Novel uroflow stop test at time of catheter removal is a strong predictor of early urinary continence recovery following robotic-assisted radical prostatectomy: A pilot study

El-Hakim, Assaad; Alhathal, Naif; Al‐Qaoud, Talal; Gagné, Ginette; Larocque, Suzanne; Denis, Ronald; Zorn, Kevin C.

doi:10.1002/nau.22481

Cited by 12 publications

(5 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The pathophysiology of urinary incontinence after RALP has been investigated, and multiple factors are associated with urinary incontinence after prostatectomy, including damage to the urinary sphincter, bladder neck dysfunction, and dysfunction of the pelvic diaphragm …”

Section: Introductionmentioning

confidence: 99%

Postoperative cystogram findings predict recovery of urinary continence after robot‐assisted laparoscopic radical prostatectomy

Fukui

Kagebayashi

Iemura

et al. 2019

LUTS

View full text Add to dashboard Cite

Objectives: To assess the association between postoperative cystogram findings and subsequent outcomes on urinary continence after robot-assisted laparoscopic radical prostatectomy (RALP).Methods: A retrospective review of 250 consecutive patients who were observed for at least 12 months after RALP. The postoperative cystogram findings examined were: the location of the bladder neck, degree of bladder abnormalities, and presence of outflow of contrast medium into the urethra during the filling phase of cystography. The continence status based on pad usage was recorded. Those who required no pad or only a safety pad were defined as continent.Results: Patients with a bladder neck location above the middle of the pubic symphysis height exhibited significantly higher continence levels than those with a lower bladder neck location at both postoperative 3 and 12 months (P < 0.0001 and P = 0.0002, respectively). The higher a bladder neck was located, the earlier the urinary continence was achieved after RALP (P < 0.0001). Patients without contrast outflow into the urethra during cystogram demonstrated a significantly more favorable continence status at the 3-month follow-up (P = 0.004). Patients without bladder abnormalities on postoperative cystogram demonstrated a significantly more favorable continence status at the 12-month follow-up than those with bladder abnormalities (P = 0.01).Conclusions: Postoperative cystogram findings may predict recovery of urinary continence after RALP. K E Y W O R D S bladder neck, cystogram, prostatectomy, RALP, urinary incontinence 1 | INTRODUCTION The spread of prostate serum antigen (PSA) screening has increased the reported incidence of prostate cancer. Robot-assisted laparoscopic radical prostatectomy (RALP) has become the most common surgical management for prostate cancer. It was reported that 85% of prostatectomies were performed under robotic surgery in the USA in 2009. 1 Although surgical techniques have improved, urinary inconti-nence is one of the most common complications following prostatectomy and has a significant impact on the quality of life (QoL) of patients who undergo radical prostatectomy. The reported incidence of patients with urinary incontinence after radical prostatectomy ranges from 6% to 20%. 2,3 Although nearly 90% of patients achieved urinary continence at the 12-month follow-up following prostatectomy, the incidence of urinary incontinence did not improve remarkably later than 12 months after prostatectomy. 4The pathophysiology of urinary incontinence after RALP has been investigated, and multiple factors are associated with urinary incontinence after prostatectomy, including damage to the urinary sphincter, 5 bladder neck dysfunction, 6 and dysfunction of the pelvic diaphragm. 6In this study, we assessed the association between the postoperative cystogram findings and subsequent urinary continence outcomes to identify factors that predict postoperative urinary incontinence.

show abstract

Section: Introductionmentioning

confidence: 99%

Postoperative cystogram findings predict recovery of urinary continence after robot‐assisted laparoscopic radical prostatectomy

Fukui

Kagebayashi

Iemura

et al. 2019

LUTS

View full text Add to dashboard Cite

show abstract

“…The afferent pathway is over the pudendal nerves and posterior roots of the third and fourth sacral segments . The urodynamic tests called stop‐test or stop‐flow test or urine stream interruption test , are used in several indications: to assess the bladder contractility, the strength of perineal muscles or the continence prognosis around a pelvi‐perineal surgery . The stop‐test can be performed with a mechanical occlusion (catheter inflated balloon) or with a voluntary pelvic floor muscles contraction to interrupt the urine flow.…”

