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World Journal of Urology Sep 2023Salvage Radical Prostatectomy is challenging and associated with high rates of incontinence. The novel Retzius-sparing RARP (RS-RARP) approach has shown impressive high... (Meta-Analysis)
Meta-Analysis
PURPOSE
Salvage Radical Prostatectomy is challenging and associated with high rates of incontinence. The novel Retzius-sparing RARP (RS-RARP) approach has shown impressive high immediate and 1-year continence rates (> 90%) when applied as primary treatment. The purpose of this study is to evaluate the impact of salvage Retzius-sparing RARP (sRS-RARP) on continence outcomes in the salvage scenario.
MATERIALS AND METHODS
Using PRISMA guidelines, a systematic review and meta-analysis of articles was conducted on Medline through PubMed and on Cochrane through Central Register of Controlled Trials databases. Inclusion and exclusion criteria were used to select 17 retrospective cohort studies published until April 2023 about sRS-RARP and continence. Data were extracted independently by at least two authors. The International Prospective Register of Systematic Reviews (PROSPERO) was registered. Retrospective studies were subjected to a domain-based risk of bias assessment in accordance with the Newcastle-Ottawa quality assessment scale cohort studies (NOS). Prostate cancer patients were chosen from prospective nonrandomized or randomized sRS-RARP or sS-RARP studies that examined continence outcomes.
RESULTS
Seventeen studies were included: 14 were retrospectives only and 3 described retrospective comparison cohorts (sRS-RARP vs sS-RARP). All the retrospective studies were of "fair" quality using the NOS. sRS-RARP may increase recovery of urinary continence after surgery compared to sS-RARP [OR 4.36, 95% CI 1.7-11.17; I = 46.8%; studies = 4; participants = 87].
CONCLUSIONS
sRS-RARP approach has potential to improve continence outcomes in the salvage setting. sRS-RARP approach has potential to positively impact continence function on patients who underwent salvage surgery.
Topics: Male; Humans; Robotic Surgical Procedures; Retrospective Studies; Treatment Outcome; Prostate; Prostatectomy; Prostatic Neoplasms; Randomized Controlled Trials as Topic
PubMed: 37414943
DOI: 10.1007/s00345-023-04505-w -
Cancers Jun 2021External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear.... (Review)
Review
External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle-Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.
PubMed: 34208888
DOI: 10.3390/cancers13133274 -
Frontiers in Endocrinology 2023Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation. (Meta-Analysis)
Meta-Analysis
CONTEXT
Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation.
OBJECTIVE
To systematically evaluate the current evidence regarding the reoperation rates of surgical treatment for LUTS in accordance with current recommendations and guidelines.
EVIDENCE ACQUISITION
Eligible studies published up to July 2023, were searched for in the PubMed (National Library of Medicine, Bethesda, MD, USA), Embase (Elsevier, Amsterdam, the Netherlands), and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases. STATA (StataCorp LP, College Station, TX, USA) software was used to conduct the meta-analysis. Random-effects models were used to calculate the pooled incidences (PIs) of reoperation and the 95% confidence intervals (CIs).
EVIDENCE SYNTHESIS
A total of 119 studies with 130,106 patients were included. The reoperation rate of transurethral resection of the prostate (TURP) at 1, 2, 3, and 5 years was 4.0%, 5.0%, 6.0%, and 7.7%, respectively. The reoperation rate of plasma kinetic loop resection of the prostate (PKRP) at 1, 2, 3, and 5 years was 3.5%, 3.6%, 5.7%, and 6.6%, respectively. The reoperation rate of holmium laser enucleation of the prostate (HoLEP) at 1, 2, 3, and 5 years was 2.4%, 3.3%, 5.4%, and 6.6%, respectively. The reoperation rate of photoselective vaporization of the prostate (PVP) at 1, 2, 3, and 5 years was 3.3%, 4.1%, 6.7%, and 7.1%, respectively. The reoperation rate of surgery with AquaBeam at 1, 2, 3, and 5 years was 2.6%, 3.1%, 3.0%, and 4.1%, respectively. The reoperation rate of prostatic artery embolization (PAE) at 1, 2, 3, and 5 years was 12.2%, 20.0%, 26.4%, and 23.8%, respectively. The reoperation rate of transurethral microwave thermotherapy (TUMT) at 1, 2, 3, and 5 years was 9.9%, 19.9%, 23.3%, and 31.2%, respectively. The reoperation rate of transurethral incision of the prostate (TUIP) at 5 years was 13.4%. The reoperation rate of open prostatectomy (OP) at 1 and 5 years was 1.3% and 4.4%, respectively. The reoperation rate of thulium laser enucleation of the prostate (ThuLEP) at 1, 2, and 5 years was 3.7%, 7.7%, and 8.4%, respectively.
