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Nerve-sparing technique and urinary control after robot-assisted laparoscopic prostatectomy

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Abstract

Objectives

To characterize determinants of 4-, 12-, and 24-month urinary control after robot-assisted laparoscopic prostatectomy (RALP).

Methods

Adjusted comparative study using prospectively collected, patient self-reported urinary control for 602 consecutive RALPs. Urinary control defined as: (1) EPIC urinary function (UF) scored from 0 to 100 and (2) continence (zero pads per day).

Results

Both UF (62.8 vs. 42.4, P < 0.001) and continence rates (47.2 vs. 26.7%, P = 0.043) were better for bilateral nerve-sparing (BNS) vs. non-nerve-sparing (NNS) at 4 months, but only UF scores were significantly better at 12- (80.9 vs. 70.7, P = 0.014) and 24-month (89.2 vs. 77.4, P = 0.024) post-RALP. No difference in positive margin rates was observed. In multivariate analysis, older age (parameter estimate −0.42, 95% CI −0.80 to −0.04) and increasing gland volume (−0.13, CI −0.26 to −0.01) resulted in lower UF scores at 4 months, while higher pre-operative UF (0.25, CI 0.05–0.46), bladder neck-sparing technique (10.1, CI 3.79–16.35), BNS (19.1, CI 9.37–28.82), and unilateral nerve-sparing (19.00, CI 7.88–30.11) resulted in higher UF scores at 4 months. At 12 months, higher pre-operative UF (0.24, CI 0.083–0.40) and BNS (9.54, CI 1.92–17.16) resulted in higher UF scores. At 24 months, higher pre-operative UF (0.20, CI 0.06–0.33), bladder neck-sparing technique (7.80, CI 3.48–12.10), and BNS (7.86, CI 1.04–14.68) resulted in higher UF scores.

Conclusions

BNS, bladder neck-sparing technique, and higher pre-operative UF score result in improved 24-month urinary control after RALP.

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References

  1. Litwin MS, Hays RD, Fink A et al (1995) Quality-of-life outcomes in men treated for localized prostate cancer. JAMA 273:129–135

    Article  CAS  PubMed  Google Scholar 

  2. Sanda MG, Dunn RL, Michalski J et al (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358:1250–1261

    Article  CAS  PubMed  Google Scholar 

  3. Foote J, Yun S, Leach GE (1991) Postprostatectomy incontinence. Pathophysiology, evaluation, and management. Urol Clin North Am 18:229–241

    CAS  PubMed  Google Scholar 

  4. Cambio AJ, Evans CP (2006) Minimising postoperative incontinence following radical prostatectomy: considerations and evidence. Eur Urol 50:903–913

    Article  PubMed  Google Scholar 

  5. Eastham JA, Kattan MW, Rogers E et al (1996) Risk factors for urinary incontinence after radical prostatectomy. J Urol 156:1707–1713

    Article  CAS  PubMed  Google Scholar 

  6. Kundu SD, Roehl KA, Eggener SE et al (2004) Potency, continence and complications in 3, 477 consecutive radical retropubic prostatectomies. J Urol 172:2227–2231

    Article  PubMed  Google Scholar 

  7. Steiner MS, Morton RA, Walsh PC (1991) Impact of anatomical radical prostatectomy on urinary continence. J Urol 145:512–514; (discussion 4-5)

    Google Scholar 

  8. Guru KA, Hussain A, Chandrasekhar R et al (2009) Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons. Can J Urol 16:4736–4741

    PubMed  Google Scholar 

  9. Hu JC, Gu X, Lipsitz SR et al (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302:1557–1564

    Article  CAS  PubMed  Google Scholar 

  10. Levinson AW, Pavlovich CP, Ward NT et al (2008) Association of surgeon subjective characterization of nerve sparing quality with potency following laparoscopic radical prostatectomy. J Urol 179:1510–1514

    Article  PubMed  Google Scholar 

  11. Freire MP, Weinberg AC, Lei Y et al (2009) Anatomic bladder neck preservation during robotic-assisted laparoscopic radical prostatectomy: description of technique and outcomes. Eur Urol 56:972–980

    Article  PubMed  Google Scholar 

  12. Berry A, Korkes F, Hu JC (2008) Landmarks for consistent nerve sparing during robotic-assisted laparoscopic radical prostatectomy. J Endourol 22:1565–1567

    Article  PubMed  Google Scholar 

  13. Wei JT, Dunn RL, Litwin MS et al (2000) Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 56:899–905

    Article  CAS  PubMed  Google Scholar 

  14. Konety BR, Sadetsky N, Carroll PR et al (2007) Recovery of urinary continence following radical prostatectomy: the impact of prostate volume-analysis of data from the CaPSURETM database. J Urol 177:1423–1426

