Preservation of Putative Continence Nerves during Radical Retropubic Prostatectomy Leads to More Rapid Return of Urinary Continence

Hollabaugh, Robert S.; Dmochowski, Roger R.; Kneib, Timothy G; Steiner, Mitchell S.

doi:10.1016/s0090-4295(98)00128-9

Cited by 124 publications

(82 citation statements)

References 15 publications

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“…21 The most probable step during RP where pelvic nerves supplying the bladder are injured is during seminal vesicle dissection. 22 During MIS cases, the seminal vesicles are approached through a posterior approach, 23 whereas during an open case they are approached through an anterior approach. 21 During open RP, dissection can be performed in close proximity to the seminal vesicles due to traction on the prostate, sparing nerves at the base of the bladder.…”

Section: Discussionmentioning

confidence: 99%

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Chung

Dillon

Kurta

et al. 2012

CUAJ

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Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population. Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation. Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009). Conclusions: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.

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Section: Discussionmentioning

confidence: 99%

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Chung

Dillon

Kurta

et al. 2012

CUAJ

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“…These nerves are located inferior and laterally to the prostate and represent its main nervous supply. On the other hand, the anterior and supra-lateral surfaces do not appear to have significant innervation (6,7).…”

Section: Commentsmentioning

confidence: 98%

Efficacy of intrarectal lidocaine hydrochloride gel for pain control in patients undergoing transrectal prostate biopsy

et al. 2004

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Objective: To determine the efficacy of intrarectal lidocaine hydrochloride gel in reducing pain in patients undergoing transrectal prostate biopsy.Materials and Methods: During the period from June to November 2002, 72 patients undergoing transrectal prostate biopsy at an outpatient service were prospectively randomized. Patients were divided into 2 groups. In group 1, 20 mL of 2% lidocaine gel were administered by intrarectal route 15 minutes before biopsy. In group 2 (placebo), 20 mL of ultrasound gel were administered under the same conditions. At the end of the procedure, patients were asked to classify the discomfort degree observed during the procedure through a verbal pain scale. Statistical analysis was performed through qui-square test.Results: The majority of patients in both groups presented slight pain on the examination, and 26 patients (76.4%) from group 1, and 26 (68.3%) patients from group 2 reported slight pain or no pain at all (p > 0.05). Moderate or intense pain was felt by 23.4% of patients in group 1 and 31.5% of patients in group 2 (p > 0.05).Conclusions: We concluded that lidocaine probably exerts a minimal effect on patients' tolerance to pain on transrectal prostate biopsy.

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“…2) As described above, the rhabdosphincter receives nerve fibers from the pelvic nerve and dual innervation from an intrapelvic branch and a perineal branch of the pudendal nerve. Preservation of an intrapelvic branch of the pudendal nerve has been shown to improve and maintain rhabdosphincter function after RRP 16) . However, although there is clear evidence that a neurovascular bundle -sparing technique has an advantage for preservation of postoperative potency, there is controversy over whether preservation of nerves around the bladder, prostate and urethra results in improvement of urinary continence after RARP.…”

Section: Techniques To Improve Urinary Continence Following Rarpmentioning

confidence: 99%

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

FJMS

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: Although open retropubic radical prostatectomy has been the most commonly used surgical technique for patients with localized prostate cancer for decades, robot -assisted radical prostatectomy (RARP) has recently become an alternative option and widely used in Japan as well as around the world. RARP has been shown to have higher postoperative continent rates than retropubic and laparoscopic radical prostatectomy ; however, urinary incontinence has remained one of the most significant causes for concern among patients who seek surgical treatment for prostate cancer, even after the introduction of RARP. The literature has shown that certain technical modifications to improve urinary continence are advocated as potential aids to reduce the risk of urinary incontinence after RARP. These modifications might be divided into 3 categories to realize the improvement of early return of urinary continence after RARP : 1) preservation, 2) reconstruction, and 3) reinforcement of the anatomic structures in the pelvis, which will make a new supporting system after radical prostatectomy. In this review, we discuss the intraoperative techniques to improve outcomes for early return of urinary continence following RARP, and provide a critical summary of current knowledge on its outcome in the literature.

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Preservation of Putative Continence Nerves during Radical Retropubic Prostatectomy Leads to More Rapid Return of Urinary Continence

Cited by 124 publications

References 15 publications

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Detrusor underactivity is prevalent after radical prostatectomy: a urodynamic study including risk factors

Efficacy of intrarectal lidocaine hydrochloride gel for pain control in patients undergoing transrectal prostate biopsy

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

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