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Deutsches Arzteblatt International Dec 2020Benign prostatic hyperplasia (BPH) is characterized by the occurrence of.disorders of urine storage and bladder emptying. Most men over the age of 60 years are affected... (Review)
Review
BACKGROUND
Benign prostatic hyperplasia (BPH) is characterized by the occurrence of.disorders of urine storage and bladder emptying. Most men over the age of 60 years are affected to some degree.
METHODS
A selective literature search with additional scrutiny of guidelines and meta-analyses.
RESULTS
The management of patients with BPH is complex. Emptying and retention disorders can be treated by various pharmacological and surgical means. Transurethral resection of the prostate (TURP) has long been considered the gold standard for operative treatment. Transurethral enucleation procedures show a better risk profile in some uses, however, and have, above all, largely displaced suprapubic prostatectomy. Numerous innovative treatment options have been developed in recent years, but their long-term effects remain to be determined. These treatment techniques can nevertheless be used in individual cases after thorough discussion with the patient.
CONCLUSION
The care of patients with BPH should be interdisciplinary. The efficacy and safety of many new developments in the area of pharmacological and minimally invasive treatment remain to be demonstrated in randomized trials.
Topics: Humans; Laser Therapy; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 33593479
DOI: 10.3238/arztebl.2020.0843 -
Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy.Nature Reviews. Urology May 2021Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the... (Review)
Review
Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the surgical technique, urinary continence recovery time remains variable. A range of surgical and patient-related risk factors contributing to urinary incontinence after radical prostatectomy have been described, including age, BMI, membranous urethral length and urethral sphincter insufficiency. Physical activity interventions incorporating aerobic exercise, resistance training and pelvic floor muscle training programmes can positively influence the return to continence in men after radical prostatectomy. Traditional approaches to improving urinary continence after radical prostatectomy have typically focused on interventions delivered during the postoperative period (rehabilitation). However, the limited efficacy of these postoperative approaches has led to a shift from the traditional reactive model of care to more comprehensive interventions incorporating exercise-based programmes that begin in the preoperative period (prehabilitation) and continue after surgery. Comprehensive prehabilitation interventions include appropriately prescribed aerobic exercise, resistance training and specific pelvic floor muscle instruction and exercise training programmes. Transperineal ultrasonography is a non-invasive and validated method for the visualization of the action of the pelvic floor musculature, providing real-time visual biofeedback to the patient during specific pelvic floor muscle instruction and training. Importantly, the waiting time before surgery can be used for the delivery of comprehensive prehabilitation exercise-based interventions to increase patient preparedness in the lead-up to surgery and optimize continence and health-related quality-of-life outcomes following radical prostatectomy.
Topics: Humans; Male; Postoperative Complications; Preoperative Exercise; Prostatectomy; Prostatic Neoplasms; Treatment Outcome; Urinary Incontinence
PubMed: 33833445
DOI: 10.1038/s41585-021-00445-5 -
European Urology Jul 2017There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa). (Review)
Review
CONTEXT
There is controversy regarding the therapeutic role of pelvic lymph node dissection (PLND) in patients undergoing radical prostatectomy for prostate cancer (PCa).
OBJECTIVE
To systematically review the relevant literature assessing the relative benefits and harms of PLND for oncological and non-oncological outcomes in patients undergoing radical prostatectomy for PCa.
EVIDENCE ACQUISITION
MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2015. Comparative studies evaluating no PLND, limited, standard, and (super)-extended PLND that reported oncological and non-oncological outcomes were included. Risk-of-bias and confounding assessments were performed. A narrative synthesis was undertaken.
EVIDENCE SYNTHESIS
Overall, 66 studies recruiting a total of 275,269 patients were included (44 full-text articles and 22 conference abstracts). Oncological outcomes were addressed by 29 studies, one of which was a randomized clinical trial (RCT). Non-oncological outcomes were addressed by 43 studies, three of which were RCTs. There were high risks of bias and confounding in most studies. Conflicting results emerged when comparing biochemical and clinical recurrence, while no significant differences were observed among groups for survival. Conversely, the majority of studies showed that the more extensive the PLND, the greater the adverse outcomes in terms of operating time, blood loss, length of stay, and postoperative complications. No significant differences were observed in terms of urinary continence and erectile function recovery.
CONCLUSIONS
Although representing the most accurate staging procedure, PLND and its extension are associated with worse intraoperative and perioperative outcomes, whereas a direct therapeutic effect is still not evident from the current literature. The current poor quality of evidence indicates the need for robust and adequately powered clinical trials.
PATIENT SUMMARY
Based on a comprehensive review of the literature, this article summarizes the benefits and harms of removing lymph nodes during surgery to remove the prostate because of PCa. Although the quality of the data from the studies was poor, the review suggests that lymph node removal may not have any direct benefit on cancer outcomes and may instead result in more complications. Nevertheless, the procedure remains justified because it enables accurate assessment of cancer spread.
