Post-prostatectomy radiotherapy adversely affects urinary continence irrespective of radiotherapy regime

Nyarangi‐Dix, Joanne; Steimer, Johannes; Brückner, Thomas; Jakobi, Hildegard; Koerber, Stefan A.; Hadaschik, Boris; Debus, Jürgen; Hohenfellner, Markus

doi:10.1007/s00345-017-2081-x

Cited by 14 publications

(7 citation statements)

References 27 publications

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“…Interestingly, only 2 of 19 (11%) patients who received radiotherapy after rsRARP observed a decline in continence after radiotherapy. Previous studies revealed that only 22% of men who are continent at the start of radiotherapy remained continent afterwards [31]. During rsRARP most attachments of the bladder remain untouched and pubourethral and pubovesical attachments remain intact avoiding bladder/urethral hypermobility [32].…”

Section: Discussionmentioning

confidence: 99%

Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

et al. 2019

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BackgroundRetzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort.MethodsProspectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery.Results3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out.Considering the 17 preoperatively potent patients who underwent bi- or unilateral nerve-sparing surgery, 41% reported their first sexual intercourse within 1 year after rsRARP.84% of patients had ≥pT3a disease and 42% positive surgical margins. A lymphadenectomy was done in 94% of patients with a median lymph node removal of 15 and lymph node metastasis in 13%.34% underwent adjuvant radiotherapy and 22% adjuvant androgen deprivation therapy (ADT). 1-year recurrence-free survival was 96%, including 25% of patients on adjuvant or salvage ADT.ConclusionsRsRARP in high-risk PCa is feasible and results in excellent continence rates, even after postoperative radiotherapy. The potency rates are promising but need further clarification in larger cohorts. Reliable oncologic outcomes require longterm follow-up and are awaited.

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Section: Discussionmentioning

confidence: 99%

Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

et al. 2019

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“…In the present study, preoperative/biological parameters were comparable between the RARP and LRP groups with the PM method being applied, but the robotic platforms allowed the enhanced preservation of membranous urethra and nerve branches and the reconstruction of the bladder neck, thus supporting the higher UC probability after RARP over the whole follow-up period. Many studies found that postoperative adjuvant radiotherapy adversely affects UC recovery following RP [ 41 , 42 ], which may be attributed to a biological hypothesis that irradiation could lead to further damage and secondary inflammatory response to the surgical site. However, the impact of this factor affecting UC recovery in our analysis was extremely limited due to the statistically similar proportion of patients receiving adjuvant radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

Deng

Chen

Zhu

et al. 2021

Journal of Oncology

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Aim. To evaluate the urinary continence (UC), erectile function, and cancer control obtained following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for intermediate- and high-risk localized prostate cancer (PCa). Materials and Methods. 232 patients bearing intermediate- and high-risk localized PCa were enrolled in this study. Perioperative, functional, and oncological outcomes were analyzed after applying the propensity score matched method. Results. Within the matched cohort, the RARP group was corrected with a significantly shorter mean operative time than the LRP group ( p < 0.001). Patients in the RARP arm were also at a lower risk of ≤ Grade II complications than those in the LRP group ( p = 0.036). Meanwhile, the proportions of transfusion and ≥ Grade II complications in the RARP group were similar to those in the LRP group ( p = 0.192 and p = 1.000, respectively). No significant differences regarding the rates of pT3 disease and positive surgical margin existed between the two groups. RARP versus LRP tended to a significantly higher percentage of UC recovery within the follow-up period. Significant differences were also found between the RARP and LRP arms in terms of erectile function at postoperative 6 months and the last follow-up ( p = 0.013 and p = 0.009, respectively). Statistical comparability in biochemical recurrence-free survival was observed between the two groups ( p = 0.228). Conclusions. For the surgical management of intermediate- and high-risk localized PCa, RARP tended to a lower risk of ≤ Grade II complications and superior functional preservation without cancer control being compromised than LRP.

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“…Longer OP times maybe be confounded by advanced tumor stage. Advanced pathology stage patients may receive adjuvant therapy after 3 months of surgery which can decrease the continence rate (22)(23)(24). There have been many studies that have shown benefit of nerve sparing surgery in continence among radical prostatectomy patients (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Retzius-sparing Robotic-assisted Radical Prostatectomy Facilitates Early Continence Regardless of Neurovascular Bundle Sparing

Liao

Hung

et al. 2020

Anticancer Res

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Background/Aim: Retzius-sparing robotic-assisted radical prostatectomy (RARP) has had better results in early continence rate and comparable oncological safety compared to the retropubic approach. However, the role the neurovascular bundle (NVB) sparing plays in the rate of early continence after catheter removal remains unclear. In this study, we sought to compare the early continence rate between Retzius-sparing RARP and the retropubic approach RARP to assess whether NVB sparing affects the continence rate in patients with prostate cancer. Patients and Methods: This was a retrospective case series of 133 patients who underwent RARP from 2004 to 2017. 92 patients underwent retropubic RARP and 41 patents underwent Retzius-sparing RARP. All procedures were performed by a single surgical team in a single institution. Baseline patient characteristics were recorded and analyzed. Continence results and oncological outcomes were compared between the two groups. Continence outcome of Retzius-sparing RARP with NVB sparing was also analyzed. Results: No differences in age, prostate size, pathology T stage, PSA, and NVB sparing were found between the two groups. The oncological results including surgical margin and biochemical recurrence rate at one year showed no difference between the two groups. With respect to immediate continence results, the Retzius-sparing group showed a better continence result compared to the retropubic approach (75.6% vs. 26.1 %, respectively, p<0.001) after catheter removal. However, there was no difference between the two groups after 6 months. Furthermore, no significant difference in immediate continence result was found in the Retzius-sparing group between patients with NVB sparing (75 %) and those without (75 % vs. 78%, respectively, p=1.00). Conclusion: Retzius-sparing RARP may provide a better immediate continent result compared to retropubic RARP. In Retzius-sparing RARP, NVB sparing did not enhance immediate continence after the operation.

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Post-prostatectomy radiotherapy adversely affects urinary continence irrespective of radiotherapy regime

Abstract: Postoperative RT adversely affects long-term continence; this negative effect is irrespective of time of initiation or indication for RT. These results suggest a need for innovative strategies of prostate cancer therapy with lasting oncological, functional and QoL outcomes.

Cited by 14 publications

References 27 publications

Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

Retzius-sparing robot-assisted laparoscopic radical prostatectomy: functional and early oncologic results in aggressive and locally advanced prostate cancer

Functional Preservation and Oncologic Control following Robot-Assisted versus Laparoscopic Radical Prostatectomy for Intermediate- and High-Risk Localized Prostate Cancer: A Propensity Score Matched Analysis

Retzius-sparing Robotic-assisted Radical Prostatectomy Facilitates Early Continence Regardless of Neurovascular Bundle Sparing

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