Preservation of fecal continence and bowel function after radical perineal and retropubic prostatectomy: a questionnaire-based outcomes study

Korman, Howard; Mulholland, Timothy L.; Huang, Ray R.

doi:10.1038/sj.pcan.4500723

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Korman et al suggested, however, that there is no difference in anal incontinence rates or bowel function when comparing RPP patients to RRP or control patients according to the Expanded Prostate Cancer Index Composite questionnaire [9]. Dahm et al performed a prospective, longitudinal study of RPP patients using the bowel domain of the Expanded Prostate Cancer Index Composite questionnaire as well [4].…”

Section: Discussionmentioning

confidence: 99%

Anorectal functions after perineal and retropubic radical prostatectomy - a prospective clinical and anal manometric assessment

Aydemi̇r

Albayrak²,

Cangüven³

et al. 2011

aoms

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IntroductionThe aim of this study is to evaluate the anorectal functions of prostate cancer patients who have undergone radical perineal prostatectomy (RPP) or radical retropubic prostatectomy (RRP) surgery.Material and methodsThirty-seven patients with an indication for radical prostatectomy were included after informed consent. Anorectal manometry was performed before and one month after the surgery in 22 RPP and 15 RRP patients in our clinic. Clinical assessment was evaluated by anorectal functions with anal incontinence scoring (AIS) (Fernandez; no incontinence = 0; maximal incontinence = 12). Patients with a history of anorectal surgery were excluded from the study. The following data were recorded: external anal sphincteric pressure (EASP), internal anal sphincteric pressure (IASP), minimum ano-rectal reflex volume (MARRV) and minimum rectal sensory volume (MRSV).ResultsIn the RPP and RRP groups, the mean age was 66 (56-75) and 64.3 (52-73) years, respectively. In the RPP group, EASP and IASP values showed a significant decrease after the surgery. In the RRP group, EASP and IASP were also decreased after the surgery, but without statistical significance. No significant change was seen in MARRV and MRSV of either group. When the scores of AIS were analysed, no significant clinical difference between pre- or post-operative scores was seen in RPP and RRP groups.ConclusionsPerineal or retropubic surgery may injure pelvic floor muscles and/or supplying nerves, which likely causes anorectal dysfunction. Although there is a significant decrease in early postoperative EASP and IASP after RPP, it has no clinical significance according to AIS.

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Section: Discussionmentioning

confidence: 99%

Anorectal functions after perineal and retropubic radical prostatectomy - a prospective clinical and anal manometric assessment

Aydemi̇r

Albayrak²,

Cangüven³

et al. 2011

aoms

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“…All techniques have the potential to cause rectal injury. In a study conducted by Korman and Harris [23] , rectal injury varying between 1-11% was reported in open RPP. They reported no difference in rectal injury between RRP and open RPP techniques.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted radical perineal prostatectomy: first experience of 15 cases

Tuğcu

Akça

Şimşek

et al. 2017

Turkish Journal of Urology

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Objective: Minimally invasive techniques are increasingly evolving and preferred to reduce surgical induced morbidity and mortality and minimize the challenges of surgical techniques. Especially radical perineal prostatectomy (RPP) includes some challenges like working in a deep and narrow space and challenging ergonomics for the surgeons. Because of these issues open RPP is still performed in experienced centers. In order to reduce these difficulties, robot-assisted radical perineal prostatectomy (r-RPP) is developed. In this study, we report our first clinical results for r-RPP. Material and methods:Between November 2016 and February 2017, 15 patients underwent r-RPP in our center. Multiparametric magnetic resonance imaging was performed for all patients to exclude locally advanced disease. The patients with chronic obstructive pulmonary disease and locally advanced prostate cancer were not chosen for r-RPP method. The patient was positioned in the exaggerated lithotomy with 15 degrees of Trendelenburg position. After incision and dissection of subcutaneous tissue, dissection was advanced to the margin of posterior recto-urethral muscle fibers. Then a GelPOINT ® device was placed and robotic system was docked. Results:The mean age of the patients was 60.2±7.8 years. The mean body mass index of the patients was 28.8±1.9 kg/m 2 . Four patients had previous major abdominal surgeries. Preoperative mean prostate specific antigen value was 7.3±2.4 ng/mL. The mean prostate volume was 40.8±12.4 cc. Mean perineal dissection time was 60±10.1 minutes. Mean console time and total operation time was 95±11.3 and 167±37.4 minutes, respectively. The mean time of postoperative catheterization was 8.3±1.7 days. Early continence rate was 40% after urethral catheter removal and at 3rd month of the surgery mean continence rate was 94% for all patients. Conclusion:We demonstrate that r-RPP is a feasible and efficient method. But still this method needs for further studies in this area.

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“…In 2004, Korman et al7 published the results of a validated bowel function domain questionnaire (University of Michigan) that was expanded to the Prostate Cancer Index Composite (EPIC) and applied to patients who underwent perineal and retropubic prostatectomy. The authors used patients who underwent prostate biopsy as a control group.…”

Section: Discussionmentioning

confidence: 99%

“…The correlation between anal incontinence and perineal prostatectomy has been described by many authors based on clinical observations 5-7. However, the correlation between this surgical approach and postoperative anal incontinence is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Influence of perineal prostatectomy on anal continence

Guilger

Jorge

Costa

et al. 2011

Clinics

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OBJECTIVE:Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy.METHODS:From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry.RESULTS:The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003).CONCLUSION:There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.

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Preservation of fecal continence and bowel function after radical perineal and retropubic prostatectomy: a questionnaire-based outcomes study

Cited by 7 publications

References 9 publications

Anorectal functions after perineal and retropubic radical prostatectomy - a prospective clinical and anal manometric assessment

Anorectal functions after perineal and retropubic radical prostatectomy - a prospective clinical and anal manometric assessment

Robot-assisted radical perineal prostatectomy: first experience of 15 cases

Influence of perineal prostatectomy on anal continence

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