Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review

Heesakkers, John; Farag, Fawzy; Bauer, Ricarda M.; Sandhu, Jaspreet S.; Ridder, Dirk De; Stenzl, Arnulf

doi:10.1016/j.eururo.2016.09.031

Cited by 193 publications

(186 citation statements)

References 76 publications

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“…Several studies demonstrated that preoperative MUL was an important factor associated with early resolution of UI after RP . However, in this study, although preoperative MUL was longest in the large prostate type (cluster 3), UI was most prolonged in this type among these four clusters.…”

Section: Discussioncontrasting

confidence: 68%

“…However, to the best of our knowledge, the sample size of this study is the largest of the studies that evaluated UI and OAB symptoms. Second, although perioperative MUL and prostate size were considered to be among the most important factors related to UI after RP, factors other than MUL and prostate size, such as age, nerve‐sparing, and so on, might be involved in the UI and LUTS after RP . However, although age, pathological stage of prostate cancer, and nerve‐sparing status were evaluated among each cluster, there were no significant differences in these factors among the clusters.…”

Section: Discussionmentioning

confidence: 97%

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Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

Onoda

Haga

Kurimura

et al. 2019

Neurourology and Urodynamics

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Aims The aim of the present study was to construct a novel classification based on perioperative changes of membranous urethral length (MUL) using hierarchical cluster analysis to predict urinary incontinence (UI) and overactive bladder (OAB) symptoms after robot‐assisted radical prostatectomy (RARP). Methods A total of 299 patients who underwent RARP with complete pre and postoperative MUL data were included in the present study. Hierarchical cluster analysis was performed to identify the groups with similar perioperative MUL and prostate size. UI and OAB symptoms after RARP were evaluated in each cluster for 12 months after RARP. Results Four groups were identified by the cluster analysis of these factors: preservation of MUL type (cluster 1, n = 92); standard type (cluster 2, n = 137); large prostate type (cluster 3, n = 23); and loss of MUL type (cluster 4, n = 47). Although there was significantly more UI in clusters 3 and 4 than in clusters 1 and 2 up to 3 months after RARP, UI improvement was the most delayed in cluster 3. Improvement of OAB symptoms was also most delayed in cluster 3. Urinary quality of life (QOL) was significantly worse in cluster 4 than in clusters 1 and 2. Conclusions Cluster analysis successfully classified patients after RARP into four characteristic groups based on perioperative MUL. Recovery from UI and OAB symptoms and urinary QOL after RARP were significantly different among these groups. This classification based on cluster analysis might be useful to predict recovery from UI and OAB symptoms when following QOL after RARP.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 97%

Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

Onoda

Haga

Kurimura

et al. 2019

Neurourology and Urodynamics

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“…These include patient factors (age, body mass index, comorbidity, lower urinary tract symptoms, and prostate volume) [8], surgeon experience, and surgical technique. Surgical technique is the only modifiable factor among these, and therefore, identifying and developing an optimal operative technique is likely to impact on continence outcomes [9].…”

Section: Introductionmentioning

confidence: 99%

Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer

et al. 2017

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Purpose of ReviewA variety of different surgical techniques are thought to impact on urinary continence (UC) recovery in patients undergoing robot assisted radical prostatectomy (RARP) for prostate cancer. Herein, we review current evidence and propose a composite evidence-based technique to optimize UC recovery after RARP.Recent FindingsA literature search on studies reporting on surgical techniques to improve early continence recovery post robotic prostatectomy was conducted on PubMed and EMBASE. The available data from studies ranging from randomized control trials to retrospective cohort studies suggest that minimizing damage to the internal and external urinary sphincters and their neural supply, maximal sparing of urethral length, creating a secure vesicourethral anastomosis, and providing anterior and posterior myo- fascio-ligamentous support to the anastomosis can improve early UC recovery post RARP.SummaryA composite evidence-based surgical technique incorporating the above principles could optimize early UC recovery post RARP. Evidence from randomized studies is required to prove benefit.

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“…The integrity of these structures is essential for proper sphincter function. Heesakkers et al, have recently published a systematic review assessing contributing factors in post prostatectomy incontinence . Neurovascular bundle damage, devascularization, laxity of posterior support, extensive dissection, fibrosis, and stricture formation have all been shown to have a negative impact.…”

Section: Methodsmentioning

confidence: 99%

The role of male slings in post prostatectomy incontinence: ICI‐RS 2015

Sahai

Abrams

Dmochowski

et al. 2017

Neurourology and Urodynamics

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Pathophysiology and Contributing Factors in Postprostatectomy Incontinence: A Review

Cited by 193 publications

References 76 publications

Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

Usefulness of a novel classification based on perioperative changes of membranous urethral length using hierarchical cluster analysis of urinary incontinence and overactive bladder symptoms after robot‐assisted radical prostatectomy: A prospective observational study

Surgical Techniques to Optimize Early Urinary Continence Recovery Post Robot Assisted Radical Prostatectomy for Prostate Cancer

The role of male slings in post prostatectomy incontinence: ICI‐RS 2015

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