Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence

2018 ◽  
Vol 122 (3) ◽  
pp. 456-462 ◽  
Author(s):  
Yoshifumi Kadono ◽  
Takahiro Nohara ◽  
Shohei Kawaguchi ◽  
Renato Naito ◽  
Satoko Urata ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Urinary Continence

scholarly journals Detrusorrhaphy during Robot-Assisted Radical Prostatectomy: Early Recovery of Urinary Continence and Surgical Technique

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Tae Young Shin ◽  
Yong Seong Lee
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Intraoperative Complications ◽  
Risk Groups ◽  
Catheter Removal ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Early Recovery ◽  
Open Radical Prostatectomy

Robot-assisted radical prostatectomy (RARP) has largely replaced open radical prostatectomy as the standard surgical treatment for prostate cancer. However, postoperative urinary incontinence still persists and has a significant impact on quality of life. We report the superior results of the detrusorrhaphy technique during RARP that helps achieve early continence. Our prospective study involved 95 consecutive patients who underwent RARP between March 2015 and May 2017; fifty patients underwent RARP using the new detrusorrhaphy technique (group 1) and 45 underwent standard RARP (group 2). The postoperative oncological and functional outcomes were compared between the two groups. The postoperative continence was assessed at 0 day, 1 week, 4 weeks, 8–12 weeks, and 6 months after catheter removal. Continence was defined as the use of no pad over a 24 h period. Mean operative time in groups 1 and 2 were 250 and 220 min, respectively. Intraoperative complications were not encountered in any patient. The continence rates after catheter removal in groups 1 and 2 were 68% and 0% at 0 day, 78% and 17.8% at 1 week, 86% and 64.4% at 4 weeks, 92% and 73.3% at 8–12 weeks, and 100% and 91.1% at 6 months, respectively. In the multivariate analysis, the nerve sparing technique, D’Amico risk groups, and prostate volume were involved in the early recovery of urinary continence. The detrusorrhaphy technique is simple, safe, and feasible, which helped achieve earlier continence. It showed significantly better outcomes than those achieved with the standard RARP technique in terms of urinary incontinence. Nevertheless, our findings need to be validated in further studies.

scholarly journals Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy

2017 ◽  
Vol 11 (3-4) ◽  
pp. 93 ◽  
Author(s):  
Wan Song ◽  
Chan Kyo Kim ◽  
Byung Kwan Park ◽  
Hwang Gyun Jeon ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Urinary Incontinence ◽  
Magnetic Resonance ◽  
Radical Prostatectomy ◽  
Urinary Continence ◽  
Resonance Imaging ◽  
Robotic Assisted ◽  
Percent Change ◽  
Robotic Assisted Radical Prostatectomy ◽  
Penile Bulb

Introduction: We sought to investigate the impact of preoperative and postoperative membranous urethral length (MUL) on urinary continence using 3 Tesla (3T) magnetic resonance imaging (MRI) after robotic-assisted radical prostatectomy (RARP).Methods: Between 2008 and 2013, 190 men with RARP underwent preoperative and postoperative MRI. Patients who received adjuvant radiotherapy or who were lost to followup were excluded, leaving 186 patients eligible for analysis. Preoperative MUL was estimated from the prostate apex to the penile bulb, while postoperative MUL was estimated from the bladder neck to penile bulb. Patients with no pads or protection were considered to have complete continence. Logistic regression analysis was used to identify predictors associated with urinary incontinence at six and 12 months.Results: Age was commonly associated with urinary incontinence at six and 12 months. In addition, diabetes mellitus (DM) was another factor associated with urinary incontinence at 12 months. When adjusting these variables, preoperative MUL ≤16 mm (95% confidence interval [CI] 1.01‒1.14; p=0.022), postoperative MUL ≤14 mm (95% CI 1.16‒9.80; p=0.025) and percent change of MUL >18% (95% CI 1.17‒7.23; p=0.021) were significantly associated with urinary incontinence at six months. However, at 12 months, preoperative MUL ≤13.5 mm (95% CI 1.85‒19.21; p=0.003) and postoperative MUL ≤13 mm (95% CI 1.24‒13.84; p=0.021) had impacts on urinary incontinence, but not percent change of MUL.Conclusions: Preoperative and postoperative MUL were significantly associated with urinary continence recovery after RARP. Therefore, efforts to preserve MUL are highly recommended during surgery for optimal continence outcomes after RARP.

