Preservation of the Neurovascular Bundles Is Associated with Improved Time to Continence After Radical Prostatectomy But Not Long-term Continence Rates: Results of a Systematic Review and Meta-analysis

Reeves, Fairleigh; Preece, Patrick; Kapoor, Jada; Everaerts, Wouter; Murphy, Declan; Corcoran, Niall M.; Costello, Anthony J.

doi:10.1016/j.eururo.2014.10.020

Cited by 161 publications

(136 citation statements)

References 58 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…Reeves and colleagues recently summarized the literature on the subject and performed a meta-analysis reporting 6 wk, 3-4 mo, 6 mo, and 12 mo continence rates of 42.2%, 64.8%, 88.9%, and 83.9% in the NS patients compared with 26.8%, 47.6%, 69.8%, and 75.2% in the NNS patients, respectively [3]. The difference in continence rates of both patient groups was significant up to 6 mo after RP in their meta-analysis but not beyond that.…”

Section: Discussionmentioning

confidence: 96%

“…Existing studies have been clearly imbalanced with regard to other parameters influencing post-RP continence rates such as age [3].…”

Section: Discussionmentioning

confidence: 98%

“…Reeves and colleagues recently summarized the existing studies on the influence of the preservation of the NVBs on continence after RP and conducted a metaanalysis using data from 13 749 patients in 27 studies [3]. Their meta-analysis demonstrated improved early urinary continence rates (up to 6 mo postoperatively) for patients undergoing nerve-sparing (NS) RP compared with patients undergoing non-nerve-sparing (NNS) RP.…”

Section: Introductionmentioning

confidence: 94%

“…Some authors have argued that the difference in continence rates may be attributable to the differing surgical techniques of NS versus NNS RP [3]. The meticulous apical dissection associated with the NS RP technique may be responsible for the improved continence outcome in this patient group [5,6].…”

Section: Introductionmentioning

confidence: 97%

See 3 more Smart Citations

Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

et al. 2016

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 96%

“…Existing studies have been clearly imbalanced with regard to other parameters influencing post-RP continence rates such as age [3].…”

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

et al. 2016

View full text Add to dashboard Cite

“…9 This deleterious effect persisted despite controlling for factors known to affect urinary con- Urinary function post rP and penile rehabilitation valescence, including age, nerve-sparing quality/quantity as captured by nerve-sparing score (NSS), and time after surgery. While the effects of better nerve-sparing on improving early urinary outcomes after RP in previously potent men have been suggested in the literature, [10][11][12] it has not been shown that early PDE5i use after RP may adversely affect early urinary health-related quality of life. It is known that PDE5i therapy improves erections during the convalescence from nerve-sparing RP; 13 its effects on penile rehabilitation with daily use after RP are less clear.…”

Section: Discussionmentioning

confidence: 99%

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Hyndman

Bivalacqua

Mettee

et al. 2015

CUAJ

View full text Add to dashboard Cite

Introduction: This is a report on potency results from a randomized trial of nightly versus on-demand sildenafil after nerve-sparing radical prostatectomy (RP). A secondary objective was to analyze the effects of these sildenafil administration schemes on urinary health-related quality of life after RP. Methods: In total, 100 potent men were equally randomized to nightly and on-demand sildenafil 50 mg after minimally-invasive RP for 1 year. Health-related quality of life questionnaires were administered at various postoperative intervals. Urinary function was assessed using appropriate expanded prostate cancer index composite (EPIC) subscales. Analyses of covariance and linear mixed-effects modeling were used to compare the effects of treatment over time on urinary recovery, controlling for age, nervesparing score, and time from surgery. Results: The nightly (n = 50) and on-demand (n = 50) sildenafil groups were well-matched at baseline. Nightly sildenafil patients had worse EPIC urinary bother and urinary irritative/obstructive subscale scores at 3 and 6 months after RP, even after controlling for multiple variables. On mixed-model analyses, the differences between groups for these EPIC subscales (4.9 and 2.5, respectively) were greater than documented thresholds for clinical significance. Increasing nerve-sparing score was associated with improvements in EPIC urinary summary, bother, incontinence, and function scores; time from surgery was associated with improvements in all EPIC urinary health-related quality of life subscales. Conclusions: In this specific population and drug dose, we found that on-demand short-acting phosphodiesterase-5 inhibitor (PDE5i) dosing may be more effective after RP to maximize early urinary and erectile health-related quality of life. In preoperatively potent men, nightly sildenafil 50 mg impaired urinary health-related quality of life more than on-demand use in the early months after nerve-sparing RP, independent of effects on urinary continence.

show abstract

Selection of patients for nerve sparing surgery in robot‐assisted radical prostatectomy

et al. 2021

View full text Add to dashboard Cite

Context Robot‐assisted radical prostatectomy (RARP) has become the standard surgical procedure for localized prostate‐cancer (PCa). Nerve‐sparing surgery (NSS) during RARP has been associated with improved erectile function and continence rates after surgery. However, it remains unclear what are the most appropriate indications for NSS. Objective The objective of this study is to systematically review the available parameters for selection of patients for NSS. The weight of different clinical variables, multiparametric magnetic‐resonance‐imaging (mpMRI) findings, and the impact of multiparametric‐nomograms in the decision‐making process on (side‐specific) NSS were assessed. Evidence acquisition This systematic review searched relevant databases and included studies performed from January 2000 until December 2020 and recruited a total of 15 840 PCa patients. Studies were assessed that defined criteria for (side‐specific) NSS and associated them with oncological safety and/or functional outcomes. Risk of bias assessment was performed. Evidence synthesis Nineteen articles were eligible for full‐text review. NSS is primarily recommended in men with adequate erectile function, and with low‐risk of extracapsular extension (ECE) on the side‐of NSS. Separate clinical and radiological variables have low accuracy for predicting ECE, whereas nomograms optimize the risk‐stratification and decision‐making process to perform or to refrain from NSS when oncological safety (organ‐confined disease, PSM rates) and functional outcomes (erectile function and continence rates) were assessed. Conclusions Consensus exists that patients who are at high risk of ECE should refrain from NSS. Several multiparametric preoperative nomograms were developed to predict ECE with increased accuracy compared with single clinical, pathological, or radiological variables, but controversy exists on risk thresholds and decision rules on a conservative versus a less‐conservative surgical approach. An individual clinical judgment on the possibilities of NSS set against the risks of ECE is warranted. Patient summary NSS is aimed at sparing the nerves responsible for erection. NSS may lead to unfavorable tumor control if the risk of capsule penetration is high. Nomograms predicting extraprostatic tumor‐growth are probably most helpful.

show abstract

Preservation of the Neurovascular Bundles Is Associated with Improved Time to Continence After Radical Prostatectomy But Not Long-term Continence Rates: Results of a Systematic Review and Meta-analysis

Cited by 161 publications

References 58 publications

Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

Nerve-sparing Surgery Technique, Not the Preservation of the Neurovascular Bundles, Leads to Improved Long-term Continence Rates After Radical Prostatectomy

Nightly sildenafil use after radical prostatectomy has adverse effects on urinary convalescence: Results from a randomized trial of nightly vs on-demand dosing regimens

Selection of patients for nerve sparing surgery in robot‐assisted radical prostatectomy

Contact Info

Product

Resources

About