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Preserving Continence During Robotic Prostatectomy

  • New Imaging Techniques (A Atala, Section Editor)
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Abstract

Preservation of postoperative urinary continence remains the primary concern of all men and their surgeons following robot-assisted radical prostatectomy (RARP). Without doubt, continence is the most important quality of life issue following radical prostatectomy. Identification of difficulties and lessons learned over time has helped focus efforts in order to improve urinary quality of life and continence. This review will examine definitions of continence and urinary quality of life evaluation, technical aspects and the impact of patient-related factors affecting time to and overall continence.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Loughlin KR, Prasad PM. Post-prostatectomy incontinence: a confluence of 3 factors. J Urol. 2010;183(3):871–7. Very good overview of continence after radical prostatectomy.

    Article  PubMed  Google Scholar 

  2. •• Ficarra V, Novara G, Rosen RC, et al. Systematic review and meta-analysis of studies reporting continence recovery after robot-assisted radical prostatectomy. Eur Urol. 2012;62(3):405–17. Excellent Review of current robotic prostatectomy outcomes.

    Article  PubMed  Google Scholar 

  3. Walsh PC, Marchle P, Ricker D, et al. Patient reported urinary continence and sexual function after radical prostatectomy. Urol. 2000;55:58–62.

    Article  PubMed  CAS  Google Scholar 

  4. Wei JT, Montie JE. Comparison of patient’s and physician’s rating of urinary incontinence following radical prostatectomy. Semin Urol Oncol. 2000;18:76–80.

    PubMed  CAS  Google Scholar 

  5. Kundu SD, Roehl KA, Eggener SE, et al. Potency, continence and complications in 3,477 consecutive radical retropubic prostatectomies. J Urol. 2004;172:2227–31.

    Article  PubMed  Google Scholar 

  6. Liss MA, Osann K, Canvasser N, et al. Continence definition after radical prostatectomy using urinary quality of life: evaluation of patient reported validated questionnaires. J Urol. 2010;183(4):1464–8.

    Article  PubMed  Google Scholar 

  7. Chou M, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2011;155:762–71.

    PubMed  Google Scholar 

  8. Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. 2005;65(4):740–4.

    Article  PubMed  Google Scholar 

  9. Link BA, Nelson R, Josephson DY, et al. The impact of prostate gland weight in robot assisted laparoscopic radical prostatectomy. J Urol. 2008;180(3):928–32.

    Article  PubMed  Google Scholar 

  10. Castle EP, Atug F, Woods M, et al. Impact of body mass index on outcomes after robot assisted radical prostatectomy. World J Urol. 2008;26(1):91–5.

    Article  PubMed  Google Scholar 

  11. Skarecky D, Morales B, Chang A, Ahlering T. Simple prediction method of return to pad-free continence for men undergoing Robotic Radical Prostatectomy (RARP). J Endourol. 2011;25(9):1451–5.

    Article  PubMed  Google Scholar 

  12. Twiss C, Martin S, Shore R, Lepor H. A continence index predicts the early return of urinary continence after radical retroubic prostatectomy. J Urol. 2000;164:1241–7.

    Article  PubMed  CAS  Google Scholar 

  13. Ates M, Teber D, Gozen AS, et al. A new postoperative predictor of time to urinary continence after laparosocpic radical prostatectomy: the urine loss ratio. Eur Urol. 2007;52:178–85.

    Article  PubMed  Google Scholar 

  14. Van Kampen M, De Weerdt GW, Van Poppel H. An easy prediction of urinary incontinence duration after retropubic radical prostatectomy based on urine loss the first day after catheter withdrawal. J Urology. 2009;181:2461–646.

    Article  Google Scholar 

  15. Perimenis P, Burkhard FC, Kessler TM, et al. Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern. Eur Urol. 2004;46(5):406–9.

    Article  Google Scholar 

  16. Ahlering T, Morales B, Van T, et al. Nocturnal versus daytime pad free continence following Robotic-Assisted Radical Prostatectomy. J Endourol. 2012;26(Supp1):132. MP 19–14.

