Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function

Abstract

Objectives:To assess the impact of laparoscopic radical prostatectomy on vesicourethral function and compare it to that of open radical prostatectomy. Methods: Sixty-three patients undergoing laparoscopic radical prostatectomy for localized prostate cancer were included in this retrospective analysis. Urodynamic parameters, including maximum urethral closing pressure (MUCP), functional profile length (FPL), bladder compliance, maximum cystometric capacity (MCC) and detrusor overactivity, were considered. Continence status and changes in urodynamic findings before and after surgery were evaluated. In addition, postoperative urodynamic findings were compared with those in 58 patients undergoing open radical prostatectomy. Results: After laparoscopic radical prostatectomy, MUCP and FPL showed a significant postoperative decrease. Continence rates after surgery were 82% in the laparoscopic and 78% in the open group. Comparison of postoperative data between continent and incontinent patients in both surgical groups showed significantly lower MUCP, shorter FPL, lower bladder compliance and higher incidence of detrusor overactivity in incontinent patients. Although there was no significant difference in postoperative MUCP and FPL between the two groups, bladder compliance was significantly lower and incidence of detrusor overactivity was significantly higher in the open prostatectomy group. Conclusions: Laparoscopic radical prostatectomy has a negative impact on storage function by impairing function of the urethral sphincter and decreasing bladder compliance. There is no difference in postoperative urethral function between open and laparoscopic radical prostatectomy. Laparoscopic surgery might be associated with less impairment of bladder function than open surgery.

Urodynamic Findings in Men Presenting with Incontinence After Open Versus Robotic Radical Prostatectomy

“…Matsukawa and colleagues showed a significantly increased rate of DO in patients undergoing an open compared with a laparoscopic prostatectomy, which also accounted for some increased incidence of PPI in their series [7]. We did not find a statistically significant difference in DO between the 2 groups in our study, but we did have a P value approaching significance, suggesting that trend.…”

“…These urodynamic findings include an increase in the incidence of ISD, a decrease in cystometric capacity and bladder compliance, and an increase in both detrusor overactivity and detrusor under activity [5][6][7][8][9][10][11]. Some of these variables have been shown to improve with time, but even 3 years following prostatectomy, they may not parameters in patients who underwent radical retropubic (RRP) versus minimally invasive prostatectomy is not nearly as well reported.…”

“…Urodynamic findings in patients with UI following radical prostatectomy have been reported by several authors in an effort to characterize the nature of their incontinence. It is now widely accepted that intrinsic sphincter deficiency (ISD) is at least a contributing factor in the majority of men with post-prostatectomy incontinence (PPI) [4][5][6][7][8][9][10]. Chae and Mayo found sphincteric deficiency in 96% of men with PPI in their cohort, and it was the sole cause in over half [5].…”

De novo overactive bladder after robot‐assisted laparoscopic radical prostatectomy

“…Urinary incontinence comprises stress urinary incontinence (SUI) and urgeny urinary incontinence (UUI). Epidemiology and pathophysiology of SUI after RARP has been assessed in detail and the decrease of urethral sphincter function has been reported as the main etiologic factor of SUI . Storage symptoms such as urinary urgency and UUI are reported to be more bothersome and more prone to reduce QOL than voiding and post‐micturition symptoms .…”

Postoperative urinary incontinence exacerbates nocturia‐specific quality of life after robot‐assisted radical prostatectomy

“…[1][2][3] The causes of post-prostatectomy incontinence are considered to be decreased sphincter function, 4 decreased maximum bladder volume, 5 de novo detrusor overactivity and so on. 6 The same underlying mechanism that induces post-prostatectomy incontinence might cause nocturia after radical prostatectomy. However, the association between post-prostatectomy incontinence and nocturia after radical prostatectomy has yet to be clarified.…”