Deep learning using preoperative MRI information to predict early recovery of urinary continence after robot-assisted radical prostatectomy.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 310-310
Author(s):  
Makoto Sumitomo ◽  
Atsushi Teramoto ◽  
Naohiko Fukami ◽  
Kosuke Fukaya ◽  
Kenji Zennami ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Deep Learning ◽  
Radical Prostatectomy ◽  
Predictive Value ◽  
Clinical Stage ◽  
Clinicopathological Parameters ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Early Recovery ◽  
Data Set

310 Background: Urinary incontinence remains one of the most bothersome postoperative complications even after robot-assisted radical prostatectomy (RARP). We aimed to make a novel prediction system that can be used preoperatively to inform patients of the accuracy of early recovery of urinary continence after RARP using a deep learning (DL) model from magnetic resonance imaging (MRI) information and preoperative clinicopathological parameters. Methods: A retrospective cohort study was conducted on prostate cancer (PC) patients who had undergone RARP at our hospital between August 2015 and July 2019. Patients using no pads/no leakage of urine or the use of a safety pad within 3 months after RARP is categorized into “good” continence and others into “no good” continence. MRI DICOM data from axial, coronal and sagittal imaging as well as preoperative clinicopathological covariates (age, BMI, prostate volume, serum PSA level, Gleason score, clinical stage) were assessed. Supervised DL algorithms, which included AdaBoost, Naive Bayes, Neural Network, Random Forest, and SVM were trained and tested as binary classifiers (good or no good). To evaluate the DL models from the testing data set, their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as area under the receiver operating characteristic curve (AUC) were analyzed. Results: Data were available for 497 patients in the study period. The AdaBoost DL algorithm using MRI information in addition to clinicopathological parameters had the highest performance with sensitivity at 92%, specificity at 77%, PPV at 79%, NPV at 91%, and AUC at 84% for predicting good continence, while that using clinicopathological parameters only had the performance with sensitivity at 50%, specificity at 69%, PPV at 60%, NPV at 60%, and AUC at 60%. Conclusions: Our results suggest that the DL algorithms using MRI imaging information are highlighted as an accurate method for strongly predicting early recovery of urinary continence after RARP. Thus, DL predictions may help allocation of treatment strategies for PC patients who dislike prolonged urinary incontinence after RARP.

Investigating The Mechanism Underlying Urinary Continence Using Dynamic-MRI After Retzius-sparing Robot-assisted Radical Prostatectomy

2021 ◽  
Author(s):  
Yoshifumi Kadono ◽  
Takahiro Nohara ◽  
Shohei Kawaguchi ◽  
Suguru Kadomoto ◽  
Hiroaki Iwamoto ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Bladder Wall ◽  
Dynamic Mri ◽  
Early Postoperative Period ◽  
Urinary Continence ◽  
Abdominal Pressure ◽  
Robot Assisted ◽  
High Position ◽  
Membranous Urethra

Abstract Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been reported to exhibit better postoperative urinary continence compared to conventional RARP (C-RARP) via the anterior approach, but the reasons behind this are unknown. The early postoperative urinary incontinence and anatomical differences were compared between 51 cases each of C-RARP and RS-RARP, which were selected via propensity score matching. Dynamic-MRI was performed before and after surgery to investigate the pelvic anatomical changes under abdominal pressure. The median urine loss ratio in the early postoperative period was 11.0% and 1.0% for C-RARP and RS-RARP, respectively. Postoperative MRI revealed the anterior bladder wall after RS-RARP was fixed in a high position compared to C-RARP. Dynamic-MRI after C-RARP showed cephalocaudal compression of the bladder during abdominal pressure caused expansion of the membranous urethra and the urine flowed out. In RS-RARP cases, the rectum moved forward during abdominal pressure to compress the membranous urethra by closing it from behind, as was observed preoperatively. This was the first study using dynamic-MRI which revealed the importance of a high attachment of the anterior bladder wall for the urethral closure mechanism during abdominal pressure. RS-RARP, which can completely preserve this mechanism, was the least likely to cause stress urinary incontinence.

scholarly journals Biofeedback in the treatment of patients with urine incontinence after radical prostatectomy

