Anatomical, surgical and technical factors influencing continence after radical prostatectomy

Abstract

Radical prostatectomy (RP) is the most frequent treatment with curative intent performed for prostate cancer to date. Different surgical approaches (perineal, transperitoneal, and extraperitoneal) and techniques (laparoscopic and robot assisted) have been described to increase the efficiency and potentially diminish the postoperative complications of this procedure.The aim of this narrative review is to investigate and define the factors that influence postprostatectomy urinary continence. We highlighted the anatomical landmarks and the modifications of surgical techniques aimed at improving the continence rates and thus, patient quality of life.After RP, the long-term continence rates range from 84% to 97%. In order to achieve good continence rates, a careful dissection along with meticulous anatomical reconstruction is required. To this end, a detailed knowledge of the periprostatic anatomy is mandatory.

Psychological nursing intervention on anxiety and depression in patients with urinary incontinence after radical prostatectomy

“…Radical prostatectomy is the common treatment for PC [ 12 ] and the most common postoperative complications are the injury of urethral sphincter and UI caused by parastatal neurovascular bundle. [ 13 , 14 ] UI after operation will not threaten the patients’ life, but will significantly affect the life quality of patients. Patients with severe UI are generally suffered anxiety and depression in the social, psychological as well as physical aspects.…”

Inter-observer variability of cribriform architecture and percent Gleason pattern 4 in prostate cancer: relation to clinical outcome

“…Radical prostatectomy (RP) is one of the main treatment modalities for prostate cancer. Despite its oncological efficacy, RP is complicated by urinary incontinence and erectile dysfunction in a significant number of men [1,2]. Since postoperative complications and oncological outcome are significantly affected by the surgical urologists' experience, RP procedures are increasingly performed in high-volume expert centres [3][4][5][6].…”

Intraoperative assessment and reporting of radical prostatectomy specimens to guide nerve‐sparing surgery in prostate cancer patients (NeuroSAFE)

“…Although RP was initially mostly performed for low‐risk to intermediate‐risk disease, patients with high‐risk cancer are increasingly being offered RP in Europe and North America 1,2 . Despite its efficacy in oncological disease control, RP is complicated by urinary incontinence and erectile dysfunction in 3–16% and 20–90% of patients, respectively 3,4 . Surgical preservation of neurovascular bundles adjacent to the prostate, urologists' experience and centralisation in high‐volume expert centres can all contribute to reducing complication rates 5–9 .…”