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European Urology Nov 2023Little is known regarding functional outcomes after robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction.
BACKGROUND
Little is known regarding functional outcomes after robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction.
OBJECTIVE
To report on urinary continence (UC) and erectile function (EF) at 12 mo after RARC and ICNB reconstruction and investigate predictors of these outcomes.
DESIGN, SETTING, AND PARTICIPANTS
We used data from a multi-institutional database of patients who underwent RARC and ICNB reconstruction for bladder cancer.
SURGICAL PROCEDURE
The cystoprostatectomy sensu stricto followed the conventional steps. ICNB reconstruction was performed at the physician's discretion according to the Studer/Wiklund, S pouch, Gaston, vescica ileale Padovana, or Hautmann technique. The techniques are detailed in the video accompanying the article.
MEASUREMENTS
The outcomes measured were UC and EF at 12 mo.
RESULTS AND LIMITATIONS
A total of 732 male patients were identified with a median age at diagnosis of 64 yr (interquartile range 58-70). The ICNB reconstruction technique was Studer/Wiklund in 74%, S pouch in 1.5%, Gaston in 19%, vescica ileale Padovana in 1.5%, and Hautmann in 4% of cases. The 12-mo UC rate was 86% for daytime and 66% for nighttime continence, including patients who reported the use of a safety pad (20% and 32%, respectively). The 12-mo EF rate was 55%, including men who reported potency with the aid of phosphodiesterase type 5 inhibitors (24%). After adjusting for potential confounders, neobladder type was not associated with UC. Unilateral nerve-sparing (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.88-7.85; p < 0.001) and bilateral nerve-sparing (OR 6.25, 95% CI 3.55-11.0; p < 0.001), were positively associated with EF, whereas age (OR 0.93, 95% CI 0.91-0.95; p < 0.001) and an American Society of Anesthesiologists score of 3 (OR 0.46, 95% CI 0.25-0.89; p < 0.02) were inversely associated with EF.
CONCLUSIONS
RARC and ICNB reconstruction are generally associated with good functional outcomes in terms of UC. EF is highly affected by the degree of nerve preservation, age, and comorbidities.
PATIENT SUMMARY
We investigated functional outcomes after robot-assisted removal of the bladder in terms of urinary continence and erectile function. We found that, in general, patients have relatively good functional outcomes at 12 months after surgery.
Topics: Humans; Male; Urinary Bladder; Cystectomy; Robotics; Erectile Dysfunction; Treatment Outcome; Urinary Bladder Neoplasms; Robotic Surgical Procedures; Urinary Diversion
PubMed: 37117109
DOI: 10.1016/j.eururo.2023.04.009 -
TheScientificWorldJournal 2015Erectile dysfunction is the most common complication after pelvic radical surgery. Rehabilitation programs are increasingly being used in clinical practice but there is... (Review)
Review
Erectile dysfunction is the most common complication after pelvic radical surgery. Rehabilitation programs are increasingly being used in clinical practice but there is no high level of evidence supporting its efficacy. The principle of early penile rehabilitation stems from animal studies showing early histological and molecular changes associated with penile corporal hypoxia after cavernous nerve injury. The concept of early penile rehabilitation was developed in late nineties with a subsequent number of clinical studies supporting early pharmacologic penile rehabilitation. These studies included all available phosphodiesterase type 5 inhibitors, intracavernosal injection and intraurethral use of prostaglandin E1 and to lesser extent vacuum erectile devices. However, these studies are of small number, difficult to interpret, and often with no control group. Furthermore, no studies have proven an in vivo derangement of endothelial or smooth muscle cell metabolism secondary to a prolonged flaccid state. The purpose of the present report is a synthetic overview of the literature in order to analyze the concept and the rationale of rehabilitation program of erectile dysfunction following radical pelvic surgery and the evidence of such programs in clinical practice. Emphasis will be placed on penile rehabilitation programs after radical cystoprostatectomy, radical prostatectomy, and rectal cancer treatment. Future perspectives are also analyzed.
Topics: Alprostadil; Animals; Erectile Dysfunction; Humans; Male; Pelvic Neoplasms; Penis; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prostatectomy; Rectal Neoplasms; Risk Factors; Urologic Surgical Procedures
PubMed: 25785286
DOI: 10.1155/2015/876046 -
Advances in Clinical and Experimental... 2015According to the Polish National Cancer Registry, bladder cancer is the 4th most common cancer in the male population (7.0%), while prostate cancer takes 2nd place...
BACKGROUND
According to the Polish National Cancer Registry, bladder cancer is the 4th most common cancer in the male population (7.0%), while prostate cancer takes 2nd place (14.0%). In the case of both cancer types, prognoses are precarious and depend on many factors, such as the size of the primary tumor, infiltration of regional lymph nodes, histological grade and occurrence of distant metastases.
