Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case–control study

Qin, Haixiang; Qiu, Xuefeng; Ma, Haoxing; Xu, Linfeng; Liu, Xu; Li, Xiaogong; H, Guo

doi:10.1007/s11255-018-02071-4

Cited by 14 publications

(21 citation statements)

References 29 publications

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“…Chang et al conducted a retrospective study recruiting a total of 839 patients who received RALP (298 in RS-RALP vs 541 in C-RALP), demonstrating that the patients with C-RALP had a higher incidence of inguinal hernia than those with RS-RALP (79.2 vs 20.8%, respectively, P = 0.02) [14]. Recently, Qin et al performed a case-control study in which 110 patients underwent RS-RALP and indicated that RS-RALP increased the recovery of urinary continence [26]. However, they found that prostate volume was an independent factor that impacted urinary continence after a multivariable regression analysis (p = 0.032).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

et al. 2020

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Background: To compare the postoperative continence and clinical outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) with non-RS RALP for patients with prostate cancer. Methods: We searched PUBMED, EMBASE and the Cochrane Central Register from 1999 to 2019 for studies comparing RS-RALP to non-RS RALP for the treatment of prostate cancer. We used RevMan 5.2 to pool the data. Results: A total of eight studies involving 1620 patients were included in our meta-analysis. No significant difference was found in positive surgical margins (PSM), bilateral nerve-sparing, postoperative hernia, complications, blood loss, or operative time. Postoperative continence was better with RS-RALP compared with non-RS RALP (OR = 1.02, OR: 2.86, 95% CI 1.94-4.20, p < 0.05). Conclusions: RS-RALP had a better recovery of postoperative continence than non-RS RALP. The perioperative outcomes were comparable for the two methods.

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Section: Discussionmentioning

confidence: 99%

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

et al. 2020

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“…We hypothesized that intravesical prostatic protrusion may lead to a shortening of preoperative MUL, but evidence about the association between preoperative MUL and IPPL is lacking. PV was also suggested to be a predictor of urinary continence recovery after RP [5,22]. A potential reason could be subclinical bladder dysfunction related to benign prostatic hyperplasia that manifested after surgery.…”

Section: Resultsmentioning

confidence: 97%

Impact of Preoperative Magnetic Resonance Imaging Anatomic Features on Urinary Continence Recovery after Laparoscopic Radical Prostatectomy

et al. 2020

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KeywordsProstate cancer · Prostatectomy · Continence · Intravesical prostatic protrusion · Membranous urethral length Abstract Purpose: To evaluate the impact of preoperative magnetic resonance imaging anatomic features on urinary continence recovery after laparoscopic radical prostatectomy (LRP). Methods: We retrospectively analyzed 150 consecutive prostate cancer patients who underwent LRP between July 2015 and June 2018 in our institution. Patients reporting freedom from using safety pad (0 pads/day) were defined as urinary continent. We evaluated the association of urinary continence recovery after LRP and the perioperative variables, including age, prostatic volume (PV), intravesical prostatic protrusion length (IPPL), membranous urethral length (MUL), and neurovascular bundle (NVB) sparing status. Kaplan-Meier and log-rank tests were used to compare urinary continence rates between groups. Univariate and multivariate Cox proportional hazards regression analyses were used to identify independent predictors for urinary continence recovery. Results: 60.6% (91/150), 83.3% (125/150), and 96.0% (144/150) of the patients experienced urinary continence recovery at 3, 6, and 12 months, respectively. There was significant difference in PV, IPPL, MUL, and NVB sparing between groups stratified by urinary continence status at 3, 6, and 12 months. Kaplan-Meier curves of urinary continence rates showed significant differences between groups stratified by PV (< 50 mL vs. ≥50 mL, p < 0.001), IPPL (< 5 mm vs. ≥5 mm, p < 0.001), MUL (≥15 mm vs. < 15 mm, p < 0.001), and NVB sparing status (yes vs. no, p = 0.003), respectively. On univariate analysis, PV, IPPL, MUL, and NVB sparing were significantly associated with urinary continence recovery (all, p < 0.05). On multivariate analysis, only IPPL (HR = 0.94, p = 0.003) and MUL (HR = 1.10, p < 0.001) were independent predictors for urinary continence recovery. Conclusion: Patients with larger IPPL and shorter MUL have higher chances of delayed recovery of urinary continence after LRP. IPPL and MUL were reliable morphometric parameters for predicting urinary continence.

