel blockers were significantly associated with low preoperative MUCP. Study B A total of 515 patients were included. Cox proportional hazard regression showed that the number of predictive factors and VUA method were significantly associated with the time to pad‐free status. Conclusions Our study demonstrated that older age, larger prostate volume, poor erectile function, and calcium channel blocker use could be predictive markers for recovery from postprostatectomy urinary incontinence.

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“…In a recent study, Mastukawa et al identified that low maximum urethral closure pressure at baseline and its decrease postoperatively were strong predictors of de novo post-rPR OAB underlying the role of the intrinsic sphincter deficiency on the pathophysiology of OAB (40).…”

Section: Oab and Urgency Incontinencementioning

confidence: 99%

Current Management of Post-radical Prostatectomy Urinary Incontinence

et al. 2021

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Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.

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De novo overactive bladder after robot‐assisted laparoscopic radical prostatectomy

Abstract: The incidence rate of de novo OAB after RARP was about 40%, and seemed unexpectedly high. Decreased urethral function was significantly related to de novo OAB after surgery.

Cited by 30 publications

References 27 publications

Prevalence and predictors of postoperative detrusor underactivity after robot‐assisted radical prostatectomy: A prospective observational study

Prevalence and predictors of postoperative detrusor underactivity after robot‐assisted radical prostatectomy: A prospective observational study

Urodynamic evaluation before and after to RARP to identify pre and intraoperative factors affecting postoperative continence

Current Management of Post-radical Prostatectomy Urinary Incontinence

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