OBJECTIVES
The objective of this work is to verify the coincidence of prostate cancer and bladder cancer in patients who underwent radical cystoprostatectomy in Wroclaw Medical University, Department of Urology and Oncological Urology, as well as to indicate factors that may influence the peri- and post-operative course.
MATERIAL AND METHODS
We have retrospectively reviewed patients who underwent radical cystoprostatectomy for muscular-invasive bladder cancer between 2009 and 2014, which comprised of 116 male patients. We managed to establish telephone and personal contact with the patients.
RESULTS
Seventeen of the 116 patients were diagnosed with coincidental prostate cancer in post-operative histological examination (14.6%). This result is lower than in other series of cystoprostatectomy cases (range 23-68%). The mean age of patient was 68.9 years and the median was 69.5 years. Factors influencing the peri- and post-operative periods were not statistically significant.
CONCLUSIONS
Serum PSA level and DRE should be performed more often on patients prepared for radical cystoprostatectomy. An accurate pre-operative assessment of cancer infiltration is required for both types of tumors. Complete resection of prostate prevents residual neoplasm infiltration. It is important to take into account the possibility of primary prostate tumor occurrence in patients qualified for radical cystectomy. The post-operative supervision should be focused not only on bladder carcinoma but on the prostate carcinoma, too.
Topics: Aged; Cystectomy; Humans; Kallikreins; Male; Neoplasms, Multiple Primary; Poland; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Registries; Retrospective Studies; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 26469111
DOI: 10.17219/acem/41070 -
Asian Journal of Andrology Jan 2013Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention... (Review)
Review
Erectile dysfunction (ED) and stress urinary incontinence (SUI) from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.
Topics: Erectile Dysfunction; Humans; Male; Penile Prosthesis; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Prosthesis Implantation; Treatment Outcome; Urinary Incontinence, Stress; Urinary Sphincter, Artificial
PubMed: 23202702
DOI: 10.1038/aja.2012.115 -
Asian Journal of Urology Oct 2022Primary urethral carcinoma (PUC) is a rare malignant carcinoma but with limited therapeutic options. This review aims to provide an overview of the current strategies on... (Review)
Review
OBJECTIVE
Primary urethral carcinoma (PUC) is a rare malignant carcinoma but with limited therapeutic options. This review aims to provide an overview of the current strategies on this patient settings.
METHODS
Recent literature ranging from January 1987 and December 2021 was assessed through PubMed search to assess the diagnostic and therapeutic principles of PUC.
RESULTS
A complete of examination including cystoscopy, imaging, and biopsy should be conducted for these patients. Once diagnosed, the clinical decision of PUC should be made according to the tumor location, pathological pattern, and extent of the tumor. For patients with superficial and distal urethral lesions, organ sparing approaches or radical reconstructive procedures can be utilized. While for more advanced disease or nodal involvement, an optimal multimodal treatment strategy consisted of surgery and radiochemotherapy should be adopted. For patients with urothelial carcinoma of the prostate, the management including transurethral resection of the prostate followed by bacille Calmette-Guerin or radical cystoprostatectomy should depend on the infiltration depth of PUC.
CONCLUSION
A complete of examination is important for the diagnosis of PUC. The management of PUC should be determined by the location, pathological pattern, and extent of the tumor. More multi-institutional collaborations should be held to investigate better treatment modalities for PUC.
PubMed: 36381601
DOI: 10.1016/j.ajur.2022.04.005 -
Experimental and Therapeutic Medicine Apr 2023The aim of the present study was to analyze incidence, histopathological features and clinical outcomes of patients undergoing radical cystoprostatectomy (RCP) for...
The aim of the present study was to analyze incidence, histopathological features and clinical outcomes of patients undergoing radical cystoprostatectomy (RCP) for bladder cancer, in which incidental prostate cancer (PCa) was found. How these types of cancer impacted the patients' management and whether prostate-sparing cystectomy could be an option for these patients was determined. The current study retrospectively analyzed the data of a cohort of patients from 'Umberto I' Hospital of Nocera Inferiore who underwent RCP for bladder transitional cell carcinoma. Patients with a preoperative diagnosis or clinical suspicion of PCa were excluded. Patients affected by incidental PCa in the RCP specimens were identified, and then their demographic, histopathological and clinical outcome data were collected. Overall, it was revealed that of the 303 patients undergoing RCP for bladder cancer, 69 (22.7%) had incidental PCa, with a median age of 71.6 (age range, 54-89 years). In total, 23 (33.33%) of the 69 patients with incidental PCa were considered to have clinically significant prostate disease. In conclusion, it was relatively common to identify incidental PCa in RCP specimens but no preoperative predictive factors were identified that were able to determine 'non-aggressive' PCa status. Therefore, the present results demonstrate the need for a careful and complete prostate removal during RCP. Nevertheless, since organ-sparing surgeries are widely performed in young population, due to the impossibility of predicting aggressive prostate cancer, these patients require close monitoring through lifelong PSA surveillance, particularly focusing on the possible relapse of PCa after RCP.
