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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 -
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 -
International Braz J Urol : Official... 2022Several techniques of robotic-assisted radical prostatectomy (RARP) using the da Vinci SP (SP) have been described since its clearance by the FDA (Food and Drug...
INTRODUCTION
Several techniques of robotic-assisted radical prostatectomy (RARP) using the da Vinci SP (SP) have been described since its clearance by the FDA (Food and Drug Administration) in 2018 (1, 2). Even with the expanding literature about this robot, the SP technology has been restricted to a few centers in the US and Asia due to the recent release of this robot in the marked.3 In this scenario, we provided, in this video compilation, a consensus of SP referral centers describing the current approaches and techniques of da Vinci SP Radical prostatectomy (SP-RARP).
SURGICAL TECHNIQUE
We have illustrated five different techniques, including transperitoneal, extraperitoneal, Retzius-sparing, transvesical, and transperineal (4-6). Each surgery demonstrated crucial steps from the trocar placement until anastomosis. All approaches follow anatomic concepts and landmarks to minimize positive surgical margins, optimize oncological outcomes and promote optimal functional recovery. The trocar placement and the use of an assistant port were selected according to the operative technique of each institution. None of these surgeries had intra- or postoperative complications, and the pain management until discharge was controlled without using narcotics. All patients were discharged in less than 16 hours of surgery.
CONCLUSION
Robotic-assisted radical prostatectomy performed with the da Vinci SP is feasible and safe with optimal perioperative outcomes. Five different approaches were described in this video compilation, and we believe that the technical details provided by this multicentric collaboration are crucial for centers willing to initiate the SP approach to radical prostatectomy.
Topics: Humans; Male; Margins of Excision; Prostate; Prostatectomy; Robotic Surgical Procedures; Seminal Vesicles
PubMed: 35363458
DOI: 10.1590/S1677-5538.IBJU.2022.99.15 -
Acta Clinica Croatica Oct 2022Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries... (Review)
Review
Radical prostatectomy (RP) performed by open, laparoscopic, or robotic approach is considered the gold standard for localized prostate cancer (PCa). However, it carries the risk of postprostatectomy urinary incontinence (UI) and erectile dysfunction (ED) which significantly reduce patients' satisfaction with surgery and quality of life (QoL), therefore it is important to decrease the possibility or severity of these complications to a minimum. There are several preoperative prognostic factors such as urethral length and closing pressure obtained by magnetic resonance imaging and profilometry, as well as several variations in the surgical approach such as preservation of the neurovascular bundle (NVB) and puboprostatic ligaments, sparing or reconstruction of bladder neck, Retzius-sparing approach, and meticulous surgical dissection, used to predict or prevent unwanted side effects of RP. In addition, there are postoperative methods that can help reduce complications. In this review, we will present the role of pelvic rehabilitation with an emphasis on pelvic floor muscle training (PFMT) in reducing consequences of radical surgery.
Topics: Male; Humans; Quality of Life; Prostatectomy; Urinary Incontinence; Urinary Bladder; Erectile Dysfunction; Prostatic Neoplasms
PubMed: 36938558
DOI: 10.20471/acc.2022.61.s3.10 -
Chirurgia (Bucharest, Romania : 1990) 2018Retroperitoneal Laparoscopic Radical Prostatectomy (RLRP) has been introduced in our department as the first line treatment for patients with localized prostatic cancer...
Retroperitoneal Laparoscopic Radical Prostatectomy (RLRP) has been introduced in our department as the first line treatment for patients with localized prostatic cancer and life expectancy over 10 years. At the time, the surgical team had already extensive experience in minimally invasive urologic surgery. Our aim is to describe the laparoscopic technique we currently use and to analyze our oncologic and functional results. Patients and All the patients who underwent RLRP in our institution (PONDERAS ACADEMIC HOSPITAL) from January 2015 to March 2017 were included into a prospective study. The standard preoperative protocol included blood tests, prostate biopsy, pelvis MRI and bone scintigraphy, while the particular therapy was discussed and approved by the Institutional Multidisciplinary Tumor Board. In all the 45 cases, RLRP was indicated for localized prostate cancer. The average patientâÃÂÃÂs age was 68 years (range 45 âÃÂ" 74 years), mean preoperative prostate specific antigen (PSAi) level was 8 ng/mL (range 3âÃÂ"15 ng/mL) and prostatic volume between 26 and 52 cc. The laparoscopic approach was completed in all 45 cases âÃÂ" no conversions to open surgery. Bilateral nerve sparing was performed in 7 cases (16%) and unilateral in 23 cases (51%). The mean operative time was 165 minutes (range 120 - 240 min), while the average blood loss was 255 mL (range 20âÃÂ"800) and two patients received blood transfusions. The mean catheterization time was 10 days (range 7âÃÂ"14 days). Positive surgical margins were observed in 8 cases (17.7%). Overall, 86% and respectively, 93% of the patients were continent during the following 3 and 6 months. 51% of the patients had erectile disfunction 6 month after the intervention. Four complications were encountered: intraoperatively - rectal injury (1 case) and postoperatively - bleeding (2 cases) and stenosis at the vesicourethral anastomosis (1 case). No mortality or late morbidity encountered. The radical laparoscopic prostatectomy is a safe and efficient procedure for localized prostate cancer with minimal complications and short hospitalization time, but it requires an experienced team of laparoscopic surgeons. The functional and oncological outcomes of LRP are expected to be improved as the medical team experience is extended.
