Open Versus Laparoscopic Radical Prostatectomy: A Prospective Comparison of Postoperative Urinary Incontinence Rates

Jacobsen, Niels; Moore, Katherine; Estey, Eric; Voaklander, Donald C.

doi:10.1016/j.juro.2006.09.022

Cited by 56 publications

(33 citation statements)

References 21 publications

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“…[21,38,42] Several studies have investigated the effect of surgical approach, though none have demonstrated significant differences in continence rates between the perineal and retropubic approaches [45,46] or among the open, laparoscopic, and robotic approaches. [12,13,[47][48][49] …”

Section: Risk Factorsmentioning

confidence: 99%

“…Approximately half of patients seek some form of treatment for incontinence following prostatectomy [7] , while anywhere between 6% and 9% of men ultimately elect for surgical approaches. [7][8][9][10][11][12][13][14] Thorough evaluation consists of a detailed history, including baseline status, prior use of prostate-or bladder-based medications, and previous interventions on the prostate or genitourinary tract, and physical examination. Urinalysis, uroflowmetry, and a bladder diary from the patient are also quick and useful tools.…”

Section: Introductionmentioning

confidence: 99%

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Post-prostatectomy incontinence: Etiology, evaluation, and management

Singla

2014

Turkish Journal of Urology

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Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.

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Section: Risk Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Post-prostatectomy incontinence: Etiology, evaluation, and management

Singla

2014

Turkish Journal of Urology

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“…According to the 24-hour pad test, 13% of RRP patients and 17% of LRP patients remained incontinent at 1 year. 13 In a recent systematic review and meta-analysis on urine incontinence after RARP from high-volume centres worldwide, the weighted mean rate of urine continence at 12 months was 84% (range: 69-96) using the no-pad definition. 4 In the era of PSA screening, younger patients with good functional status are being diagnosed with prostate cancer.…”

Section: First Robotic Prostatectomy Program In Quebecmentioning

confidence: 99%

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Alhathal

El-Hakim

2013

CUAJ

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Background: Robotic-assisted radical prostatectomy (RARP) is being increasingly done in Canada. Despite this, the Canadian literature lacks publications on the oncologic and functional outcomes of RARP. The objective of this study is to report the longest single surgeon experience in the province of Quebec. Methods: We collected prospective data from 250 consecutive patients who underwent RARP by a single fellowship trained surgeon (AEH) from October 2006 to October 2012. Mean followup was 28 months (range: 1-72). The D'Amico risk stratification distribution was 34% in low-risk, 48% in intermediate-risk and 18% in high-risk groups. Results: The mean operation time (±SD) was 194 ± 60.6 minutes, and estimated blood loss 318 ± 179 mL. The transfusion rate was only 0.4%. All procedures were completed robotically. The mean hospital stay was 1.2 days, and 88% of patients were discharged on postoperative day 1. The mean catheterization time was 7 days (range: 6-13). There were 2% major (Clavien III-IV) and 7.2% minor (Clavien I-II) postoperative complications, and no mortalities. On final pathology, 76% of patients were organ-confined and 70% specimen-confined. Pathological Gleason sum ≥7 accounted for 86%. Return of urinary continence (0-pads) at 3, 6, 12, and 24 months was 73.3%, 83.5%, 92.3%, 96.5%, respectively. Potency rate (successful penetration with or without medication) at 6, 12, and 24 months was 49.3%, 85%, and 95.3%, respectively. Operative time and positive surgical margin (PSM) in organ-confined disease (pT2) decreased significantly after 50 cases. Seventeen patients (6.8%) had no undetectable prostate-specific antigen (PSA) at first visit (PSA <0.1 ng/mL). Of remaining 233 patients, biochemical recurrence (PSA >0.2 ng/mL) was 4.7% (11 patients), and another 3.4% (8 patients) received early salvage radiotherapy (rising PSA, but <0.2 ng/mL). No patients with undetectable PSA required salvage treatments within 6 months postoperatively. Conclusions:Our results compare favourably with high-volume RARP programs, despite mainly intermediate-to high-risk disease. Initial learning curve was estimated to be 50 cases. Fellowship training was instrumental in achieving adequate functional and oncological outcomes, while maintaining low complications rate.

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“…Lower urinary tract dysfunctions such as OAB or a weakened pelvic floor are much more likely to result in incontinence in women as a result of weaker sphincteric mechanisms and the possibility of damage to them by childbirth. An increasing number of men also present nowadays with urinary incontinence owing to the increasing use of radical prostatectomy to treat organ confined prostate cancer [10]. Urinary incontinence is usually classified as either stress urinary incontinence (SUI) where leakage occurs with increases in intra-abdominal pressure, or urgency urinary incontinence (UUI) with leakage preceded by urinary urgency; any condition that weakens the sphincteric mechanisms or pelvic floor will make either condition more apparent.…”

Section: Urinary Incontinencementioning

confidence: 99%