PubMed: 37006882
DOI: 10.3892/etm.2023.11872 -
Minerva Urologica E Nefrologica = the... Aug 2019To evaluate the factors including pelvic dimensions, which might influence operative difficulty and complications after open radical cystoprostatectomy and orthotopic...
BACKROUND
To evaluate the factors including pelvic dimensions, which might influence operative difficulty and complications after open radical cystoprostatectomy and orthotopic neobladder reconstruction in men.
METHODS
A total of 198 RC patients operated in our institution with preoperative magnetic resonance (MRI) were analyzed were included in the study. Pelvic dimensions, including interspinous distance (ISD), bony femoral - (BFW) and soft tissue width (SW), apical prostate depth (AD), upper conjugate (UC), lower conjugate (LC) were measured by preoperative MRI. BFW, ISD, and SW indexes were defined as BFW/AD, ISD/AD, and SW/AD, respectively. Complicatons were classified according to the Clavien-Dindo classification system. As indicators of surgical difficulty; transfusion rate (TR), estimated blood loss (EBL), operative time (OT) and hospital stay (HS) were assessed. SPSS version 17.0 was used for statistical analyses.
RESULTS
A total of 239 complications developed in 143 of the 198 patients (72.2%). Correlation analysis revealed a significant indirect relationship between TR and SW/AD (P=0.023). For EBL, there were significant indirect correlations between the SW/AD, BFW/AD and ISD/AD indexes (P=0.026, P=0.05, P=0.009; respectively). Additionally, OT was directly correlated body mass index (BMI) (P=0.001); and indirectly correlated with UC, SW/AD, and BFW/AD (P=0.047, P=0.038, P=0.016, respectively). On multivariate logistic regression analyses higher American Society of Anesthesiologist (ASA) score was associated with major complications. Multivariate analyses revealed that pathological stage was a significant predictor of EBL.
CONCLUSIONS
Patients with smaller pelvises might undergo more difficult surgeries. However, it seems that small sized pelvis does not impact on operative difficulty and complication rate in radical cystoprostatectomy and orthotopic neobladder.
Topics: Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Transfusion; Humans; Length of Stay; Magnetic Resonance Imaging; Male; Middle Aged; Operative Time; Pelvis; Postoperative Complications; Prostate; Prostatectomy; Plastic Surgery Procedures; Urinary Bladder
PubMed: 31086130
DOI: 10.23736/S0393-2249.19.03195-3 -
Sexual Medicine Feb 2021Penile prosthesis implantation is a widely used treatment option for erectile dysfunction. Data is limited with regard to patient satisfaction with a penile prosthesis...
INTRODUCTION
Penile prosthesis implantation is a widely used treatment option for erectile dysfunction. Data is limited with regard to patient satisfaction with a penile prosthesis following radical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies.
AIM
To examine patient satisfaction with penile prosthesis implantation and determine if a difference in satisfaction exists in post-prostatectomy/cystoprostatectomy patients vs patients with erectile dysfunction of other etiologies. We hypothesize that etiology does not affect satisfaction.
METHODS
A total of 164 patients underwent penile prosthesis implantation at our institution between August 2017 and December 2019, with 102 patients completing a validated 14 item questionnaire, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), at 6 months postoperation. Demographics, surgical characteristics, and erectile dysfunction etiology were recorded. Patients were assigned to one of 2 groups: postprostatectomy/postcystoprostatectomy erectile dysfunction or other etiologies. The study group was further analyzed between radical prostatectomy or radical cystoprostatectomy.
MAIN OUTCOME MEASURES
Satisfaction based on key EDITS questions with postradical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies.
RESULTS
Responses to 3 questions were analyzed: overall satisfaction, expectations met in the past 4 weeks, and confidence in the ability to participate in sexual activity. Chi-square analysis was performed to determine the difference in responses. No difference was seen in overall satisfaction (P = .96), expectations (P = .78), or confidence (P = .78) between groups. On subgroup analysis, there was no difference in reported overall satisfaction (P = .47) or confidence (P = .080) between postprostatectomy and postcystoprostatectomy patients. Postprostatectomy and postcystoprostatectomy patients differed in whether the penile prosthesis implantation met expectations (P = .033). Postprostatectomy patients reported a mean score of 3.5/4 compared to postcystoprostatectomy patients, who reported a mean of 3.0/4.