CONCLUSION
Our results summarized the reoperation rates of 10 surgical procedures over follow-up durations of 1, 2, 3, and 5 years, which could provide reference for urologists and LUTS patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023445780.
Topics: United States; Humans; Male; Prostatic Hyperplasia; Transurethral Resection of Prostate; Prostate; Reoperation; Embolization, Therapeutic; Lower Urinary Tract Symptoms
PubMed: 38027158
DOI: 10.3389/fendo.2023.1287212 -
Urology Research & Practice Jan 2024Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP),...
OBJECTIVE
Prostate cancer is the second- leading cause of cancer death among men. We aimed to evaluate high-intensity focused ultrasound (HIFU), open radical prostatectomy (ORP), robot-assisted radical prostatectomy (RARP), and external beam radiation therapy (RT) in the treatment of localized low- and intermediate-risk prostate cancer.
METHODS
We searched bibliographic databases for case-control, cohort, and randomized controlled studies. We used MeSH subject headings and free text terms for prostate cancer, HIFU, ORP, RARP, RT, failure-free survival (FFS), biochemical disease-free survival (BDFS), urinary incontinence (UI), and erectile dysfunction (ED).
RESULTS
Fourteen studies were included in the review, for a total of 34 927 participants. Among the 8 studies of HIFU as the primary treatment of localized low- and intermediate- risk prostate cancer, 4 studies reported 5-year FFS rates ranging from 67.8% to 97.8%, 3 studies reported 5-year BDFS ranging from 58% to 85.4%, 5 studies reported 1-year UI rates ranging from 0% to 6%, and 4 studies reported 1-year ED rates ranging from 11.4% to 38.7%. Furthermore, our search revealed a 5-year FFS benefit favoring ORP compared to RT, a 1-year UI rate favoring ORP compared to RARP, and a 1-year ED rate favoring ORP compared to RARP.
CONCLUSION
Our systematic review and meta-analysis revealed lack of studies with active comparators comparing HIFU to standard of care (ORP, RARP, or RT) in primary treatment of localized low- and intermediate-risk prostate cancer. Open radical prostatectomy has favorable efficacy outcomes compared to RT, while RARP has beneficial functional outcomes compared to ORP, respectively.
PubMed: 38451125
DOI: 10.5152/tud.2024.23123 -
Cancers Mar 2022Prostate cancer (PCa) treatment involves multiple strategies depending on the disease's stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced... (Review)
Review
Prostate cancer (PCa) treatment involves multiple strategies depending on the disease's stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.
