Longitudinal change of comprehensive lower urinary tract symptoms and various types of urinary incontinence during robot‐assisted radical prostatectomy

Abstract

Aims To clarify longitudinal change of lower urinary tract symptoms (LUTS) and various types of urinary incontinence following robot‐assisted radical prostatectomy (RARP) using validated questionnaires. Materials and methods The core lower urinary tract symptom score (CLSS) and the International Consultation on Incontinence Questionnaire (ICIQ)‐Short Form (SF) questionnaires were administered to 607 consecutive, treatment‐naïve men receiving RARP before and after surgery. The time course of comprehensive LUTS and various types of urinary incontinence, including stress‐, urgency‐, and urinary incontinence with no obvious reason, were evaluated. Continence recovery rates were compared for the different types of incontinence using Cox hazard regression analysis. Results After surgery, stress urinary incontinence (SUI) was reported most frequently (32% of cases) as the chief complaint with the most impact on daily life, as assessed by the CLSS questionnaire, followed by urgency urinary incontinence (UUI; 27% of cases). The rates of continence recovery differed among the different types of urinary incontinence, such as after urinating, when dressed, when asleep, when physically active or exercising, when coughing or sneezing, before reaching the toilet, and for no obvious reason. Incontinence for no obvious reason at 1 month after RARP was a strongest prognostic factor of delayed continence recovery (hazard ratio, 0.61; P < 0.0001), whereas patients reporting SUI and UUI gradually regained continence. Conclusions Further time course on continent recovery after RARP would be more precisely predictable based on the incontinence status at one month postoperatively. Especially, incontinence with no obvious reason would be a significant factor for delayed recovery.

Particle Swarm Algorithm-Based Analysis of Pelvic Dynamic MRI Images in Female Stress Urinary Incontinence

“…The cause of SUI patients was that the external bladder and other factors worked together to reduce the maximum closure pressure of the urethra [ 9 ]. Niu et al [ 10 ] introduced the topology structure into the PSO algorithm, which gradually developed from the initial static topology structure to the dynamic topology structure, thus solving the problem that even when the problem was complicated, and good optimization was achieved.…”

Longer preserved urethral length in robot‐assisted radical prostatectomy significantly contributes to post‐operative urinary continence recovery

“…Baseline patient characteristics and perioperative and pathological outcomes were obtained from medical records, including age, body mass index (BMI), preoperative prostate‐specific antigen (PSA), day of the surgery, presence or absence of urinary continence after RARP, number of days to achieve urinary continence, date of last consultation, total operative time, console time, loss of blood volume, weight of the resected prostate, pathological T stage, surgical margin status and follow‐up periods according to a previous literature. 5 The day of continence recovery was registered when social continence was attained (a small 20‐ml pad required daily) according to previous literature. 5 Urethral balloon catheters were removed in all patients on post‐operative Day 6.…”

“… 5 The day of continence recovery was registered when social continence was attained (a small 20‐ml pad required daily) according to previous literature. 5 Urethral balloon catheters were removed in all patients on post‐operative Day 6. All patients were instructed to perform pelvic floor exercises post‐operatively.…”

“…RARP was performed using a transperitoneal approach with six ports according to standard techniques, as previously described. 5 In case of unilateral nerve sparing, the sparing side was determined from imaging findings of MRI and the positive site of prostate biopsy. Bilateral nerve sparing was performed when the positive site of prostate biopsy was only in the transition zone.…”

Effectiveness of ultrasound-guided pelvic floor muscle training in improving prolonged urinary incontinence after robot-assisted radical prostatectomy

“…Urinary incontinence (UI) after robot-assisted radical prostatectomy (RARP) is a common complication and has a negative effect on the patient's quality of life (QOL) (1,2). Approximately 90% of patients experience UI after RARP (1,2) and approximately 10% experience UI at 1 year after RARP (3,4). Although artificial urethral sphincter placement is recommended as the gold standard of treatment for these patients (5,6), inherent incidences of adverse events, such as device infection and malfunction, urethral erosion, and atrophy, have been reported (7).…”