    Google Scholar 

  17. Rodriguez E, Skarecky DW, Ahlering TE. ‘Perfect’ continence outcomes after laparoscopic radical prostatectomy. Urology. 2006;67(4):785–8.

    Article  PubMed  Google Scholar 

  18. Majoros A, Bach D, Kesztelyi A. Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study). Neurourol Urodyn. 2006;25:2.

    Article  PubMed  Google Scholar 

  19. Van Velthoven RF, Ahlering TE, Peltier A, et al. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology. 2003;61(4):699–702.

    Article  PubMed  Google Scholar 

  20. van Velthoven R, Rodriguez Jr E, Abbou CC, et al. Single Knot Anastomosis (SKA) for laparoscopic radical prostatectomy: an International Multicenter Outcome Survey of 5,235 cases. J Endourol. 2007;21(Supp1):MP08–9. A64.

    Google Scholar 

  21. Rocco F, Carmignani L, Acquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol. 2006;175(6):2201–6.

    Article  PubMed  CAS  Google Scholar 

  22. Liss M, Skarecky DW, Morales B, et al. Preventing complications of robot-assisted radical prostatectomy. Urology In Press, 2013.

  23. Strasser H, Kima G, Poisel S, et al. Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate. 1996;28:24.

    Article  PubMed  CAS  Google Scholar 

  24. Zvara P, Carrier S, Kour NW, et al. The detailed neuroanatomy of the human striated urethral sphincter. BJUI. 1994;74:182.

    Article  CAS  Google Scholar 

  25. •• Tzou DT, Dalkin BL, Christopher BA, Cui H. The failure of nerve sparing template to improve urinary continence after radical prostatectomy: attention to study design. Urologic Onc. 2009;27:358–62. Excellent paper describing the controversy of the scientific method needed to evaluate nerve sparing and return of urinary continence.

    Article  Google Scholar 

  26. Shikanov S, Desai V, Razmaria A, et al. Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after Surgery. J Urol. 2010;183:1803–7.

    Article  PubMed  Google Scholar 

  27. Pick D, Skarecky DW, Osann K, et al. The impact of cavernosal nerve preservation on continence following robotic radical prostatectomy. BJU 2011;108(9):1492–6

    Google Scholar 

  28. Eastham JA, Kattan MW, Rodgers E, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996;156:1707–13.

    Article  PubMed  CAS  Google Scholar 

  29. Hammerer P, Huland H. Urodynamic evalutation of changes in urinary control after radical retropubic prostatectomy. J Urol. 1997;157:233–6.

    Article  PubMed  CAS  Google Scholar 

  30. Ahlering TE, Eichel L, Edwards R, Skarecky DW. The impact of body mass and surgical outcomes. Urology. 2005;65(4):740–4.

    Article  PubMed  Google Scholar 

  31. Teber D, Sofikerim M, Ates M, et al. Is type 2 diabetes mellitus a predictor for incontinence after laparoscopic radical prostatectomy? A matched pair multivariate analysis. J Urol. 2010;183:1087–91.

    Article  PubMed  Google Scholar 

  32. Novara G, Ficarra V, D’elia C, et al. Evaluating urinary incontinence and preoperative predictors of urinary continence after robotic assisted laparoscopic radical prostatectomy. J Urol. 2010;184:1028–33.

    Article  PubMed  CAS  Google Scholar 

  33. Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer. JAMA. 2000;283(3):354–60.

    Article  PubMed  CAS  Google Scholar 

  34. • Finley D, Chang A, Morales B, et al. Impact of regional hypothermia on urinary continence and potency following robot-assisted radical prostatectomy. J Endourol. 2010;24(7):1111–6. Initial report of continence outcomes with hypothermic cooling.

    Article  PubMed  Google Scholar 

  35. Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009;37(7):S186–202.

    Article  PubMed  Google Scholar 

  36. Lee SM, Zhao H, Maier CM, Steinberg GK. The protective effect of early hypothermia on PTEN phosphorylation correlates with free radical inhibition in rat stroke. J Cereb Blood Flow Metab. 2009;29(9):1589–600.

