Longitudinal urgency outcomes following robotic-assisted laparoscopic prostatectomy

Kennady, Emmett H.; Zillioux, Jacqueline; Ali, Marwan; Hutchison, Dylan D.; Farhi, Jacques; DeNovio, Anthony; Barquin, David; Rapp, David E.

doi:10.1007/s00345-023-04458-0

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Our program includes exercises of all types which is important given the significant rate of UUI reported following prostatectomy ( 34 ). We have previously reported de novo UUI rates of 56% and 62% of RALP patients at 3- and 6-month timepoints, respectively ( 35 ).…”

Section: Discussionmentioning

confidence: 96%

Novel online comprehensive pelvic floor therapy program following prostatectomy

Rapp,

Hutchison,

Jones

et al. 2023

Transl Androl Urol

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Background Although pelvic floor muscle training (PFMT) is widely shown to improve post-prostatectomy incontinence (PPI), numerous barriers impede access to formal PFMT and include the limited availability of specialized therapists and financial or scheduling barriers. To address these barriers, we developed a novel online program delivering comprehensive long-term PFMT, pelvic floor education (PFE), and dietary/behavioral modification education. This study is a prospective interim analysis of online PFMT/PFE (oPFMT/PFE), with focus on feasibility, satisfaction, and continence outcomes. Methods Patients anticipating robotic-assisted laparoscopic prostatectomy (RALP) were recruited (6/2021–9/2022) for oPFMT/PFE. oPFMT/PFE comprises a 12-month program of 3 phases, including multiple exercises with varied contraction types and duration, and comprehensive dietary and behavioral technique education. Incontinence and quality of life (QOL) outcomes are assessed at 3 weeks, 3, 6, and 12 months following RALP using validated International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and Incontinence Impact Questionnaire (IIQ-7) questionnaires and additional items assessing satisfaction, improvement, and daily pad use. Primary study outcomes included ICIQ-MLUTS stress urinary incontinence (SUI) domain score (SDS) and SUI cure [ICIQ SUI domain score (SDS) =0]. Interim 6-month analysis was performed using mixed effects linear regression and mixed effects Poisson regression. Results Analysis included 21 men (64±6 years). At 6-month follow-up, men undergoing oPFMT/PFE showed significant improvement in SDS compared to the 3-week time point [mean ± standard error (SE) =1.05±0.24 vs. 0.45±0.17, P=0.011], but still experienced higher scores than at baseline (P=0.017). Six-month patient-reported improvement averaged 7.42±0.74 (10-point Likert scale). All (100%) of 19 respondents (2 missing data) found the program easy to use, educational, and would recommend it to others, with 89% expressing satisfaction with the program. During patient interview at 6-month follow-up, no men reported inability to access the program online or any adverse events. Finally, IIQ-7 score improved significantly from the 3-week timepoint (4.47±1.10) at both time points (3-month 1.14±0.44, P<0.001 and 6-month 1.10±0.37, P<0.001), and neither 3- nor 6-month scores differed from baseline (P=0.808 and P=0.444, respectively). Conclusions Our novel oPFMT/PFE yields significant improvements to validated urinary incontinence (UI) and QOL measures, providing a valuable and accessible treatment option for PPI.

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Section: Discussionmentioning

confidence: 96%

Novel online comprehensive pelvic floor therapy program following prostatectomy

Rapp,

Hutchison,

Jones

et al. 2023

Transl Androl Urol

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“…The first reported robot-assisted surgery was in 2000, and since then robot-assisted laparoscopic radical prostatectomy (RALP) has become accepted worldwide [2,3]. The indication of RP is cancer control, but postoperative both short-term and long-term complications such as urinary and sexual dysfunction remain of concern [4][5][6]. Furthermore, post-RALP patients sometimes present symptoms such as FI, rectal urgency, and disturbed defecation [7].…”

Section: Introductionmentioning

confidence: 99%

Anorectal function and symptoms 6 months after robot-assisted laparoscopic radical prostatectomy: a single-center study

Psarias,

Walter,

Holmbom

et al. 2024

SJU

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Introduction: Robot-assisted laparoscopic radical prostatectomy (RALP) is a common procedure for the treatment of localised prostate cancer. Anorectal symptoms such as fecal incontinence (FI), rectal urgency or disturbed defecation have been reported after the operation. Anorectal function is dependent on the integrity of anal and pelvic nerves and muscles, rectal sensory function as well as rectal reservoir function. The aim of this study was to investigate the potential influence of RALP on anorectal physiological function and bowel symptoms. Materials and Methods: In this pilot study, 29 patients with localised prostate cancer scheduled for RALP were included. Anorectal physiology was used to measure rectal sensitivity and reservoir function as well as anal sphincter pressures. Bowel symptoms were measured by a bowel function questionnaire and a 2-week bowel function diary. Measurements were done before the operation and repeated at 6 months after the operation. Results: The study observed a significant postoperative increase in rectal sensory threshold for rectal balloon distention, from 20 to 40 mmHg, P < 0.001. This change is indicative of a decrease in rectal sensation after RALP. There were no other statistical significant differences in any of the physiological tests performed. Importantly, there was no change in any of the bowel symptoms after surgery. Conclusion: This study showed that RALP may lead to impaired rectal sensory function. This finding did not, however, seem to have any influence on the patients´ postoperative clinical bowel function.

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