Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence After Robot-assisted Laparoscopic Radical Prostatectomy

Srivastava, Abhishek; Chopra, Sameer; Pham, Anthony; Sooriakumaran, Prasanna; Durand, Matthieu; Chughtai, Bilal; Gruschow, Siobhan; Peyser, Alexandra; Harneja, Niyati; Leung, Robert; Lee, Richard; Herman, Michael; Robinson, Brian D.; Shevchuk, Maria M.; Tewari, Ashutosh

doi:10.1016/j.eururo.2012.07.009

Cited by 102 publications

(81 citation statements)

References 46 publications

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“…Early return of continence was achieved by 55.8% ; of those, 71.8% were in nerve -sparing grade 1, 54.7% were in nerve -sparing grade 2, 45.7% were in nerve -sparing grade 3, and 43.5% were in nerve -sparing grade 4 (p<0.001). On multivariate analysis, better nervesparing grade was a significant independent predictor of early return of urinary continence 24) .…”

Section: Techniques To Improve Urinary Continence Following Rarpmentioning

confidence: 92%

“…Srivastava et al have evaluated the effect of a risk -stratified grade of nerve -sparing technique on early return of urinary continence 24) . Early return of continence was achieved by 55.8% ; of those, 71.8% were in nerve -sparing grade 1, 54.7% were in nerve -sparing grade 2, 45.7% were in nerve -sparing grade 3, and 43.5% were in nerve -sparing grade 4 (p<0.001).…”

Section: Techniques To Improve Urinary Continence Following Rarpmentioning

confidence: 99%

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Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

FJMS

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: Although open retropubic radical prostatectomy has been the most commonly used surgical technique for patients with localized prostate cancer for decades, robot -assisted radical prostatectomy (RARP) has recently become an alternative option and widely used in Japan as well as around the world. RARP has been shown to have higher postoperative continent rates than retropubic and laparoscopic radical prostatectomy ; however, urinary incontinence has remained one of the most significant causes for concern among patients who seek surgical treatment for prostate cancer, even after the introduction of RARP. The literature has shown that certain technical modifications to improve urinary continence are advocated as potential aids to reduce the risk of urinary incontinence after RARP. These modifications might be divided into 3 categories to realize the improvement of early return of urinary continence after RARP : 1) preservation, 2) reconstruction, and 3) reinforcement of the anatomic structures in the pelvis, which will make a new supporting system after radical prostatectomy. In this review, we discuss the intraoperative techniques to improve outcomes for early return of urinary continence following RARP, and provide a critical summary of current knowledge on its outcome in the literature.

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Section: Techniques To Improve Urinary Continence Following Rarpmentioning

confidence: 92%

Section: Techniques To Improve Urinary Continence Following Rarpmentioning

confidence: 99%

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

FJMS

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“…In fact, unilateral nerve sparing may help preserve the neurovascular bundle on a side less likely to be affected by prostate cancer. 18 However, few studies have investigated the incidence and extent of contralateral disease extension in such cases. In regards to disease extension within the contralateral lobe, a laparoscopic series by Frota and colleagues showed that unilaterally positive biopsies correlated weakly with both prostate cancer and PSM localization.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

Bienz

Hueber²,

Trudeau³

et al. 2015

CUAJ

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Introduction:We assessed the incidence of contralateral prostate cancer (cPCa), contralateral EPE (cEPE) and contralateral positive surgical margins (cPSM) in patients diagnosed preoperatively with unilateral prostate cancer and evaluated risk factors predictive of contralateral disease extension. Methods: The occurrence of cPCa, cEPE and cPSM and the sidespecific nerve-sparing technique performed were collected postoperatively from 327 men diagnosed with unilateral prostate cancer at biopsy. Parameters, such as the localization, proportion, and percentage of cancer in positive cores, were prospectively collected. Results: Overall, 50.5% of patients had bilateral disease, and were at higher risk when associated with a positive biopsy core at the apex (p = 0.016). The overall incidence of ipsilateral EPE and cEPE were 21.4% and 3.4%, respectively (p < 0.001). Compared to cPCa, ipsilateral disease was at an almost 4-fold higher risk of extending out of the prostate (p < 0.001). None of the criteria tested were identified as useful predictors for cEPE. The low incidence of cEPE in our cohort could limit our ability to detect significance. The overall incidence of ipsilateral PSM and cPSM were 15.3% and 5.8%, respectively (p < 0.001). More aggressive nerve-sparing was not associated with a higher incidence of PSM. Prostate sides selected for more aggressive nerve-sparing were associated with younger patients (p < 0.001), a smaller prostate (p = 0.006), and a lower percentage of cancer in biopsy material (p = 0.008). Conclusion: Although the risk of cPCa is high in patients diagnosed with unilateral prostate cancer at biopsy, the risk of cEPE and cPSM is low, yet not insignificant. Contralateral aggressive nervesparing should be used with caution and should not compromise oncological outcome.

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“…'ları yaptıkları çalışmada sinir koruyucu yaklaşım yapılarak hamak yapısı korunmasının erken kontinans sağlama açısından bağımsız bir öngörücü olduğunu rapor etmişlerdir (43). Hamada ve ark.…”

Section: Posterior Ve Anterior Rekonstrüksiyonunclassified

Robot Yardımlı Laparoskopik Radikal Prostatektomide Tam Kontinans İçin Neler Yapılmalı?

Tavukçu¹,

Aytaç²,

Atug³

2015

Endouroloji

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A çık radikal prostatektomi (ARP) sonrası idrar kaçırma, hastaların yaşam kalitesini ve hasta memnuniyetini bozan en önemli etkenlerden biri olarak karşımıza çıkmak-tadır (1). Yıllar boyunca radikal prostatektomi ameliyatlarındaki gelişmelere rağmen ARP ve laparoskopik radikal prostatektomi (LRP) serilerinde %60 ile %95 arasında kontinans oranları bildirilmiştir (2,3,4). Robotik teknolojinin optik büyütme, üç boyutlu görüntü ve 7 derece harekete imkan tanıyan robotik kolları; kontinans ve erektil fonksiyonda etkili anatomik noktaların korunmasına ve perioperatif komplikasyonların azalmasına imkan sağlamaktadır. İlk yıllarda yapılan robot yardımlı laparoskopik radikal prostatektomi (RYLP) operasyonları, açık ve konvansiyonel laparoskopik seriler ile karşılaştırıldığında, kontinans iyileşmesi açısından anlamlı farklılık ve teknikler arasında birbirlerine üstünlük-ler görülmemesine karşın, son yıllarda bildirilen RYLP serilerinde, ameliyat tekniklerindeki gelişmelere paralel olarak kontinans oranlarında oldukça anlamlı iyileşmeler rapor edilmektedir (2). Bu derlememizde RYLP' de tam kontinans elde edilmesi için neler yapılması gerektiğini literatür eşli-ğinde tartışacağız. RYLP Sonrası İdrar Kaçırma Oranları ve İdrar Kaçırmayı Öngören ÖzelliklerGüncel RYLP serilerindeki kontinans durumu Tablo 1'de verilmiştir. Tablo'daki çalışmalarda görüldüğü üzere 12 ay sonunda hiç ped kullanmama temel alındığında kontinans

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Effect of a Risk-stratified Grade of Nerve-sparing Technique on Early Return of Continence After Robot-assisted Laparoscopic Radical Prostatectomy

Cited by 102 publications

References 46 publications

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

Robot Yardımlı Laparoskopik Radikal Prostatektomide Tam Kontinans İçin Neler Yapılmalı?

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