scholarly journals The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes

2017 ◽  
Vol 12 (3) ◽  
pp. E121-5 ◽  
Author(s):  
Mansour Alnazari ◽  
Marc Zanaty ◽  
Khaled Ajib ◽  
Assaad El-Hakim ◽  
Kevin C. Zorn
Keyword(s):  
Risk Factors ◽  
Radical Prostatectomy ◽  
Urinary Retention ◽  
Catheter Removal ◽  
Urinary Continence ◽  
Median Lobe ◽  
Robot Assisted ◽  
Patient Counselling ◽  
Nerve Preservation ◽  
Significant Difference

Introduction: We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes.Methods: The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated.Results: The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months.Conclusions: While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

scholarly journals Clinical significance and risk factors of urethrovesical anastomotic urinary leakage following robot-assisted radical prostatectomy: a multi-institutional study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shigenori Kakutani ◽  
Yuta Takeshima ◽  
Yuta Yamada ◽  
Tetsuya Fujimura ◽  
Shoichi Nagamoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Radical Prostatectomy ◽  
Clinical Significance ◽  
Final Analysis ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Urinary Leakage ◽  
Postoperative Continence ◽  
The University

Abstract Background There has been a limited number of reports on the significance and risk factors of urethrovesical anastomotic urinary leakage (AUL) following robot-assisted radical prostatectomy (RARP). We aimed to analyze the clinical significance of AUL and evaluated its risk factors. Methods We conducted a multi-institutional study to review patients with prostate cancer undergoing RARP in three centers (The University of Tokyo Hospital, Mitsui Memorial Hospital, and Chiba Tokushukai Hospital). “Positive AUL” was defined as urinary extravasation at the anastomosis detected by post-operative cystogram and was further categorized into minor or major AUL. Univariate and multivariate analyses were performed to identify predictors of AUL. Postoperative continence rates and time to achieve continence were also analyzed. Results A total of 942 patients underwent RARP for prostate cancer in 3 centers. Of these patients, a cystogram after the RARP procedure was not performed in 26 patients leaving 916 patients for the final analysis. AUL was observed in 56 patients (6.1%); 34 patients (3.7%) with minor AUL and 22 patients (2.4%) with major AUL. Patients with major AUL exhibited a significantly longer time to achieve continence than those without major AUL. Multivariate analysis demonstrated that longer console time (≥ 184 min) was significantly associated with overall AUL, and higher body mass index (≥ 25 g/kg2) was a significant predictor of both major and overall AUL. Conclusions The presence of major AUL was associated with the achievement of urinary continence, suggesting clinical relevance of its diagnosis by postoperative cystogram. A selective cystogram has been proposed for high-risk cases. Furthermore, identification of the risk factors of AUL will lead to optimal application.

scholarly journals Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiang-Nan Xu ◽  
Zhen-Yu Xu ◽  
Hu-Ming Yin
Keyword(s):  
Radical Prostatectomy ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Postoperative Continence ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P < 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P < 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P < 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

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 The Impact of Catheter Removal Time on Urinary Continence and Overactive Bladder Symptoms After Robot-Assisted Radical Prostatectomy: A Retrospective Analysis of Consecutive 250 Cases From a Single Institution

2021 ◽  
Author(s):  
Han Hao ◽  
Xu Chen ◽  
Yue Liu ◽  
Longmei Si ◽  
Yuke Chen ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Overactive Bladder ◽  
Catheter Removal ◽  
Urinary Continence ◽  
Removal Time ◽  
Overactive Bladder Symptoms ◽  
Significant Difference ◽  
Bladder Symptoms ◽  
The Impact ◽  
Time Point

Abstract Background After radical prostatectomy, the optimal length of postoperative catheterization time remains to be determined. This study investigates the impact of catheter removal time on urinary continence and overactive bladder symptoms after robot-assisted radical prostatectomy (RARP).Methods Two hundred and fifty consecutive patients underwent RARP by a single surgeon between November 2020 and May 2021. Time to catheter removal was categorized into 7, 10, and ≥ 14 days. Continence was defined as no more than 1 pad used or no more than 20 grams of urine leakage per 24 hours. The patients' continence rates and overactive bladder symptom score (OABSS) were assessed at 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal.Results Overall, continence rates were 36% 48 hours after catheter removal, 55.6% 1 week, 74.8% 4 weeks, 98.4% 12 weeks, and 100% 24 weeks after catheter removal. The median time to regain continence was 1 week. After stratification according to catheterization time, no significant difference in continence rates was found between different groups at each time point after catheter removal. Longer catheterization was not an independent predictor of continence recovery (10 days: OR 0.985, 95% CI 0.689-1.409, p = 0.936; ≥14 days: OR 1.194, 95% CI 0.869-1.642, p = 0.274). The presence of diabetes was associated with worse continence outcomes (OR 1.535, 95% CI 1.105-2.132, p = 0.011). The mean OABSS of patients in the continent group were significantly lower than the incontinent group at 48 hours, 1 week, and 4 weeks after catheter removal. No significant difference in OABSS was found between different catheterization time groups at each time point after catheter removal.Conclusions Our results demonstrated that different catheterization time (7 days, 10 days, ≥14 days) is not associated with short-, intermediate-, long-term continence outcomes or overactive bladder symptoms.

scholarly journals Functional and oncological outcomes of salvage external beam radiotherapy following robot-assisted radical prostatectomy in a Canadian cohort