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“…Therefore, Satake et al proposed mRUL as a new parameter to reflect MUL (12). Compared to MUL, mRUL has clear boundaries on MRI, from the lower margins of the [8][9][10][11][12][13][14][15][16][17][18][19]; severe [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. BMI, body mass index; MRI, magnetic resonance imaging; mRUL, minimal residual membranous urethral length; PSA, prostate-specific antigen; PSC, periurethral sphincter complex; LAM, levator ani muscle; OIM, obturator internus muscle; UWT, urethral wall thickness; IPSS, international prostate symptom score.…”

Section: Discussionmentioning

confidence: 99%

“…Several preoperative factors have been shown to be associated with early recovery of continence after RARP. Biological patient-related factors, such as advanced age, higher BMI, lager prostate volume, and severe preoperative prostate symptom have been reported to be risk factor for continence outcome after RP (8). Furthermore, preoperative anatomic variables measured on magnetic resonance imaging (MRI), such as membranous urethra length (MUL) and periurethral supporting structures, have also been demonstrated to be associated with urinary continence outcome after RP (9).…”

Section: Introductionmentioning

confidence: 99%

Association of preoperative urethral parameters on magnetic resonance imaging and immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy

Li¹,

Li²,

Lu³

et al. 2020

Transl Androl Urol

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Background: Studies regarding predictive factors of urinary continence following Retzius-sparing radical prostatectomy (RP) is limited. This study was designed to evaluate association of urethral parameters on preoperative magnetic resonance imaging (MRI) and immediate recovery of urinary continence following Retzius-sparing robot assisted radical prostatectomy (RS-RARP).Methods: This retrospective cohort study enrolled 156 patients with clinically localized prostate cancer who underwent MRI before RS-RARP. We measured the following structures on preoperative MRI: minimal residual membranous urethral length (mRUL), peri-urethral sphincter complex (PSC) thickness, urethral wall thickness (UWT), the thicknesses of the levator ani muscle (LAM) and obturator internus muscle (OIM). Immediate urinary continence was defined as patients reported freedom from using safety pad within 7 days after removal of urinary catheter. Patients were divided into two groups according the median of each parameter on MRI. We retrospectively analyzed the patients in term of preoperative clinical factors and postoperative urinary continence.Results: A total of 100 patients (64.1%) reported immediate urinary continence after RS-RARP. Immediate urinary continence was significantly more in patients with longer mRUL (≥8.70 mm) than in patients with shorter mRUL (<8.70 mm; P=0.000). On multivariable analysis, longer mRUL was significantly related to immediate urinary continence after RS-RAPA (odds ratio 8.265; P=0.000). PSC, UWT, LAM and OIM were not associated with immediate urinary continence. Conclusions:Our results firstly demonstrated that preoperative mRUL measured on MRI was an independent predictor of immediate urinary continence following RS-RARP. Therefore, preservation of membranous urethra is still the anatomical basis of better urinary outcome after RS-RARP.

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Predictors for immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy: a case–control study

Cited by 14 publications

References 29 publications

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

Comparison of Retzius-sparing robot-assisted laparoscopic radical prostatectomy vs standard robot-assisted radical prostatectomy: a meta-analysis

Impact of Preoperative Magnetic Resonance Imaging Anatomic Features on Urinary Continence Recovery after Laparoscopic Radical Prostatectomy

Association of preoperative urethral parameters on magnetic resonance imaging and immediate recovery of continence following Retzius-sparing robot-assisted radical prostatectomy

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