Influence of perineal prostatectomy on anal continence

Abstract

OBJECTIVE:Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy.METHODS:From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry.RESULTS:The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003).CONCLUSION:There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.

Quality of Life in Men Undergoing Prostatectomy: Integrative Review

“…Ambos são descritivos observacionais, que apresentam como objetivo a avaliar os efeitos do acesso perineal em mecanismos de continência anal após a PR (Guilger et al, 2011) e relatar taxas de sucesso e fracasso do tratamento para fístula de reparação do reto após a PR (Thompson et al, 2014). Ambos avaliam o impacto do tratamento sobre os resultados de QV relacionada a saúde.…”

Quality of Life in Men Undergoing Prostatectomy: Integrative Review

“…Wang & Eriksson, 2014) e trinta e três estudos observacionais (Anderson et al, 2012;Bach et al, 2011;Berge et al, 2013;Bradford et al, 2010;Choi et al, 2011;Dahl et al, 2014;Froehner et al, 2012;Geraerts et al, 2013;Guilger et al, 2011;Hartz et al, 2013;Holm et al, 2013;Inoue et al, 2009;Kimura et al, 2011;Koehler et al, 2012;Ku et al, 2009;Lee et al, 2012;Lin et al, 2012;Martin et al, 2011;Namiki et al, 2012;Namiki et al, 2009;Nyarangi-Dix et al, 2013;Parker et al, 2011;Pfalzgraf et al, 2014;Santa Mina et al, 2014;Santa Mina et al, 2010;Thompson et al, 2014;Thornton et al, 2012;Treiyer et al, 2011;van der Poel et al, 2013;R. Wang et al, 2012;Willis et al, 2012).…”

“…Ao analisarmos o delineamento de pesquisa, observou-se delineamento quantitativo em trinta e nove estudos (Anderson et al, 2012;Bach, Döring, Gesenberg, Möhring, & Goepel, 2011;Berge et al, 2013;Bradford et al, 2010;Choi et al, 2011;Dahl et al, 2014;Delongchamps, Belas, Saighi, Zerbib, & Peyromaure, 2013;Froehner et al, 2012;Geraerts et al, 2013;Guilger et al, 2011;Hartz et al, 2013;Holm, Fosså, Hedlund, & Dahl, 2013;Imbimbo et al, 2011;Inoue et al, 2009;Kimura et al, 2011;Koehler et al, 2012;Ku et al, 2009;Lee et al, 2012;Lin, Yu, Lin, Yang, & Kao, 2012;Martin et al, 2011;Mehnert, Lehmann, Graefen, Huland, & Koch, 2010;Miyazato et al, 2014;Namiki et al, 2012;Namiki, Ishidoya, Tochigi, Ito, & Arai, 2009;NyarangiDix, Radtke, Hadaschik, Pahernik, & Hohenfellner, 2013;Parker, Wang, He, & Wood Jr, 2011;Pfalzgraf et al, 2014;Ratcliff, Cohen, Pettaway, & Parker, 2013;Santa Mina et al, 2014;Santa Mina et al, 2010;Sugimoto, Tsunemori, & Kakehi, 2009;Thompson et al, 2014;Thornton, Perez, Oh, & Crocitto, 2012;Treiyer, Anheuser, Bütow, & Steffens, 2011;E. Y. Wang & Eriksson, 2014;R.…”

“…De acordo com a classificação dos NE utilizada, vinte e cinco apresentam nível de evidência VI (Anderson et al, 2012;Bach et al, 2011;Berge et al, 2013;Choi et al, 2011;Froehner et al, 2012;Geraerts et al, 2013;Guilger et al, 2011;Imbimbo et al, 2011;Inoue et al, 2009;Koehler et al, 2012;Ku et al, 2009;Lee et al, 2012;Lin et al, 2012;Martin et al, 2011;Namiki et al, 2009;Pfalzgraf et al, 2014;Santa Mina et al, 2014;Santa Mina et al, 2010;Thompson et al, 2014;Thornton et al, 2012;Treiyer et al, 2011;Willis et al, 2012), seis apresentam nível IV (Hartz et al, 2013;Namiki et al, 2012;Thompson et al, 2014;van der Poel et al, 2013;E. Y. Wang & Eriksson, 2014;R.…”

“…Y. Wang & Eriksson, 2014;R. Wang et al, 2012;Willis et al, 2012), onze estudos foram utilizadas associações de instrumentos específicos à genéricos Hartz et al, 2013;Holm et al, 2013;Imbimbo et al, 2011;Inoue et al, 2009;Namiki et al, 2012;Namiki et al, 2009;Ratcliff et al, 2013;Santa Mina et al, 2014;Treiyer et al, 2011) em quatro estudos foram utilizados instrumentos específicos de sintomas urinários e/ou incontinência ou sintomas intestinais (Froehner et al, 2012;Guilger et al, 2011;Martin et al, 2011;Pfalzgraf et al, 2014), em três estudos foram utilizados instrumentos genéricos (Geraerts et al, 2013;Mehnert et al, 2010;Thorsteinsdottir et al, 2013), em dois estudos foram utilizados questionários elaborados pelos próprios autores (Delongchamps et al, 2013;Thompson et al, 2014), e em dois estudos foram utilizados instrumentos específicos da próstata (Ku et al, 2009;Santa Mina et al, 2010). O instrumento mais utilizado foi o EPIC, usado em treze estudos, seguido do UCLA-PCI, em nove estudos, seguido do SF-12 que foi usado em cinco estudos e SF-36 em outros cinco estudos.…”