2017 ◽  
Vol 12 (2) ◽  
pp. 45-9
Author(s):  
Khaled Ajib ◽  
Marc Zanaty ◽  
Mansour Alnazari ◽  
Emad Rajih ◽  
Pierre-Alain Hueber ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
External Beam Radiotherapy ◽  
Specific Antigen ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Time Points ◽  
Canadian Experience ◽  
Significant Difference ◽  
The Impact

Introduction: We sought to determine the impact of salvage radiotherapy (SRT) on oncological and functional outcomes of patients with prostate cancer after biochemical recurrence (BCR) following robot-assisted radical prostatectomy (RARP).Methods: Data of 70 patients with prostate cancer treated with SRT after developing BCR were retrospectively analyzed from a prospectively collected RARP database of 740 men. Oncological (prostate- specific antigen [PSA]) and functional (pads/day, International Prostate Symptom Score [IPSS], and Sexual Health Inventory for Men [SHIM]) outcomes were reported at six, 12, and 24 months after RT and adjusted for pre-SRT status.Results: Men who underwent SRT had a mean age, PSA, and time from radical prostatectomy (RP) to RT of 61.8 years (60.1‒63.6), 0.5 ng/ml (0.2‒0.8), and 458 days (307‒747), respectively. Freedom from biochemical failure (FFBF) post-SRT, defined as a PSA nadir <0.2 ng/mL, was observed in 89%, 93%, and 81%, at six, 12, and 24 months, respectively. Undetectable PSA was observed in 14%, 35%, and 40% at the same time points, respectively. There was no significant difference in urinary continence post-SRT (p=0.56). Rate of strict continence (0 pads/day) was 71% at 24 months compared to 78% pre-SRT. Mean IPSS at six, 12, and 24 months was 3.4, 3.6, and 3.6, respectively compared to pre-RT score of 3.3 (p=0.61). The mean SHIM score pre-SRT was comparable at all time points following treatment (p=0.86).Conclusions: In this unique Canadian experience, it appears that early SRT is highly effective for the treatment of BCR following RARP with little impact on urinary continence and potency outcomes.

Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors

2018 ◽  
Vol 17 (14) ◽  
pp. e2836
Author(s):  
S. Waigankar ◽  
Y. Thyavihally Boregowda ◽  
A. Pednekar ◽  
S. Ramani
Keyword(s):  
Risk Factors ◽  
Radical Prostatectomy ◽  
Urinary Continence ◽  
Robot Assisted

Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors

2015 ◽  
Vol 116 (5) ◽  
pp. 764-770 ◽  
Author(s):  
Anup Kumar ◽  
Srinivas Samavedi ◽  
Anthony S. Bates ◽  
Rafael F. Coelho ◽  
Bernardo Rocco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Prostatectomy ◽  
Urinary Continence ◽  
Robot Assisted

scholarly journals Long-term urinary functional outcome of vesicourethral anastomosis with bidirectional poliglecaprone (Monocryl®) vs. barbed polyglyconate suture (V-LocTM 180) in robot-assisted radical prostatectomy

2019 ◽  
Vol 14 (3) ◽  
Author(s):  
Emad Rajih ◽  
Malek Meskawi ◽  
Abdullah M. Alenizi ◽  
Kevin C. Zorn ◽  
Mansour Alnazari ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Single Layer ◽  
Barbed Suture ◽  
Urinary Continence ◽  
First Year ◽  
Robot Assisted ◽  
Monofilament Suture ◽  
Significant Difference ◽  
Vesicourethral Anastomosis ◽  
One Year

Introduction: We aimed to evaluate urinary continence recovery following robot-assisted radical prostatectomy (RARP) using monofilament poliglecaprone (Monocryl®) suture vs. barbed suture (V-LocTM 180) during vesicourethral anastomosis. Methods: In this prospective, observational cohort, data were collected on 322 consecutive patients. All patients underwent continuous, bidirectional, single-layer running anastomosis with either 3.0-monofilament suture (n=141) or 3.0 barbed suture (n=181). The primary outcome was continence recovery defined as time to 0 pad at one, three, six, 12, and 24 months following surgery. Results: Continence rates were significantly better with monofilament VUA at all followup time points up to one year. Median time to continence was one month vs. five months in the monofilament group vs. barbed group, respectively (p<0.001). Continence rates in monofilament suture vs. barbed group at one, three, six, 12, and 24 months were 56% vs. 26% (p<0.001), 73% vs. 36.4% (p<0.001), 84.4% vs. 60.2% (p<0.001), 90.8% vs. 71.9% (p<0.001), and 93.5% vs.87.1% (p=0.1), respectively. Anastomosis time was shorter in the barbed group, with a median of 23 vs. 30 utes (p<0.001). Patients anastomosed with Monocryl suture had smaller prostate weight (median 42.5 g vs. 50 g; p<0.001) and harbored less advanced disease (T2a‒c 76.6 vs. 74%; p=0.01) relative to patients treated with V-Loc 180 suture. However, in a multivariate Cox logistic regression analyses, independent predictors of continence recovery were suture type (hazard ratio [HR] 53; 95% confidence interval [CI] 0.41‒0.68; p=0.02] and prostate size (HR 0.99; 95% CI 0.98‒0.99; p<0.001). Conclusions: Barbed VUA contributed to delayed continence recovery compared to monofilament poliglecaprone suture during the first year post-RARP. However, no statistically significant difference was recorded at two years post-RARP. These results warrant special attention, especially with the widespread use of barbed suture in recent years.

Sign in / Sign up

Export Citation Format

Share Document