Hypothermic Robotic Radical Prostatectomy: Impact on Continence

Abstract

Local hypothermia during prostatectomy resulted in a significant improvement in early postoperative zero pad continence rates. Longer and deeper cooling appears to be associated with improved continence, particularly among older patients.

Urodynamic Evaluation Before and Immediately After Robot-assisted Radical Prostatectomy

“…In addition, urinary incontinence was evaluated in hospitalized patients; therefore, the volume of urine leakage may not indicate normal incontinence status because activity in the hospital is reduced compared with that in normal daily life. Recently, several techniques to improve the functional outcome of RARP have been reported, for example, regional pelvic cooling during prostatectomy, 25 dissection of neurovascular bundles without tension and any use of electrocautery, 26 and a novel approach passing through the pouch of Douglas and avoiding the Retzius structures. 27 The results of these methods, particularly urinary continence, are usually determined according to pad use, pad tests of urinary leakage, and satisfaction questionnaires regarding continence status.…”

Monocyte Chemotactic Protein-1 (MCP-1) as a Predictor of Prolonged Urinary Incontinence After Radical Prostatectomy

“…Another evolving concept regarding reducing inflammation is hypothermia of the prostate via a rectal balloon at the time of surgery [16]. Our previous study is quite remarkable because all patients who received hypothermia during prostatectomy, had a significant reduction in post prostatectomy incontinence [17]. However, in this pilot study, we were unable to determine the true effect of hypothermia, specifically on MCP-1 because we did not measure intraoperative or postoperative MCP-1 levels.…”

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

“…Intraoperative cooling Finley [29] Regional pelvic cooling during RRP was associated with early return of continence. Longer and deeper cooling improved continence.…”

“…In a small sample of patients, Asimakopoulos et al described their anatomic dissection plane ventrally between the detrusor apron and the prostate to spare the plexus of Santorini, essentially leaving the dorsal vein complex intact [28]. Using an intraoperative cooling balloon in 109 patients, hypothermia was introduced by Finley et al to potentially better recover both continence and potency after surgery in a prospective study with a historic control group [29]. The median temperature achieved was 25.5 ∘ C. Long-term followup showed that the time to 0 pad status at 3 and 12 months was 81% to 89% and 100% for the initial and extended cooling groups compared with 69% and 89% in the control group, respectively.…”