Topics: Adult; Aged; Aged, 80 and over; Disease-Free Survival; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Odds Ratio; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 28126351
DOI: 10.1016/j.eururo.2016.12.003 -
American Journal of Men's Health Jul 2018The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted radical prostatectomy on postprocedural incontinence problems. This study was a randomized controlled trial. Pelvic floor muscle exercises were applied to the procedure group three times a day for 6 months. No exercises were applied to the control group. Incontinence and quality-of-life assessments of the 60 patients in the experimental and control groups were performed on months 0 (10 days after removal of the urinary catheter), 1, 3, and 6 through face-to-face and telephone interviews. Total Incontinence Consultation on Incontinence-Short Form scores, which provide an objective criterion for the evaluation of individuals with incontinence problems, decreased over time. This decrease was statistically highly significant in the third and sixth months. Pelvic muscle floor exercises are suitable for patients experiencing incontinence after radical prostatectomy.
Topics: Aged; Biofeedback, Psychology; Exercise Therapy; Humans; Male; Middle Aged; Pelvic Floor; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Quality of Life; Reference Values; Risk Assessment; Severity of Illness Index; Treatment Outcome; Urinary Incontinence
PubMed: 29540090
DOI: 10.1177/1557988318757242 -
Ugeskrift For Laeger Apr 2023The treatment of benign prostatic hyperplasia includes a variety of options ranging from medication to open prostatectomy. Several newer technologies have been... (Review)
Review
The treatment of benign prostatic hyperplasia includes a variety of options ranging from medication to open prostatectomy. Several newer technologies have been developed. Transurethral resection of the prostate remains the gold standard among surgical procedures for prostates less than 80 cc whereas enucleation and simple open prostatectomy are most documented for larger prostates. This review has focus on the status of treatment available in Denmark at the moment. Thorough evaluation of the patients before treatment and shared decision-making with regard to treatment options is essential.
Topics: Male; Humans; Prostatic Hyperplasia; Transurethral Resection of Prostate; Prostatectomy; Prostate; Laser Therapy
PubMed: 37057701
DOI: No ID Found -
The Canadian Journal of Urology Oct 2020INTRODUCTION To characterize procedure variables and outcome data from men undergoing the Aquablation Therapy of the prostate procedure for lower urinary tract symptoms...
UNLABELLED
INTRODUCTION To characterize procedure variables and outcome data from men undergoing the Aquablation Therapy of the prostate procedure for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). We evaluated the safety and efficacy of robotically guided waterjet-based prostate resection in the first study of all-comers in a single-center, commercial setting in the United States.
MATERIALS AND METHODS
The analysis was a retrospective review of prospectively collected data.
RESULTS
Fifty-five men underwent the Aquablation of the prostate between July 2018 and December 2019. Mean prostate volume was 100 cc, and 85% had a prominent, obstructing middle lobe. Operative time averaged 59 minutes, and the mean hemoglobin drop was 1 g/dL. A substantial improvement of 80% (17 points) was seen in BPH symptoms scores. By uroflowmetry, Qmax improved by 182% (14 mL/sec). Men with prostate volume > 100 cc had similar hospital length of stay, BPH symptom reduction, and Qmax improvement compared to those with volume < 100 cc.
CONCLUSION
In the setting of a community private urology practice, Aquablation Therapy was safe and effective for the treatment of men with BPH regardless of prostate shape or prostate size.
Topics: Ablation Techniques; Aged; Aged, 80 and over; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Prostatectomy; Prostatic Hyperplasia; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; Water
PubMed: 33049190
DOI: No ID Found -
Current Oncology (Toronto, Ont.) Apr 2023In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application... (Review)
Review
In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.
Topics: Male; Humans; Prospective Studies; Robotic Surgical Procedures; Robotics; Prostatic Neoplasms; Prostatectomy
PubMed: 37185441
DOI: 10.3390/curroncol30040328 -
Current Urology Reports Sep 2017Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative... (Review)
Review
PURPOSE OF REVIEW
Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative erectile dysfunction (ED). The aim of this study is to summarize the current literature on surgical techniques for managing post-prostatectomy erectile dysfunction.