PubMed: 35406556
DOI: 10.3390/cancers14071784 -
Journal of Robotic Surgery Dec 2023Laser enucleation of the prostate (LEP) and robotic-assisted simple prostatectomy (RASP) are two main treatment methods for large benign prostatic hyperplasia (BPH), but... (Meta-Analysis)
Meta-Analysis Review
Laser enucleation of the prostate (LEP) and robotic-assisted simple prostatectomy (RASP) are two main treatment methods for large benign prostatic hyperplasia (BPH), but the superiority between these two methods in treating large BPH is currently unclear. This study aims to conduct a meta-analysis to compare the efficacy and the safety of LEP and RASP in treating large BPH. We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared safety and efficacy outcomes of both LEP and RASP. Review Manager 5.3 was used for the meta-analysis. Six studies with a total of 1235 patients were included in the analysis. Resected adenoma weight was similar in LEP than RASP group. Operative time [mean difference (MD) - 67.96; 95% confidence interval [CI] - 131.66 to - 4.25; p = 0.04], catheterization time (MD -6.31; 95% CI - 9.44 to - 3.18; p < 0.0001), and length of stay (MD - 2.44; 95% CI - 3.55 to - 1.34; p < 0.0001) were lower in LEP. The International Prostate Symptom Score, maximum urinary flow rate, prostate-specific antigen, and post-void residual urine volume were also comparable between two groups. Furthermore, LEP demonstrated lesser hemoglobin decrease (MD - 0.50; 95% CI - 0.96 to - 0.05; p = 0.03), lower blood transfusion rate [odd ratio (OR) 0.23, 95% CI 0.08-0.66; p = 0.006], and lower rate of Clavien-Dindo Grade ≥ 3 complications (OR 0.435, 95% CI 0.189-0.998; p = 0.049). Finally, there was no significant difference in overall complications between two groups. Current evidence shows that LEP offers favorable perioperative outcomes compared with RASP. However, there was no conclusive evidence that LEP was advantaged in terms of efficacy outcomes.
Topics: Male; Humans; Prostate; Prostatic Hyperplasia; Prostatectomy; Robotic Surgical Procedures; Lasers; Treatment Outcome; Quality of Life
PubMed: 37796379
DOI: 10.1007/s11701-023-01734-4 -
Frontiers in Public Health 2023We performed a systematic review and meta-analysis to evaluate the effect of preoperative pelvic floor muscle exercise on urinary incontinence after radical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We performed a systematic review and meta-analysis to evaluate the effect of preoperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy.
METHODS
We searched the literature for randomized controlled trials evaluating the diagnostic analysis of preoperative pelvic floor muscle exercise (PFME) and postprostatectomy incontinence in the MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, China Biomedical Literature Database, China Journal Full-text Database, Wanfang Database and Weipu Database. The retrieval time limit is from the establishment of the database to January 2023. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses.
RESULTS
Twelve studies were included based on the selection criteria. The total number of patients included in the final analysis was 1,365. At 1th month, there was no difference in continence rates between the groups [odds ratio (OR): 0.47; 95% confidence interval (CI), 0.22-1.02, = 0.06]. At 3th month, there was statistically significant difference in PFME group before operation (OR: 0.61; 95% CI, 0.37-0.98, = 0.04). At 6th and 12th months, there was no difference between groups (OR: 0.57; 95% CI, 0.28-1.17, = 0.13), (OR: 0.56; 95% CI, 0.27-1.15, = 0.12).
CONCLUSION
Preoperative pelvic floor muscle exercise can improve postoperative urinary incontinence at 3rd months after radical prostatectomy, but it cannot improve urinary incontinence at 6th months or longer after surgery, which indicates that preoperative PFME can improve early continence rate, but cannot improve long-term urinary incontinence continence rate.
Topics: Male; Humans; Pelvic Floor; Prostatectomy; China; Databases, Factual; Urinary Incontinence
PubMed: 37588123
DOI: 10.3389/fpubh.2023.1186067 -
Journal of Vascular and Interventional... Apr 2022To review and to compare indirectly the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To review and to compare indirectly the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.
MATERIALS AND METHODS
A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostatic artery embolization (PAE). Data on the following variables were included: International prostate symptom score (IPSS), maximum urinary flow rate, quality of life, and postvoid residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect.
RESULTS
There was no significant difference in outcomes between therapies for IPSS at the 3, 6, and 12-month follow ups. Although outcomes for Rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation versus PAE versus Rezum. TURP PVR was significantly better than Urolift at 3, 6, and 12 months. No significant differences in minor or major adverse events were noted.
CONCLUSION
Although significant differences in outcomes were limited, Aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while Aquablation has limited high quality data and has been associated with bleeding-related complications.
Topics: Embolization, Therapeutic; Humans; Lower Urinary Tract Symptoms; Male; Network Meta-Analysis; Prostate; Prostatic Hyperplasia; Quality of Life; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34968671
DOI: 10.1016/j.jvir.2021.12.029 -
Journal of Robotic Surgery Dec 2023To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of transurethral thulium laser enucleation versus robot-assisted prostatectomy for large-volume benign prostatic hyperplasia: a systematic review and meta-analysis.