    Article  PubMed  Google Scholar 

  15. Poore RE, McCullough DL, Jarow JP (1998) Puboprostatic ligament sparing improves urinary continence after radical retropubic prostatectomy. Urology 51:67–72

    Article  CAS  PubMed  Google Scholar 

  16. Paparel P, Akin O, Sandhu J et al (2009) Recovery of urinary continence after radical prostatectomy: association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging. Eur Urol 55:629–639

    Article  PubMed  Google Scholar 

  17. John Wei (2009) Personal communication of unpublished data

  18. Krupski TL, Saigal CS, Litwin MS (2003) Variation in continence and potency by definition. J Urol 170:1291–1294

    Article  PubMed  Google Scholar 

  19. van der Poel HG, de Blok W, Joshi N, van Muilekom E (2009) Preservation of lateral prostatic fascia is associated with urine continence after robotic-assisted prostatectomy. Eur Urol 55:892–900

    Article  PubMed  Google Scholar 

  20. Potdevin L, Ercolani M, Jeong J et al (2009) Functional and oncologic outcomes comparing interfascial and intrafascial nerve sparing in robot-assisted laparoscopic radical prostatectomies. J Endourol 23:1479–1484

    Article  PubMed  Google Scholar 

  21. Nelles JL, Freedland SJ, Presti JC Jr et al (2009) Impact of nerve sparing on surgical margins and biochemical recurrence: results from the SEARCH database. Prostate Cancer Prostatic Dis 12:172–176

    Article  CAS  PubMed  Google Scholar 

  22. Burkhard FC, Kessler TM, Fleischmann A et al (2006) Nerve sparing open radical retropubic prostatectomy–does it have an impact on urinary continence? J Urol 176:189–195

    Article  PubMed  Google Scholar 

  23. Sacco E, Prayer-Galetti T, Pinto F et al (2006) Urinary incontinence after radical prostatectomy: incidence by definition, risk factors and temporal trend in a large series with a long-term follow-up. BJU Int 97:1234–1241

    Article  PubMed  Google Scholar 

  24. Kaiho Y, Nakagawa H, Ikeda Y et al (2005) Intraoperative electrophysiological confirmation of urinary continence after radical prostatectomy. J Urol 173:1139–1142

    Article  PubMed  Google Scholar 

  25. Hollabaugh RS Jr, Dmochowski RR, Kneib TG et al (1998) Preservation of putative continence nerves during radical retropubic prostatectomy leads to more rapid return of urinary continence. Urology 51:960–967

    Article  PubMed  Google Scholar 

  26. Wei JT, Dunn RL, Marcovich R et al (2000) Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol 164:744–748

    Article  CAS  PubMed  Google Scholar 

  27. Nelson CP, Montie JE, McGuire EJ et al (2003) Intraoperative nerve stimulation with measurement of urethral sphincter pressure changes during radical retropubic prostatectomy: a feasibility study. J Urol 169:2225–2228

    Article  PubMed  Google Scholar 

  28. Marien TP, Lepor H (2008) Does a nerve-sparing technique or potency affect continence after open radical retropubic prostatectomy? BJU Int 102:1581–1584

    Article  PubMed  Google Scholar 

  29. Narayan P, Konety B, Aslam K et al (1995) Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol 153:337–341

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This project was funded by the Department of Defense research grant to Dr. Hu (W81XWH-08-1-0283).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Urologic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Wesley W. Choi, Marcos P. Freire, Lei Yin, Fernando Carvas, Stephen B. Williams & Jim C. Hu

  2. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Jane R. Soukup, Stuart R. Lipsitz & Jim C. Hu

  3. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Jim C. Hu

  4. Division of Urology, Brigham and Women’s Hospital, 45 Francis St, ASB-II, Boston, MA, 02115, USA

    Stephen B. Williams & Jim C. Hu

Authors
  1. Wesley W. Choi
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  2. Marcos P. Freire
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  3. Jane R. Soukup
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  4. Lei Yin
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  5. Stuart R. Lipsitz
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  6. Fernando Carvas
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  7. Stephen B. Williams
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  8. Jim C. Hu
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Corresponding author

Correspondence to Jim C. Hu.

Additional information

W. W. Choi and M. P. Freire are contributed equally.

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Choi, W.W., Freire, M.P., Soukup, J.R. et al. Nerve-sparing technique and urinary control after robot-assisted laparoscopic prostatectomy. World J Urol 29, 21–27 (2011). https://doi.org/10.1007/s00345-010-0601-z

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  • DOI: https://doi.org/10.1007/s00345-010-0601-z

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