RECENT FINDINGS
The PubMed database was searched for English-language articles published up to Jan 2017 using the following search terms: "prostatectomy AND erectile dysfunction", "prostatectomy AND penile prostheses", and "prostatectomy AND penile implants". All of the studies that evaluated medical treatment were excluded. In the last few decades, the understanding of the anatomy of the male pelvis and prostate has improved. This has led to significant changes in the nerve-sparing radical prostatectomy techniques, with the aim of preserving post-surgical erectile function (EF). In this scenario, the prostate vascular supply and the anatomy of the neurovascular bundles have a central role. Penile prosthesis implantation is considered the third-line treatment option for RP ED patients, and they have been reported to be a very successful treatment with the highest patient satisfaction rate. Considering the failure of penile rehabilitation, and the lack of evidence for accessory pudendal artery (APA) preservation and nerve graft, nerve-sparing surgery and penile prostheses represent, today, the only methods to permanently and definitively preserve or erectile function after RP.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penis; Prostatectomy; Prostatic Neoplasms
PubMed: 28965315
DOI: 10.1007/s11934-017-0735-2 -
Sexual Medicine Reviews Apr 2018The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual... (Review)
Review
INTRODUCTION
The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual dysfunction in patients and their intimate partners.
AIM
To identify predictors of sexual satisfaction in prostate cancer survivors and their partners based on a review of the current literature.
METHODS
We performed a comprehensive review of the PubMed database from January 2000 to May 2017 focused on the (i) prevalence of patient and partner sexual dysfunction related to radical prostatectomy, (ii) differences in patient and partner perspectives of sexual function and dysfunction, and (iii) predictors of patient and partner sexual satisfaction after radical prostatectomy.
MAIN OUTCOME MEASURES
Patient- and partner-reported sexual satisfaction.
RESULTS
There is a paucity of published data examining sexual satisfaction in prostate cancer survivors and their partners. Patients and partners can have different expectations of sexual outcomes after radical prostatectomy and different attitudes toward the relative importance of recovery of sexual function after surgery. Available data suggest that patients' and partners' mental and physical health and the quality of communication between them are important contributors to their sexual satisfaction. Patient-perceived partner support also is associated with better patient-reported erectile function and greater relationship satisfaction.
CONCLUSION
Mental health, physical health, quality of interpersonal communication, and patient-perceived partner support appear to be the most important predictors of sexual satisfaction for patients and partners in the post-prostatectomy period. There is a definite need for further research on this topic to develop interventions to improve sexual function and quality of life for prostate cancer survivors and their intimate partners. Guercio C, Mehta A. Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy. Sex Med Rev 2018;6:295-301.
Topics: Female; Humans; Male; Orgasm; Personal Satisfaction; Prostatectomy; Prostatic Neoplasms; Sexual Dysfunction, Physiological; Sexual Partners
PubMed: 29128271
DOI: 10.1016/j.sxmr.2017.08.005 -
The Canadian Journal of Urology Oct 2015Prostatectomy for benign disease, also known as a 'simple prostatectomy', is neither simple in indication nor approach. In the post-Medical Therapy of Prostatic Symptoms... (Comparative Study)
Comparative Study Review
INTRODUCTION
Prostatectomy for benign disease, also known as a 'simple prostatectomy', is neither simple in indication nor approach. In the post-Medical Therapy of Prostatic Symptoms (MTOPS), NCT00021814 trial era, the medical management of benign prostatic hyperplasia (BPH) and consequent bladder outlet obstruction (BOO) has shifted surgical intervention to those patients who are medical-non responders, present with advanced signs of BOO and obstructive uropathy, and those with prostate gland volumes beyond the size normally approachable with standard transurethral resection of the prostate (TURP). Simple prostatectomy through an open surgical approach is associated with improvements in BOO and lower urinary tract symptoms (LUTS) but at the expense of considerable surgical and perioperative morbidity. Advances in technology have made it possible for patients to be offered standard open surgical approaches as well as transurethral approaches with photon-based energy sources (i.e. laser prostatectomy) and laparoscopic simple prostatectomy. A review of the historical challenges of BPH and the standard-of-care of open prostatectomy will put into perspective the potential advantages and disadvantages of laparoscopic and robotic prostatectomy for the treatment of benign BOO due to BPH.
MATERIALS AND METHODS
A careful review of the literature was performed utilizing PubMed and ClinicalKey searches to identify relevant articles. Search terms 'simple prostatectomy', 'robotic simple prostatectomy' and 'laparoscopic simple prostatectomy'.
RESULTS
Over 14 series of open simple prostatectomies and over 20 minimally invasive series were identified and used as a reference. Additionally, several review articles were identified and incorporated.
CONCLUSIONS
Simple prostatectomy may be performed safely in appropriately selected patients utilizing either open or minimally invasive approaches. Clinical criteria should be used to determine the appropriateness of either retropubic versus transvesical approach.
Topics: Aged; Aged, 80 and over; Follow-Up Studies; Humans; Laparoscopy; Laparotomy; Length of Stay; Male; Minimally Invasive Surgical Procedures; Operative Time; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Reoperation; Risk Assessment; Robotic Surgical Procedures; Survival Rate; Treatment Outcome
PubMed: 26497345
DOI: No ID Found