2021 ◽  
Vol 11 (1) ◽  
pp. 69-78
Author(s):  
Natalia O. Krotova ◽  
Tatiana V. Ulitko ◽  
Igor V. Kuzmin ◽  
Salman K. Al-Shukri
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Conservative Treatment ◽  
Therapeutic Effect ◽  
Clinical Studies ◽  
Review Article ◽  
Urinary Continence ◽  
Muscle Training ◽  
Urine Incontinence ◽  
Pelvic Muscles

The review article is devoted to the application of the biofeedback in the treatment of patients with urinary incontinence after radical prostatectomy. The data on the mechanism of urinary continence in men and its damage during surgery are presented, the pathogenetic basis of the therapeutic effect of pelvic muscle training in this patients is highlighted. The analysis of the main russian and foreign clinical studies on the use of the biofeedback in patients with urinary incontinence after prostatectomy has been carried out. It is indicated that biofeedback increases the effectiveness of conservative treatment of urinary incontinence, however the even wider use of this method of treatment is limited by the lack of standard protocols for training pelvic muscles under the control of biofeedback.

scholarly journals Preoperative MRI Parameters Predict Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy in Prostatic Cancer Patients

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 102 ◽  
Author(s):  
Shinji Fukui ◽  
Yoriaki Kagebayashi ◽  
Yusuke Iemura ◽  
Yoshiaki Matsumura ◽  
Shoji Samma
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Prostatic Cancer ◽  
Pubic Symphysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Mri Findings ◽  
Postoperative Observation ◽  
Lower Group

We aimed to investigate whether preoperative MRI findings could predict the bladder neck location on postoperative cystography and recovery of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP). We retrospectively reviewed 270 consecutive patients who had complete preoperative data, including MRI, and underwent postoperative observation for more than three months. Preoperative MRI parameters consisted of the membranous urethral length (MUL) and pubic symphysis-prostate apex length (PAL) on sagittal images. The bladder neck location on a postoperative cystography was defined as the lowest extension of the tapering contrast medium in the bladder, and its relation to the pubic symphysis (above (higher group) and below (lower group) the middle of the pubic symphysis height) was evaluated. Those who required no pad or a safety pad were defined as being continent. PAL was significantly shorter in the higher group than that in the lower group (25.5 vs. 29.1 mm; p < 0.0001). The continent group at three months had a significantly longer MUL and shorter PAL than those in the incontinent group (8.1 vs. 6.7 mm; p < 0.05, and 26.0 vs. 28.1 mm; p < 0.05, respectively). Preoperative MRI parameters could predict the bladder neck location on postoperative cystograms and the recovery of urinary incontinence after RALP.

scholarly journals Urinary continence outcomes of four years of follow-up and predictors of early and late urinary incontinence in patients undergoing robot-assisted radical prostatectomy

2019 ◽  
Author(s):  
Xing Li ◽  
Huan Zhang ◽  
Zhuo Jia ◽  
Yunpeng Wang ◽  
Yong Song ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Logistic Regression Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
One Year ◽  
Late Stages

Abstract Background Although the wide application of robot-assisted radical prostatectomy (RARP) in recent years, studies about long urinary continence were few. In this study, we aimed to examine the outcomes of continence rates (CRs) and determine the predictive factors of early and late urinary incontinence (UI) in patients with prostate cancer (PCa) undergoing RARP.Methods This retrospective study included 650 patients treated with RARP who completed perioperative data and at least one year of follow-up from January 2009 to November 2017. We analyzed the preoperative, intraoperative, and postoperative parameters of the patients. Continence was defined as no pad use. CRs from one to 48 months postoperatively were examined. Logistic regression analysis was performed to evaluate the associations between the risk factors and UI in the early and late stages.Results CRs of the patients at one, three, six, 12, 24, 36, and 48 months postoperatively were 40.62%, 60.92%, 71.38%, 78.77%, 79.96%, 79.51%, and 76.50%, respectively. There were no significant differences in CR from 12 to 48 months postoperatively ( P =0.766). Logistic regression analysis proved that pelvic lymph node dissection (PLND) was a significant predictor of UI at one month, while age was an independent predictor of UI at six and 12 months, respectively. Other variables were not statistically significant predictors.Conclusions Our results demonstrated that CR gradually improved with time within one year and stabilized one year after the surgery. PLND and age were significant determinants of continence in the early and late stages, respectively. These parameters could be used for preoperatively identifying patients at high risk for UI and counselling about postoperative expectations for urinary continence.

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