CONCLUSIONS
Our analysis suggests that key erectile function scores are not significantly different between postprostatectomy/postcystoprostatectomy patients compared to other etiologies. The difference in measures between postprostatectomy and postcystoprostatectomy patients is not significant or of unclear significance. Registration # of clinical trial: HSC-MS-19-0320 Howell S, Palasi S, Green T, et al. Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Radical Prostatectomy or Radical Cystoprostatectomy to the General Population. Sex Med 2021;9:100300.
PubMed: 33429244
DOI: 10.1016/j.esxm.2020.100300 -
Prostate International Sep 2016The current standard of care for men with muscle-invasive bladder cancer is radical cystoprostatectomy (RCP). One-third of RCP specimens demonstrate incidental prostate...
BACKGROUND
The current standard of care for men with muscle-invasive bladder cancer is radical cystoprostatectomy (RCP). One-third of RCP specimens demonstrate incidental prostate cancer, primarily reported in small series with limited follow-up. The aim of this study is to report mature outcomes, including patterns of failure and disease-specific recurrence rates, and survival, for a large cohort of men with incidental prostate cancer at RCP performed at a tertiary referral center.
METHODS
This retrospective study describes cancer control and survival rates for men who underwent RCP for bladder cancer and were found incidentally to have prostate cancer. Analysis of patient-, tumor-, and treatment-specific factors were analyzed for association with disease control and survival endpoints.
RESULTS
Between 2002 and 2010, 94 patients with incidental discovery of prostate cancer postRCP were identified for inclusion in this study. Forty-five patients (45%) underwent RCP for recurrent (rather than initial presentation of) bladder carcinoma. At a median follow-up of 40.3 months (71.2 months for survivors; range, 8.9-155.5 months), 42 patients were alive without recurrence and 52 patients had died (25 associated with disease). The estimated 5-year bladder cancer disease-free, urinary tract malignancy disease-free, and prostate specific antigen (PSA) relapse-free survivals were 76% [95% confidence interval (CI), 65-84%], 64% (52-74%), and 97% (79-100%), respectively. The estimated 5-year urinary tract malignancy-specific and overall survivals were 61% (49-71%) and 52% (41-62%), respectively. Univariate analysis demonstrated associations between pathologic T/N-stage and nodal ratio with bladder cancer disease-free, urinary tract malignancy disease-specific, and overall survivals, with patient age at diagnosis as an additional adverse factor associated with overall survival. Multivariate analysis confirmed pN-stage and age as independently associated with worse survival.
CONCLUSION
For men undergoing RCP for bladder cancer, the present study suggests that incidentally discovered prostate cancers, irrespective of pathologic stage, Gleason score, or clinical significance, do not impact 5-year disease control or survival outcomes.
PubMed: 27689068
DOI: 10.1016/j.prnil.2016.06.002 -
Asian Journal of Surgery Jan 2021To assess the effects of clinical factors and treatments on the overall survival (OS) of patients with prostate sarcomas. (Comparative Study)
Comparative Study Review
BACKGROUND/OBJECTIVES
To assess the effects of clinical factors and treatments on the overall survival (OS) of patients with prostate sarcomas.
METHODS
We reported 41 cases diagnosed with prostate sarcomas from eight hospitals in China and retrospectively analyzed the prognostic factors by combining our data with cases from five previously published cohorts, including one extra Chinese cohort and four cohorts from US cohorts. Additionally, we investigated the differences in treatment regimens between China (n = 66) and the USA (n = 74).
RESULTS
The median survival time of the 41 cases was 18.6 months (95% confidence interval [CI]: 13.9-23.2). The status of negative distant metastasis (P = 0.004) and radical tumor resection with negative margin (P = 0.001) were significantly associated with better overall survival, whereas age, tumor size, duration of initial symptoms, and chemo/radiotherapy were not significantly related to OS. The survival time was longer in patients with rhabdomyosarcoma than in those with leiomyosarcoma (P = 0.049). Combined analysis of the current and 5 prior cohorts showed that more patients in the US cohorts underwent radical surgery (P = 0.005), and the overall survival was better among those with radical cystoprostatectomy compared to those with radical prostatectomy alone (P = 0.008).
CONCLUSION
Radical resection to achieve a negative margin contributes to better survival for patients with prostate sarcoma.
Topics: Adolescent; Adult; Aged; Asian People; China; Cohort Studies; Cystectomy; Humans; Leiomyosarcoma; Male; Margins of Excision; Middle Aged; Prognosis; Prostatectomy; Prostatic Neoplasms; Rhabdomyosarcoma; Sarcoma; Survival Rate; Time Factors; United States; Young Adult
PubMed: 32636119
DOI: 10.1016/j.asjsur.2020.06.004