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British Journal of Nursing (Mark Allen... Oct 2023Between 8 and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology...
BACKGROUND
Between 8 and 87% of prostatectomies result in urinary incontinence, with around half of patients using incontinence pads daily at 6 months. Specialist urology continence nurses at the Norfolk and Norwich University Hospitals (NNUH) NHS Foundation Trust created a pre- and post-surgical care pathway formalising support for these patients, which involves the provision of TENA Men (Essity) male incontinence pads.
AIMS
This audit aimed to assess patient satisfaction with this pathway and TENA Men pads.
METHODS
Patients who underwent a radical prostatectomy at NNUH between 27 April and 9 November 2021 and who required continence pads were invited to fill out an online anonymous mixed-method (mainly qualitative) survey.
RESULTS
Of 28 respondents, 71% reported incontinence after their surgical catheter was removed. Most (89%) were satisfied with the preoperative advice. Of 19 respondents to questions on confidence and satisfaction, 16 were confident that the pads they had been prescribed were helping them to manage urinary leakage, and 16 were confident or very confident that they could manage their incontinence themselves. Generally, respondents were confident that their overall and mental health had improved, and most were confident or very confident that they had less anxiety. However, less than a quarter of respondents were 'very confident' about going out, meeting people or exercising. All but one respondent found TENA Men pads easy to fit, and the most used words in the free-text explanations of what they most liked, included 'easy', 'discreet', 'comfortable' and 'unobtrusive'.
CONCLUSION
The clinical pathway helped give patients undergoing radical prostatectomy confidence in their ability to manage post-surgery incontinence themselves and could be of value in other hospitals. Easy access to incontinence pads designed for the male anatomy has an important part in this.
Topics: Humans; Male; Patient Satisfaction; Urinary Incontinence; Incontinence Pads; Prostatectomy; Personal Satisfaction
PubMed: 37861468
DOI: 10.12968/bjon.2023.32.Sup19.S17 -
Harefuah Jul 2008Prostate cancer is the most common malignant disease in men. The incidence of prostate cancer has been rising since the early 1990s. Not all men inflicted by prostate... (Review)
Review
Prostate cancer is the most common malignant disease in men. The incidence of prostate cancer has been rising since the early 1990s. Not all men inflicted by prostate cancer will develop clinical disease. Therefore, sorting these cases is a great clinical challenge. Radical prostatectomy has undergone evolution in the last 100 years. Better understanding of the pelvic anatomy has led to a decrease in the blood loss during surgery and in the rate of urinary incontinence and erectile dysfunction following surgery. The introduction of laparoscopy in the late 1990s to this surgery provided the surgeon with a magnified multi-angle field of view and facilitated accurate dissection and suturing. Decreased damage to neighboring tissue made recovery hastier. Nevertheless, laparoscopic radical prostatectomy is a technically challenging surgery and did not become popular. The last step in the evolution of radical prostatectomy is the introduction of robotic systems for assistance in laparoscopic radical prostatectomy. A master-slave robotic system is composed of console and mechanical arms. The surgeon is provided with a magnified three dimensional view of the operative field and with two mechanical arms that accurately replicate its fingers movements. The initial results of robotic-assisted laparoscopic prostatectomy seem promising, however, long-term follow-up and comparison to open surgeries are lacking. Robotic systems were rapidly implemented in the American market and in the year 2006, 40% of all radical prostatectomies were robotic assisted. Future systems may reveal deep structures to the visualized surface by superimposing MRI images on the surgical field.
Topics: History, 20th Century; History, 21st Century; Humans; Laparoscopy; Male; Prostatectomy
PubMed: 18814526
DOI: No ID Found -
The Journal of Urology Feb 2020To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence... (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
To investigate the incidence of inguinal hernia following radical prostatectomy we compared the incidence after open retropubic radical prostatectomy with the incidence after the laparoscopic and robot-assisted radical prostatectomies, and using control groups.
MATERIALS AND METHODS
We included all original articles on studies providing data on inguinal hernia incidence in patients treated with radical prostatectomy for localized prostate cancer. PubMed® and EMBASE® were searched on February 28, 2018. A meta-analysis was done as a weighted and pooled estimate of the incidence of inguinal hernia. The bias risk was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Collaboration tool for randomized clinical trials.
RESULTS
We included 54 studies with a total of 101,687 patients. The estimated incidence of inguinal hernia was 13.7% (95% CI 12.0-15.4) after open retropubic radical prostatectomy, 7.5% (95% CI 5.2-9.8) after laparoscopic radical prostatectomy and 7.9% (95% CI 5.0-10.9) after robot-assisted laparoscopic radical prostatectomy. In studies comparing the incidence of inguinal hernia after open prostatectomy vs no treatment the incidence was significantly higher in the radical prostatectomy group (11.7%, 95% CI 9.2-14.2 vs 3.3%, 95% CI 2.0-4.6). Two of 3 studies showed a significantly higher incidence after laparoscopic and robot-assisted radical prostatectomies compared with a control group. Most studies of intraoperative inguinal hernia prevention techniques demonstrated a significantly lower inguinal hernia incidence in the experimental group. Inguinal hernias that developed after radical prostatectomy were primarily indirect (81.9%, 95% CI 75.3-88.4).