To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign prostatic hyperplasia(> 80 ml). In August 2023, we undertook a comprehensive search of major global databases including PubMed, Embase, and Google Scholar, focusing solely on articles written in English. Studies that were merely reviews or protocols without any specific published data were omitted. Furthermore, articles that comprised conference abstracts or content not pertinent to our subject of study were also disregarded. To calculate the inverse variances and 95% confidence intervals (CIs) for categorical variables' mean differences, we employed the Cochran-Mantel-Haenszel approach along with random-effects models. The findings were denoted in the form of odds ratios (ORs) and 95% CIs. A p-value less than 0.05 was deemed to indicate statistical significance. Our finalized meta-analysis incorporated six articles, including one randomized controlled trial (RCT) and five cohort studies. These studies accounted for a total of 1218 patients, 944 of whom underwent Holmium Laser Enucleation of the Prostate (HoLEP) and 274 who underwent Robotic-Assisted Simple Prostatectomy (RASP). The pooled analysis from these six papers demonstrated that compared to RASP, HoLEP had a shorter hospital stay, shorter catheterization duration, and a lower blood transfusion rate. Moreover, HoLEP patients exhibited a smaller reduction in postoperative hemoglobin levels. Statistically, there were no significant differences between the two procedures regarding operative time, postoperative PSA, the weight of prostate specimens, IPSS, Qmax, PVR, QoL, and postoperative complications. (HoLEP) and (RASP) are both effective and safe procedures for treating large-volume benign prostatic hyperplasia. HoLEP, with its benefits of shorter catheterization and hospitalization duration, lesser decline in postoperative hemoglobin, and reduced blood transfusion needs, stands as a preferred choice for treating extensive prostate enlargement. However, further validation through more high-quality clinical randomized trials is required.
Topics: Humans; Male; Hemoglobins; Laser Therapy; Lasers, Solid-State; Prostatectomy; Prostatic Hyperplasia; Quality of Life; Randomized Controlled Trials as Topic; Robotic Surgical Procedures; Thulium; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 37731152
DOI: 10.1007/s11701-023-01715-7 -
Robotic Surgery (Auckland) 2019Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using... (Review)
Review
INTRODUCTION
Robotic surgery has been increasingly used in fashioning various surgical anastomoses. Our aim was to collect and analyze outcomes related to anastomoses performed using a robotic approach and compare them with those done using laparoscopic or open approaches through meta-analysis.
METHODS
A systematic review was conducted for articles comparing robotic with laparoscopic and/or open operations (colectomy, low anterior resection, gastrectomy, Roux-en-Y gastric bypass (RYGB), pancreaticoduodenectomy, radical cystectomy, pyeloplasty, radical prostatectomy, renal transplant) published up to June 2019 searching Medline, Scopus, Google Scholar, Clinical Trials and the Cochrane Central Register of Controlled Trials. Studies containing information about outcomes related to hand-sewn anastomoses were included for meta-analysis. Studies with stapled anastomoses or without relevant information about the anastomotic technique were excluded. We also excluded studies in which the anastomoses were performed extracorporeally in laparoscopic or robotic operations.
RESULTS
We included 83 studies referring to the aforementioned operations (4 randomized controlled and 79 non-randomized, 10 prospective and 69 retrospective) apart from colectomy and low anterior resection. Anastomoses done using robotic instruments provided similar results to those done using laparoscopic or open approach in regards to anastomotic leak or stricture. However, there were lower rates of stenosis in robotic than in laparoscopic RYGB (p=0.01) and in robotic than in open radical prostatectomy (p<0.00001). Moreover, all anastomoses needed more time to be performed using the robotic rather than the open approach in renal transplant (p≤0.001).
CONCLUSION
Robotic anastomoses provide equal outcomes with laparoscopic and open ones in most operations, with a few notable exceptions.
PubMed: 31921934
DOI: 10.2147/RSRR.S186768