Prospective Assessment of Patient Reported Urinary Continence After Radical Prostatectomy

Wei, John T.; Dunn, Rodney L.; Marcovich, Robert; Montie, James E.; Sanda, Martin G.

doi:10.1097/00005392-200009010-00029

Cited by 179 publications

(71 citation statements)

References 20 publications

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“…We were also able to group studies according to identical time points for follow-up patient assessments. The use of patient-reported pad use and subjective reports of UI for continence definition and assessment following RP has, however, been questioned by some authors [3,32] and supported by others [3,7,31–33]. The approach used to define and assess UI after RP surgery in this systematic review, however, remains clinically accessible and widely used.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

et al. 2017

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Context Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of continence following surgery. Objective To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of continence following RP. Evidence acquisition A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion. Evidence synthesis Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02–1.08, p < 0.001). Eleven studies (6993 patients) reported the OR (OR) for the return to continence at one or more postoperative time points. MUL had a significant positive effect on continence recovery at 3 mo (OR: 1.08, 95% CI: 1.03–1.14, p = 0.004), 6 mo (OR: 1.12, 95% CI: 1.09–1.15, p <0.0001). and 12 mo (OR: 1.12, 95% CI: 1.03–1.22, p = 0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to continence (OR: 1.09, 95% CI: 1.05–1.15, p <0.001). Conclusions A greater preoperative MUL is significantly and positively associated with a return to continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP. Patient summary We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary incontinence after surgery, or to explain a delay in achieving continence after surgery.

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Section: Discussionmentioning

confidence: 99%

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

et al. 2017

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“…This is due to the paucity of long-term studies and the lack of a universally agreed upon definition of continence. Definitions used in the literature include daily use of no pads [6,10,12], daily use of up to one pad [6,13,26,27], total control or occasional dribbling [9,13,14,28], no problem dripping or leaking urine [26], and leaking once daily [26]. To better identify how men self-define continence status, Lepor et al correlated responses to the UCLA-PCI-UFI and patients’ self-assessments of whether they considered themselves continent or incontinent [29].…”

Section: Discussionmentioning

confidence: 99%

Long-term Continence Outcomes in Men Undergoing Radical Prostatectomy for Clinically Localized Prostate Cancer

et al. 2014

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Background Urinary incontinence is a common short-term complication of radical prostatectomy (RP). Little is known about the long-term impact of RP on continence. Objective To elucidate the long-term progression of continence after RP. Design, setting, and participants From October 2000 through September 2012, 1788 men undergoing open RP for clinically localized prostate cancer by a single surgeon at an urban tertiary care center prospectively signed consent to be followed before RP and at 3, 6, 12, 24, 96, and 120 mo after RP. A consecutive sampling method was used and all men were included in this study. Intervention Men underwent open RP Outcome measurements and statistical analysis Regression models controlled for preoperative University of California, Los Angeles–Prostate Cancer Index urinary function score (UCLA-PCI-UFS), age, prostate-specific antigen level, Gleason score, stage, nerve-sparing status, race, and marital status were used to evaluate the association of time since RP with two dependent variables: UCLA-PCI-UFS and continence status. Results and limitation The mean UCLA-PCI-UFS declined between 2 yr and 8 yr (83.8 vs 81.8; p = 0.007) and marginally between 8 yr and 10 yr (81.8 vs 79.6; p = 0.036) after RP, whereas continence rate did not significantly change during these intervals. Men ≥60 yr old experienced a decline in mean UCLA-PCI-UFS between 2 yr and 8 yr (p = 0.002) and a marginal decline in continence rate between 2 yr and 10 yr (p = 0.047), whereas these variables did not change significantly in men <60 yr old. These outcomes are for an experienced surgeon, so caution should be exercised in generalizing these results. Conclusions Between 2 yr and 10 yr after RP, there were slight decreases in mean UCLA-PCIUFS and continence rates in this study. Men aged <60 yr had better long-term outcomes. These results provide realistic long-term continence expectations for men undergoing RP.

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“…Bladder neck preservation (BNP), first introduced in 1992 by Klein [11], has been proposed as a method to accelerate continence recovery, as BNP during RP promotes early return of urinary continence and erectile function [12–16]. However, some clinical trials have suggested little difference in the return of continence with BNP [17–19], and risk of a positive surgical margin (PSM) may be increased [18, 20–22]. …”

Section: Introductionmentioning

confidence: 99%

Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis

Tang

Yang

et al. 2016

Oncotarget

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Bladder neck preservation (BNP) during radical prostatectomy (RP) may improve postoperative urinary continence, although its overall effectiveness remains controversial. We systematically searched PubMed, Ovid Medline, Embase, CBM and the Cochrane Library to identify studies published before February 2016 that assessed associations between BNP and post-RP urinary continence. Thirteen trials (1130 cases and 1154 controls) assessing BNP versus noBNP (or with bladder neck reconstruction, BNR) were considered suitable for meta-analysis, including two randomized controlled trials (RCT), six prospective and five retrospective studies. Meta-analysis demonstrated that BNP improved early urinary continence rates (6 mo, OR = 1.66; 95% CI, 1.21–2.27; P = 0.001) and long-term urinary continence outcomes (>12 mo, OR = 3.99; 95% CI, 1.94–8.21; P = 0.0002). Patients with BNP also had lower bladder neck stricture frequencies (OR = 0.49; 95% CI, 0.29–0.81; P = 0.006). Anastomotic leak rates, positive surgical margins and biochemical failure rates were comparable between the two groups (P>0.05). There were no differences in baseline characteristics except for a smaller average prostate volume (WMD = −2.24 ml; 95% CI, -4.27 to -0.22; P = 0.03) in BNP patients. Our analyses indicated that BNP during RP improved early recovery and overall long-term (1 year) urinary continence and decreased bladder neck stricture rates without compromising oncologic control.

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Prospective Assessment of Patient Reported Urinary Continence After Radical Prostatectomy

Cited by 179 publications

References 20 publications

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

Preoperative Membranous Urethral Length Measurement and Continence Recovery Following Radical Prostatectomy: A Systematic Review and Meta-analysis

Long-term Continence Outcomes in Men Undergoing Radical Prostatectomy for Clinically Localized Prostate Cancer

Bladder neck preservation improves time to continence after radical prostatectomy: a systematic review and meta-analysis

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