Predictors of Early Continence after Robot-assisted Radical Prostatectomy
Yuta YAMADA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Tetsuya FUJIMURA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Correspondence: Tetsuya Fujimura, MD, PhD, Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan. Tel: 81-3-5800-8753; Fax: 81-3-5800-8917. Email: [email protected]Search for more papers by this authorHiroshi FUKUHARA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorToru SUGIHARA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTohru NAKAGAWA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorHaruki KUME
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYasuhiko IGAWA
Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYukio HOMMA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYuta YAMADA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Tetsuya FUJIMURA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Correspondence: Tetsuya Fujimura, MD, PhD, Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan. Tel: 81-3-5800-8753; Fax: 81-3-5800-8917. Email: [email protected]Search for more papers by this authorHiroshi FUKUHARA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorToru SUGIHARA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTohru NAKAGAWA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorHaruki KUME
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYasuhiko IGAWA
Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorYukio HOMMA
Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorAbstract
Objective
Our objective was to investigate predictors of early continence outcome after robot-assisted radical prostatectomy (RARP).
Methods
Clinical records were prospectively collected in 272 patients who underwent RARP. Clinical parameters, continence rates, and time to achieve continence were investigated and analyzed. Recovery of continence was defined as achieving complete continence (pad-free).
Results
In the univariate analysis, young age (≤67 years) and low pT stage (≤pT2) were significantly associated with continence achieved within 2 weeks after RARP (P = 0.0343 and P = 0.0406, respectively). Low prostate weight was the only factor associated with recovery of continence within 1 month (P = 0.0461). Multivariate analysis revealed that young age (≤67 years) and low pT stage (≤pT2) were statistically significant predictors of continence within 2 weeks after RARP (P = 0.040 and P = 0.015, respectively).
Conclusion
Young age and low pT stage were independent predictors of early continence.
REFERENCES
- 1Novara G, Ficarra V, D'elia C et al. Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol 2010; 184: 1028–33.
- 2Link BA, Nelson R, Josephson DY et al. The impact of prostate gland weight in robot assisted laparoscopic radical prostatectomy. J Urol 2008; 180: 928–32.
- 3Ko YH, Coelho RF, Sivaraman A et al. Retrograde versus antegrade nerve sparing during robot-assisted radical prostatectomy: which is better for achieving early functional recovery? Eur Urol 2013; 63: 169–77.
- 4Milhoua PM, Koi PT, Lowe D, Ghavamian R. Issue of prostate gland size, laparoscopic radical prostatectomy, and continence revisited. Urology 2008; 71: 417–20.
- 5Konety BR, Sadetsky N, Carroll PR, CaPSURE Investigators. Recovery of urinary following radical prostatectomy: the impact of prostate volume-analysis of data from the CaPSURE Database. J Urol 2007; 177: 1423–5.
- 6Jeong SJ, Kim HJ, Kim JH et al. Urinary continence after radical prostatectomy: predictive factors of recovery after 1 year of surgery. Int J Urol 2012; 19: 1091–8.
- 7Boczko J, Erturk E, Golijanin D, Madeb R, Patel H, Joseph JV. Impact of prostate size in robot-assisted radical prostatectomy. J Endourol 2007; 21: 184–8.
- 8Kim JJ, Ha YS, Kim JH et al. Independent predictors of recovery of continence 3 months after robot-assisted laparoscopic radical prostatectomy. J Endourol 2012; 26: 1290–5.
- 9Lavigueur-Blouin H, Noriega AC, Valdivieso R et al. Predictors of early continence following robot-assisted radical prostatectomy. Can Urol Assoc J 2015; 9: e93–7.
- 10Fujimura T, Menon M, Fukuhara H et al. Validation of an educational program balancing surgeon training and surgical quality control during robot-assisted radical prostatectomy. Int J Urol 2016; 23: 160–6.
- 11Ku JY, Ha HK. Learning curve of robot-assisted laparoscopic radical prostatectomy for a single experienced surgeon: comparison with simultaneous laparoscopic radical prostatectomy. World J Mens Health 2015; 33: 30–5.