    Article  PubMed  CAS  Google Scholar 

  37. Povlishock JT, Buki A, Koiziumi H, et al. Initiating mechanisms involved in the pathobiology of traumatically induced axonal injury and interventions targeted at blunting their progression. Acta Neurochir Suppl. 1999;73:15–20.

    PubMed  CAS  Google Scholar 

  38. Adachi M, Sohma O, Tsuneishi S, et al. Combination effect of systemic hypothermia and caspase inhibitor administration against hypoxic-ischemic brain damage in neonatal rats. Pediatr Res. 2001;50:590–5.

    Article  PubMed  CAS  Google Scholar 

  39. Ning XH, Chen SH, Xu CS, et al. Hypothermic protection of the ischemic heart via alterations in apoptotic pathways as assessed by gene array analysis. J Appl Physiol. 2002;92:2200–7.

    PubMed  CAS  Google Scholar 

  40. Xu L, Yenari MA, Steinberg GK, et al. Mild hypothermia reduces apoptosis of mouse neurons in vitro early in the cascade. J Cereb Blood Flow Metab. 2002;22:21–8.

    Article  PubMed  Google Scholar 

  41. Liou AK, Clark R, Henshall DC, et al. To die or not to die for neurons in ischemia, traumatic brain injury and epilepsy: a review on the stress-activated signaling pathways and apoptotic pathways. Prog Neurobiol. 2003;69:103–42.

    Article  PubMed  CAS  Google Scholar 

  42. Chatzipanteli K, Yanagawa Y, Marcillo AE, et al. Posttraumatic hypothermia reduces polymorphonuclear leukocyte accumulation following spinal cord injury in rats. J Neurotrauma. 2000;17:321–32.

    Google Scholar 

  43. Busto R, Dietrich WD, Globus MY, et al. Small differences in intraischemic brain temperature critically determine the extent of ischemic neuronal injury. J Cereb Blood Flow Metab. 1987;7:729–38.

    Article  PubMed  CAS  Google Scholar 

  44. Aibiki M, Maekawa S, Ogura S, et al. Effect of moderate hypothermia on systemic and internal jugular plasma IL-6 levels after traumatic brain injury in humans. J Neurotrauma. 1999;16:225–32.

    Article  PubMed  CAS  Google Scholar 

  45. Dietrich WD, Chatzipanteli K, Vitarbo E, et al. The role of inflammatory processes in the pathophysiology and treatment of brain and spinal cord trauma. Acta Neurochir Suppl. 2004;89:69–74.

    Article  PubMed  CAS  Google Scholar 

  46. Suehiro E, Fujisawa H, Akimura T, et al. Increased matrix metalloproteinase-9 in blood in association with activation of interleukin-6 after traumatic brain injury: influence of hypothermic therapy. J Neurotrauma. 2004;21:1706–11.

    Article  PubMed  Google Scholar 

  47. Hildebrand F, van Griensven M, Giannoudis P, et al. Impact of hypothermia on the immunologic response after trauma and elective surgery. Surg Technol Int. 2005;14:41–50.

    PubMed  Google Scholar 

  48. Finley D, Osann K, Skarecky DW, Ahlering TE. Hypothermic nerve sparing radical prostatectomy: rationale, feasibility, and impact of early continence. Urology. 2009;73(4):691–6.

    Article  PubMed  Google Scholar 

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Disclosure

A Gordon has no disclosure. T Ahlering is a consultant with Phillips Healthcare.

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Authors and Affiliations

  1. Department of Urology, University of California, Irvine, CA, USA

    Thomas E. Ahlering, Adam Gordon, Blanca Morales & Douglas W. Skarecky

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  1. Thomas E. Ahlering
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  2. Adam Gordon
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  3. Blanca Morales
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  4. Douglas W. Skarecky
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Correspondence to Thomas E. Ahlering.

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Ahlering, T.E., Gordon, A., Morales, B. et al. Preserving Continence During Robotic Prostatectomy. Curr Urol Rep 14, 52–58 (2013). https://doi.org/10.1007/s11934-012-0295-4

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  • DOI: https://doi.org/10.1007/s11934-012-0295-4

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