Early Return of Continence in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy Using Modified Maximal Urethral Length Preservation Technique

Hamada, Alaa; Razdan, Shirin; Etafy, Mohamed; Fagin, Randy; Razdan, Sanjay

doi:10.1089/end.2013.0794

Cited by 52 publications

(36 citation statements)

References 29 publications

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“…Finally, we did not have a control group. Despite these, our results were superior than those of the series in the literature, and had a new standpoint in detailed anatomy of prostate during RALP [18,23,28]. …”

Section: Discussioncontrasting

confidence: 74%

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Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex

Tunç¹,

Akın

Gümüstas³

et al. 2016

Urol Int

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Aim: To describe our surgical technique for dissecting the apex of prostate during robotic-assisted laparoscopic radical prostatectomy (RALP) and detailed surgical anatomy of prostate including relationship between urethra and dorsal vein complex with apex. Materials and Methods: In retrospective view of prospective collected data, 73 patients underwent RALP between December 2012 and September 2014. Surgical anatomy of prostate was revealed in all procedures. Quality of life (QoL) scores were assessed before, immediately after catheter removal, and 1 month after surgery. We divided urinary continence into 3 groups, as very early continence; continence at time of urethral catheter removal, early continent; and continence 1 month after surgery. The rest of the patients were accepted as continence. Results: The mean follow-up was 10.2 ± 5.4 months and mean age was 61.5 ± 6.6. Maximum protection of urethra could be provided in all. Mean catheter removal was 8.9 ± 1.7 days, and all patients were continent at the time of catheter removal. QoL scores before RALP could be protected after surgery (p = 0.2). Neither conversion to open/conventional laparoscopic surgery nor complications related with bladder neck were detected. Conclusions: Our surgical technique can be a strong candidate for being a surgical technique for preserving urethra and very early continence could be provided after surgery.

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Section: Discussioncontrasting

confidence: 74%

“…Hamada et al [18] recently reported their surgical technique for preserving the maximal urethral length. Paparel et al [19] suggested ways of preserving the maximum urethral length during RP for urinary continence.…”

Section: Discussionmentioning

confidence: 99%

Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex

Tunç¹,

Akın

Gümüstas³

et al. 2016

Urol Int

View full text Add to dashboard Cite

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“…4,[6][7][8][9] Recent studies reported that preoperative clinical factors, anatomical characteristics, and surgical techniques are significantly associated with urinary incontinence after RARP. 1,7,[10][11][12][13][14][15] Of these factors, membranous urethral length (MUL) is an important factor that directly correlates with the functional sphincter mechanism. The urethral sphincter mechanism is composed of an external striated sphincter and an internal smooth muscle layer that are both crucial to maintaining urethral closure pressure.…”

Section: Introductionmentioning

confidence: 99%

Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy

Song

Kim²,

Park³

et al. 2017

CUAJ

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Introduction: We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP). Methods: Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months. Results: Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01-1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16-9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17-7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85-19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24-13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL. Conclusions: Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.

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“…Despite technical and methodological improvements in RP, UI does occur and negatively affects quality of life [17]. Assessment of predictors associated with urinary continence has been tried in many studies [7,15,18,19]. This is important for patients and surgeons [18].…”

Section: Discussionmentioning

confidence: 99%

Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy

Zhang

Jia

et al. 2019

Preprint

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Background: Although the wide application of robot-assisted radical prostatectomy (RARP) in recent years, studies about long urinary continence were few. In this study, we aimed to examine the outcomes of continence rates (CRs) and determine the risk and protective factors of early and late urinary continence in patients with prostate cancer (PCa) undergoing RARP. Methods: This retrospective study included 650 patients treated with RARP who completed perioperative data and at least one year of follow-up from January 2009 to November 2017. We analyzed the preoperative, intraoperative, and postoperative parameters of the patients. Continence was defined as no pad use.CRs from one to 48 months postoperatively were examined. Logistic regression analysis was performed to evaluate the associations between the predictive factors and urinary continence in the early and late stages. Results: CRs of the patients at one, three, six, 12, 24, 36, and 48 months postoperatively were 40.62%, 60.92%, 71.38%, 78.77%, 79.96%, 79.51%, and 76.50%, respectively.There were no significant differences in CR from 12 to 48 months postoperatively (P=0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant risk factor of urinary continence at one month. Nerve sparing (NS) was a significant protective factor of urinary continence at one, three and six months. Age was an independent risk factor of urinary continence at six, 12 and 24 months. Other variables were not statistically significant predictors. Conclusions: Our results demonstrated that CR gradually improved with time within one year and stabilized one year after the surgery. PLND, NS and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperatively identifying patients at high risk for urinary incontinence and counselling about postoperative expectations for urinary continence. BackgroundDespite advances in surgical technique and methodology, postprostatectomy urinary incontinence (UI) remains a significant adverse event that leads to decreased quality of life [1,2]. It has been suggested that a number of factors are involved in recovery of urinary continence after radical prostatectomy (RP) [3,4]. Many patients have learned about this disease from the media. Hence, it is necessary to predict recovery of urinary continence early to minimize patients' concerns and

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Early Return of Continence in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy Using Modified Maximal Urethral Length Preservation Technique

Abstract: MULP rather than PRAS confers higher postoperative CR and shorter time to achieve continence among patients with PCa who underwent RALP without increasing risk of positive margin.

Cited by 52 publications

References 29 publications

Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex

Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex

Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy

Urinary continence outcomes of four years of follow-up and predictors of early and late urinary continence in patients undergoing robot-assisted radical prostatectomy

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