- 12 American Joint Committee on Cancer (AJCC). Prostate. In: SB Edge, DR Byrd, CC Compton, et al., eds. AJCC Cancer Staging Manual, 7th edn. New York: Springer, 2010; 457–68.
10.1007/978-0-387-88441-7_41 Google Scholar
- 13Patel VR, Coelho R, Palmer KJ, Rocco B. Periurethral suspension stitch during robot-assisted laparoscopic radical prostatectomy: description of the technique and continence outcomes. Eur Urol 2009; 56: 472–8.
- 14Campenni MA, Harmon JD, Ginsberg PC, Harkaway RC. Improved continence after radical retropubic prostatectomy using two pubourethral suspension stitches. Urol Int 2002; 68: 109–12.
- 15Rocco F, Carmignani L, Acquati P et al. Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy. J Urol 2006; 175: 2201–6.
- 16Rocco F, Carmignani L, Acquati P et al. Early continence recovery after open radical prostatectomy with restoration of the posterior aspect of the rhabdosphincter. Eur Urol 2007; 52: 376–83.
- 17Rocco F, Rocco B. Anatomical reconstruction of the rhabdosphincter after radical prostatectomy. BJU Int 2009; 104: 274–81.
- 18Wiltz AL, Shikanov S, Eggener SE et al. Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology 2009; 73: 316–22.
- 19Geraerts I, Van Poppel H, Devoogdt N, Van Cleynenbreugel B, Joniau S, Van Kampen M. Prospective evaluation of urinary incontinence, voiding symptoms and quality of life after open and robot-assisted radical prostatectomy. BJU Int 2013; 112: 936–43.
- 20You YC, Kim TH, Sung GT. Effect of bladder neck preservation and posterior urethral reconstruction during robot-assisted laparoscopic radical prostatectomy for urinary continence. Korean J Urol 2012; 53: 29–33.
- 21Gu X, Araki M, Wong C. Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP). Minim Invasive Ther Allied Technol 2015; 24: 364–74.
- 22Kojima Y, Takahashi N, Haga N. Urinary incontinence after robot-assisted radical prostatectomy: pathophysiology and intraoperative techniques to improve surgical outcome. Int J Urol 2013; 20: 1052–63.
- 23Kumar A, Samavedi S, Bates AS, Coelho RF, Rocco B, Palmer K, Patel VR. Continence outcomes of robot-assisted radical prostatectomy in patients with adverse urinary continence risk factors. BJU Int 2015; 116: 764–70.
- 24Ludovico GM, Dachille G, Pagliarulo G et al. Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients. Oncol Rep 2013; 29: 2445–50.
- 25Pick DL, Osann K, Skarecky D, Narula N, Finley DS, Ahlering TE. The impact of cavernosal nerve preservation on continence after robotic radical prostatectomy. BJU Int 2011; 108: 1492–6.
- 26Choi WW, Freire MP, Soukup JR et al. Nerve-sparing technique and urinary control after robot-assisted laparoscopic prostatectomy. World J Urol 2011; 29: 21–7.
- 27Srivastava A, Chopra S, Pham A. Effect of a risk-stratified grade of nerve-sparing technique on early return of continence after robot-assisted laparoscopic radical prostatectomy. Eur Urol 2013; 63: 438–44.
- 28van Randenborgh H, Paul R, Kubler H, Breul J, Hartung R. Improved urinary continence after radical retropubic prostatectomy with preparation of a long, partially intraprostatic portion of the membranous urethra: an analysis of 1013 consecutive cases. Prostate Cancer Prostatic Dis 2004; 7: 253–7.
- 29Dal Moro F, Crestani A, Valotto C, Zattoni F. CORPUS—novel complete reconstruction of the posterior urethral support after robotic radical prostatectomy: preliminary data of very early continence recovery. Urology 2014; 83: 641–7.
Citing Literature