CONCLUSIONS
We found a high incidence of inguinal hernia following radical prostatectomy and hernias were primarily of the indirect type. The highest incidence of inguinal hernia was noted after open radical prostatectomy, followed by laparoscopic and robot-assisted radical prostatectomies. There was no significant difference between the laparoscopic and robot-assisted groups. The incidence of inguinal hernia was significantly higher after open radical prostatectomy than in control groups with some evidence to support the same finding for the laparoscopic and robot-assisted approaches. Promising results have been reported in studies of intraoperative prophylactic surgical techniques to reduce the postoperative incidence of inguinal hernia.
Topics: Hernia, Inguinal; Humans; Incidence; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 31039101
DOI: 10.1097/JU.0000000000000313 -
Progres En Urologie : Journal de... Dec 2002The objective of this study was to evaluate salvage radical prostatectomy after failure of radiotherapy for localized prostate cancer. (Review)
Review
OBJECTIVE
The objective of this study was to evaluate salvage radical prostatectomy after failure of radiotherapy for localized prostate cancer.
MATERIAL AND METHOD
The literature published between 1984 and 2002 was reviewed by a MEDLINE search using the following key words: prostate cancer, radiotherapy, salvage radical prostatectomy.
RESULTS
A total of 404 cases of salvage radical prostatectomy were identified, including 287 radical prostatectomies and 117 radical cystoprostatectomies. Patient selection criteria for this type of surgery were: good general state with a life expectancy of at least 10 years, tumour recurrence with no signs of local or distant extension, histological evidence a minimum of 12 months after radiotherapy and PSA level less than 10 ng/ml before radiotherapy and surgery. The mean rectal injury rate was 7% (range: 0% to 28%) and the mean incontinence rate was 37% (range: 0% to 80%). Histologically, the mean rate of prostate-confined tumours was 34% (range: 20% to 60%), a mean seminal vesicle invasion rate of 36% (range: 25% to 50%) and a mean positive surgical margins rate of 36% (range: 15% to 67%). This second-line treatment was effective in terms of long-term survival, with a specific 10-year survival of 70%.
CONCLUSION
Radical prostatectomy after failure of radiotherapy is associated with considerable morbidity, but can achieve a good 10-year survival rate in carefully selected patients.
Topics: Humans; Male; Patient Selection; Prostatectomy; Prostatic Neoplasms; Salvage Therapy; Survival Rate; Treatment Failure
PubMed: 12545622
DOI: No ID Found -
Robotic-assisted radical prostatectomy with the Senhance robotic platform: single center experience.World Journal of Urology Dec 2021To describe our institution's initial experience with robot-assisted radical prostatectomy (RARP) using the Senhance robotic system.
OBJECTIVE
To describe our institution's initial experience with robot-assisted radical prostatectomy (RARP) using the Senhance robotic system.
PATIENTS AND METHODS
A prospective analysis of 127 robot-assisted radical prostatectomies was performed. Patient demographics, preoperative and intraoperative parameters, histopathological examination results, intraoperative and early postoperative complications were obtained and analyzed.
RESULTS
The median patient age was 61.0 ± 6.36 (from 37 to 73) years, with a mean body mass index of 26.2 ± 3.79 kg/m. Of 127 patients, 16.5% (n = 21) underwent a pelvic lymph node dissection, 29.1% (n = 37) underwent one sided or bilateral nerve sparing. Post-operative extracapsular invasion (≥ pT3) was found in 15% (n = 19) of the cases and a Gleason score ≥ 7 in 74.8% of all patients. Our median operative time was 180 ± 41.98 min [interquartile range (IQR) 150-215], and median blood loss was 250 ± 236 (IQR 175-430) ml. Of 127 patients, 33.9% (n = 43) had positive margins, of them 28.7% in pT2 and 57.9% in pT3. Fifteen patients (11.8%) experienced complications, of them only three had Clavien-Dindo ≥ 3. Operation time decreased by about 60 min and estimated blood loss decreased by about 200 ml from the initial experience of each surgeon.
CONCLUSIONS
Robotic prostatectomy using a Senhance robotic system is feasible, and warrants further study to determine whether it can improve patient outcomes.
Topics: Adult; Aged; Equipment Design; Humans; Male; Middle Aged; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 34313810
DOI: 10.1007/s00345-021-03792-5 -
European Urology Jun 2010
Topics: Clinical Competence; Humans; Male; Postoperative Complications; Prostatectomy; Robotics
PubMed: 20227171
DOI: 10.1016/j.eururo.2010.02.032 -
Progres En Urologie : Journal de... Sep 2020Prostatectomy (PT) is a common procedure performed by many urologists. In 2018, 20,207 prostatectomies were performed in France, and few studies evaluated the...