Topics: Aged; Humans; Laparoscopy; Male; Middle Aged; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Retroperitoneal Space; Treatment Outcome
PubMed: 30183585
DOI: 10.21614/chirurgia.113.4.542 -
International Braz J Urol : Official... 2022
Topics: Erectile Dysfunction; Humans; Male; Prostate; Prostatectomy; Seminal Vesicles
PubMed: 35838517
DOI: 10.1590/S1677-5538.IBJU.2022.0289 -
Journal of Comparative Effectiveness... May 2013Prostate cancer is the second leading cause of cancer death among men in the USA. Use of robot-assisted radical prostatectomy (RARP) for the management of localized... (Comparative Study)
Comparative Study Review
Prostate cancer is the second leading cause of cancer death among men in the USA. Use of robot-assisted radical prostatectomy (RARP) for the management of localized prostate cancer has increased dramatically in recent years. This review focuses on comparing quality of life following RARP versus retropubic radical prostatectomy. RARP is associated with improved perioperative outcomes, such as reduced blood loss and fewer transfusions. In addition, cancer control after RARP versus retropubic radical prostatectomy is equivalent, with similar incidences of positive surgical margins and comparable early oncological outcomes. RARP appears to provide advantages in recovery of continence, potency and quality of life compared with retropubic radical prostatectomy; however, methodological limitations exist in current literature.
Topics: Comparative Effectiveness Research; Disease-Free Survival; Erectile Dysfunction; Humans; Laparoscopy; Male; Neoplasm Recurrence, Local; Organ Sparing Treatments; Prostatectomy; Prostatic Neoplasms; Quality of Life; Robotics; Treatment Outcome; Urinary Incontinence
PubMed: 24236628
DOI: 10.2217/cer.13.23 -
Journal of Robotic Surgery Feb 2023The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP)...
The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1-2, 4% 3-5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51-27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.
Topics: Male; Humans; Prostate; Urethra; Robotic Surgical Procedures; Treatment Outcome; Prostatectomy; Prostatic Neoplasms; Recovery of Function
PubMed: 35459985
DOI: 10.1007/s11701-022-01408-7 -
Urologia Internationalis 2014Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results... (Review)
Review
OBJECTIVES
Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP.
METHODS
A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review.
RESULTS
44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes.
CONCLUSION
Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.
Topics: Cost-Benefit Analysis; Health Care Costs; Humans; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Risk Factors; Robotic Surgical Procedures; Treatment Outcome
PubMed: 25277444
DOI: 10.1159/000366008 -
Medicina (Kaunas, Lithuania) Mar 2022The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity... (Review)
Review
The aim of this systematic review is to evaluate the impact of radical prostatectomy (RP) on bladder function, with special attention towards detrusor underactivity investigated with the means of urodynamic evaluation. The review was performed in accordance with the PRISMA statement and was registered in the PROSPERO (ID#: CRD42020223480). The studied population was limited to men with prostate cancer who underwent urodynamic study prior to and after radical prostatectomy. Eight hundred twenty-seven studies were screened, with twenty-five finally included. A qualitative analysis was performed. Rates of detrusor underactivity (DU) before surgery were reported in eight studies and ranged from 1.6% to 75% (median of 40.8%). DU occurred de novo after RP in 9.1% to 37% of patients (median of 29.1%). On the other hand, preexisting DU resolved in 7% to 35.5% of affected men. Detrusor overactivity (DO) was the most frequently reported outcome, being assessed in 23 studies. The rate of DO preoperatively was from 5% to 76% (median of 25%). De novo was reported in 2.3-54.4% of patients (median of 15%) and resolved after RP in 19.6% to 87.5% (median of 33%) of affected patients. Baseline rates of bladder outlet obstruction (BOO) varied between studies from 19% to 59.3%, with a median of 27.8%. The most pronounced change after surgery was the resolution of BOO in 88% to 93.8% (median of 92%) of affected patients. Rates of de novo impaired bladder compliance (IBC) varied from 3.2% to 41.3% (median of 13.3%), whereas the resolution of IBC was reported with rates ranging from 0% to 47% (median of 4.8%). BOO, DO, and DU are frequently diagnosed in men scheduled for RP. BOO is improved after RP in most patients; however, there is still a substantial rate of patients with de novo DU as well as DO which may impair functional outcomes and quality of life.
Topics: Humans; Male; Prostatectomy; Quality of Life; Retrospective Studies; Urinary Bladder, Underactive; Urodynamics
PubMed: 35334557
DOI: 10.3390/medicina58030381