Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy

Carter, Stacy M; Le, Jesse; Hu, Jim C.

doi:10.1097/mou.0b013e32835b6602

Cited by 20 publications

(15 citation statements)

References 49 publications

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“…One of the leading determinants of QoL and sexual health after RP is the surgical approach: a more conservative procedure, sparing neurovascular bundles, bladder neck, and proximal urethra can strongly increase the chance of better functional outcomes [130, 131]. The decision for the surgical approach is usually a compromise between patient's desire to preserve sexual activity and the eligibility to a conservative surgery based on tumor characteristics (PSA, Clinical stage, bioptical Gleason Score).…”

Section: Impact Of Primary Treatment For Pca On Qol and Sexual Healthmentioning

confidence: 99%

Quality of Life and Sexual Health in the Aging of PCa Survivors

Gacci

Baldi

Detti

et al. 2014

International Journal of Endocrinology

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Prostate cancer (PCa) is the most common malignancy in elderly men. The progressive ageing of the world male population will further increase the need for tailored assessment and treatment of PCa patients. The determinant role of androgens and sexual hormones for PCa growth and progression has been established. However, several trials on androgens and PCa are recently focused on urinary continence, quality of life, and sexual function, suggesting a new point of view on the whole endocrinological aspect of PCa. During aging, metabolic syndrome, including diabetes, hypertension, dyslipidemia, and central obesity, can be associated with a chronic, low-grade inflammation of the prostate and with changes in the sex steroid pathways. These factors may affect both the carcinogenesis processes and treatment outcomes of PCa. Any treatment for PCa can have a long-lasting negative impact on quality of life and sexual health, which should be assessed by validated self-reported questionnaires. In particular, sexual health, urinary continence, and bowel function can be worsened after prostatectomy, radiotherapy, or hormone treatment, mostly in the elderly population. In the present review we summarized the current knowledge on the role of hormones, metabolic features, and primary treatments for PCa on the quality of life and sexual health of elderly Pca survivors.

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Section: Impact Of Primary Treatment For Pca On Qol and Sexual Healthmentioning

confidence: 99%

Quality of Life and Sexual Health in the Aging of PCa Survivors

Gacci

Baldi

Detti

et al. 2014

International Journal of Endocrinology

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“…The extrafascial plane is defined from the external part of the NVB and is a non–nerve-sparing technique. Therefore the preservation of the NVB can be achieved by either interfascial or intrafascial dissection [3536373839]. The Pasadena consensus panel suggested alternate terminology of dissection planes as full, partial and minimal nerve-sparing for the intrafascial, the interfascial and the subextrafascial dissections respectively (Fig.…”

Section: Nerve-sparing Surgical Techniques In Rarpmentioning

confidence: 99%

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

2016

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Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes.

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“…The magnified, well -illuminated robotic -operative field coupled with less blood loss has developed in parallel to a greater understanding of the periprostatic fascial planes, leading to differentiation of intrafascial versus interfascial nerve -sparing approaches 21) . Xylinas et al reported that 66% of the patients were continent (no pad), 12% presented a minimal SUI (1 pad), and 22% required >1 pad per day 1 month after intrafascial nerve -sparing RP with a robot -assisted extraperitoneal approach, and concluded that an intrafascial approach with robotic assistance provided satisfactory early functional results with respect to postoperative continence as well as potency 22) .…”

Section: Techniques To Improve Urinary Continence Following Rarpmentioning

confidence: 99%

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

Yanagida

Koguchi

Hata

et al. 2014

Fukushima J. Med. Sci.

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: Although open retropubic radical prostatectomy has been the most commonly used surgical technique for patients with localized prostate cancer for decades, robot -assisted radical prostatectomy (RARP) has recently become an alternative option and widely used in Japan as well as around the world. RARP has been shown to have higher postoperative continent rates than retropubic and laparoscopic radical prostatectomy ; however, urinary incontinence has remained one of the most significant causes for concern among patients who seek surgical treatment for prostate cancer, even after the introduction of RARP. The literature has shown that certain technical modifications to improve urinary continence are advocated as potential aids to reduce the risk of urinary incontinence after RARP. These modifications might be divided into 3 categories to realize the improvement of early return of urinary continence after RARP : 1) preservation, 2) reconstruction, and 3) reinforcement of the anatomic structures in the pelvis, which will make a new supporting system after radical prostatectomy. In this review, we discuss the intraoperative techniques to improve outcomes for early return of urinary continence following RARP, and provide a critical summary of current knowledge on its outcome in the literature.

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Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy

Cited by 20 publications

References 49 publications

Quality of Life and Sexual Health in the Aging of PCa Survivors

Quality of Life and Sexual Health in the Aging of PCa Survivors

Nerve-sparing techniques and results in robot-assisted radical prostatectomy

Current Techniques to Improve Outcomes for Early Return of Urinary Continence Following Robot-Assisted Radical Prostatectomy

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