INTRODUCTION
Prostatectomy (PT) is a common procedure performed by many urologists. In 2018, 20,207 prostatectomies were performed in France, and few studies evaluated the perioperative habits of urologists. As part of writing guidelines for enhanced recovery after surgery (ERAS) we wished to evaluate practice of urologists in their hospital management of a prostatectomy.
MATERIEL AND METHODS
A questionnaire was sent by Survey Monkey in June and July 2018 to all urologists who are members of the French Association of Urology.
RESULTS
One hundred and sixty seven urologists (14%) answered the questionnaire, 62% have private practice. The average number of operators per center performing PT was 4, with a median number of 70 interventions (0 to 486) per center in 2018. Open surgery is still gold standard (39.13%), followed by the robot-assisted transperitoneal laparoscopic (34.78%) and standard laparoscopic (24.22%). Alimentation, like first stand-up, was re-established on the first post-operative day, and the average hospital stay was 4±2 nights. The removal of the bladder catheter was most often performed at home by nurse (49.06%), one week after surgery. Only 10.06% of urologists systematically perform a cystography before removal urinary catheter.
CONCLUSION
The perioperative management of prostatectomy in France is relatively homogeneous, between urologists. The length of hospital stay remains important and could be reduced by proposing an ERAS protocol as has been obtained for cystectomy.
LEVEL OF EVIDENCE
III.
Topics: France; Health Care Surveys; Humans; Male; Postoperative Care; Practice Patterns, Physicians'; Prostatectomy; Prostatic Neoplasms; Urology
PubMed: 32646841
DOI: 10.1016/j.purol.2020.06.007 -
Anesthesiology Clinics Mar 2022This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to... (Review)
Review
This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to explore the anesthetic considerations for both open and minimally invasive techniques.
Topics: Anesthesia; Anesthesiology; Anesthetics; Humans; Laparoscopy; Male; Prostatectomy
PubMed: 35236579
DOI: 10.1016/j.anclin.2021.11.009 -
The Urologic Clinics of North America Aug 2001With improved surgical technique and perioperative care, the intraoperative and early postoperative complications of radical prostatectomy have decreased over the last 2... (Comparative Study)
Comparative Study Review
With improved surgical technique and perioperative care, the intraoperative and early postoperative complications of radical prostatectomy have decreased over the last 2 decades. Incontinence and impotence are two of the most significant long-term complications related to this procedure. Although the wide range of incontinence and impotence rates reported has been attributed to multiple factors, including the method of data collection and patient selection, it is apparent that the surgeon's experience is a significant factor, and that lower long-term morbidity can be expected from centers with more experience with radical prostatectomies. The impact of long-term complications, including urinary and sexual dysfunction, on the quality of life may be less than previously reported and should be discussed with patients.
Topics: Erectile Dysfunction; Humans; Intraoperative Complications; Male; Postoperative Complications; Preoperative Care; Prostatectomy; Prostatic Neoplasms; Quality of Life; Rectum; Time Factors; Trauma, Nervous System; Ureter; Urinary Incontinence
PubMed: 11590819
DOI: 10.1016/s0094-0143(05)70168-3 -
The Journal of Urology Sep 2008We examined the association between hospital and surgeon volume, and patient outcomes after radical prostatectomy. (Review)
Review
PURPOSE
We examined the association between hospital and surgeon volume, and patient outcomes after radical prostatectomy.
MATERIALS AND METHODS
Databases were searched from 1980 to November 2007 to identify controlled studies published in English. Information on study design, hospital and surgeon annual radical prostatectomy volume, hospital status and patient outcome rates were abstracted using a standardized protocol. Data were pooled with random effects models.
RESULTS
A total of 17 original investigations reported patient outcomes in categories of hospital and/or surgeon annual number of radical prostatectomies, and met inclusion criteria. Hospitals with volumes above the mean (43 radical prostatectomies per year) had lower surgery related mortality (rate of difference 0.62, 95% CI 0.47-0.81) and morbidity (rate difference -9.7%, 95% CI -15.8, -3.6). Teaching hospitals had an 18% (95% CI -26, -9) lower rate of surgery related complications. Surgeon volume was not significantly associated with surgery related mortality or positive surgical margins. However, the rate of late urinary complications was 2.4% lower (95% CI -5, -0.1) and the rate of long-term incontinence was 1.2% lower (95% CI -2.5, -0.1) for each 10 additional radical prostatectomies performed by the surgeon annually. Length of stay was lower, corresponding to surgeon volume.
CONCLUSIONS
Higher provider volumes are associated with better outcomes after radical prostatectomy. Greater understanding of factors leading to this volume-outcome relationship, and the potential benefits and harms of increased regionalization is needed.
Topics: Clinical Competence; Humans; Male; Outcome and Process Assessment, Health Care; Postoperative Complications; Practice Patterns, Physicians'; Prostatectomy; Prostatic Neoplasms
PubMed: 18635233
DOI: 10.1016/j.juro.2008.05.010