Section: Discussionmentioning

confidence: 99%

“…10 The urodynamic tests called stop-test or stop-flow test or urine stream interruption test, are used in several indications: to assess the bladder contractility, [11][12][13][14] the strength of perineal muscles [15][16][17][18] or the continence prognosis around a pelvi-perineal surgery. [19][20][21][22][23] The stop-test can be performed with a mechanical occlusion (catheter inflated balloon) or with a voluntary pelvic floor muscles contraction to interrupt the urine flow. When the stop-test is performed with a voluntary contraction, the isometric detrusor pressure generated is lower than during a mechanical occlusion, showing an intervention of the PDIR.…”

Section: Discussionmentioning

confidence: 99%

Influence of the urine stream interruption exercise on micturition

et al. 2019

View full text Add to dashboard Cite

Objectives To assess the effect of urine stream interruption exercise on micturition. Methods This study was conducted prospectively in female patients without urinary disorders. Two uroflowmetries were performed: one during a usual micturition and one during an exercise of urine stream interruption. For the urine stream interruption exercise the subject was asked to begin the micturition, to stop it at 3 s, when the stream is interrupted, to start voiding again, then again stop it at 3 s and repeat this manoeuvre until the end of the micturition. Results Twenty female patients (mean age 38.7 years old, SD 12.3) were included. Post void residual volume was higher after the urine stream interruption micturition (mean 36.7 mL, SD 46.6) than during standard micturition (mean 8.2 mL, SD 24.1) (P = 0.02). During normal voiding, the maximal flow rate was higher (26.9 mL/min vs 17.8 mL/min; P < 0.0001). There was no difference concerning neither the voiding volume nor the slope of ascending part of flow curve. During urine stream interruption micturition, the flow rate slope, the voiding volume and the maximal flow rate by voiding sequence were decreasing as the voiding sequences followed each other. Conclusions Urine stream interruption increases the post‐void residual volume and translates into less efficient micturition. Thus, it should not be used in current practice of pelvic floor muscles training.

show abstract

“…We used the athermal robotic technique of prostatectomy with few modifications. 6,7 At the end of the procedure, the specimen was extracted through the same mini-laparotomy incision. Urethral catheter removal was planned on postoperative Day 7 without cystogram.…”

Section: Surgical Techniquementioning

confidence: 99%

Feasibility of planned mini-laparotomy and adhesiolysis at the time of robotic-assisted radical prostatectomy in patients with prior major abdominal surgery

Alhathal¹,

Al‐Enizi²,

El-Hakim

2016

CUAJ

Self Cite

View full text Add to dashboard Cite

Introduction: Our aim was to report our experience on the feasibility of completing radical prostatectomy robotically after planned open adhesiolysis for prior major abdominal surgery with previous midline laparotomy scar. Methods: We searched our prospectively collected database of robotic assisted-radical prostatectomy (RARP) performed between October 2006 and October 2012 by a single fellowship-trained surgeon to identify all patients who underwent planned initial minilaparotomy for release of abdominal adhesions at time of RARP. Among 250 RARP patients, five patients fulfilled these criteria. Results: All patients had prostatectomy completed robotically. The mean values of patients' demographics were as follows: Age 61.8 years (range 54-69), body mass index 30.7 (range 24.3-45.3), and prostate volume 41.5 ml (range 30.8-54). Mean operative time was 245 min (range 190-280) and estimated blood loss 410 ml (range 300-650). Median hospital stay was one day (range 1-7). Postoperatively, there was one prolonged ileus, which resolved spontaneously, and one myocardial infarction. Conclusions: Robotic completion of radical prostatectomy after open adhesiolysis is feasible. This approach maintains most minimally invasive advantages of RARP, despite a slightly longer hospital stay. In the best interest of patients, robotic surgeons are encouraged to finish the case robotically rather than attempting an open approach.

show abstract

Novel uroflow stop test at time of catheter removal is a strong predictor of early urinary continence recovery following robotic-assisted radical prostatectomy: A pilot study

Abstract: Novel use of uroflowmetry at time of urethral catheter removal is a simple, non-invasive study with independent ability to predict early continence recovery following RARP.

Cited by 12 publications

References 27 publications

Postoperative cystogram findings predict recovery of urinary continence after robot‐assisted laparoscopic radical prostatectomy

Postoperative cystogram findings predict recovery of urinary continence after robot‐assisted laparoscopic radical prostatectomy

Influence of the urine stream interruption exercise on micturition

Feasibility of planned mini-laparotomy and adhesiolysis at the time of robotic-assisted radical prostatectomy in patients with prior major abdominal surgery

Contact Info

Product

Resources

About