Chronological Urodynamic Evaluation of Changing Bladder and Urethral Functions After Robot-assisted Radical Prostatectomy

Abstract

Purpose: The current tumor-node-metastasis (TNM) classification system has been used for many years.The prognosis of patients with metastatic prostate cancer (mPC) treated using primary androgen deprivation therapy (PADT) was analyzed according to the TNM classification.Methods: A total of 5,618 cases with lymph node metastases only (N1M0), non-regional lymph node metastasis (M1a), bone metastasis (M1b), and distant metastasis (M1c) were selected from the Japanese Study Group of Prostate Cancer database. Overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were calculated using Kaplan-Meier analysis. The influence of clinical variables on patient prognosis was evaluated using the Cox's proportional hazard regression model. Results:The 5-year OS, CSS, and PFS were 76.0, 83.2, and 38.8 % in N1M0, 57.5, 69.0, and 23.0 % in M1a, 54.0, 63.1, and 23.0% in M1b, and 40.0, 51.5, and 16.6% in M1c, respectively. OS, CSS, and PFS worsened as the stages progressed. OS, CSS and PFS were all significantly worse in N1M1b compared with N0M1b. Multivariate analysis revealed that OS and CSS were worse in patients with a Gleason score ≥ 8, and that combined androgen blockade (CAB) treatment provided better OS than non-CAB treatments at any tumor stage. However, OS and CSS were worse in individuals with a prostate-specific antigen > 100 ng/ml only in M1b.Conclusions: Patient prognosis worsened with stage progression, therefore, current TNM classification system of mPC for PADT was shown to be trustworthy. Each PC cell that develops bone or lymphoid metastasis may exhibit different characteristics.

Evaluating urinary incontinence before and after radical prostatectomy using the international consultation on incontinence questionnaire‐short form

“…From 3 months after RP, the proportion of patients with UUI and post‐void leakage did not change compared with that before RP probably because of the disappearance of postoperative reactions, such as acute inflammation. SUI after RP was reported to be mainly caused by urethral sphincter dysfunction . This study showed some patients who complained about post‐void leakage pre‐ and post‐RP; therefore, post‐void leakage should also be taken into consideration when evaluating UI after RP.…”

“…The types of UI reported after RP were mainly stress UI (SUI) and partially urge UI (UUI), but daily pad use and 24‐h pad weight test cannot distinguish between the two types. Urodynamic studies are useful for evaluating the pattern of UI; however, it is invasive and complicated . Various questionnaires are also used for the subjective evaluation of UI: the Expanded Prostate Cancer Index Composite is used to evaluate QOL, including the urinary status, of patients with localized prostate cancer patients; the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) is a simple questionnaire for evaluating UI after RP, including a subjective UI evaluation and the pattern of UI .…”

Artificial Urinary Sphincter: Report of the 2015 Consensus Conference

“…Urinary incontinence (UI) can occur in men after prostate surgery of benign or malignant conditions, secondary to bladder dysfunction and/or ISD arising from iatrogenic injury to the urethral sphincter muscle or its innervation …”

Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence

“…Chronological urodynamic evaluation of patients with PPI after RARP revealed that urethral sphincter and bladder function worsen immediately after RARP and recover over time [63]. In one small cohort study, 20.6% of patients had UI 1 year after RARP.…”