Sustainable functional urethral reconstruction: Maximizing early continence recovery in robotic-assisted radical prostatectomy

Abstract

Objective To evaluate the safety profile and short-term functional outcome of sustainable functional urethral reconstruction (SFUR) in robotic-assisted radical prostatectomy (RARP). Methods One hundred and sixty-two consecutive prostate cancer patients who underwent RARP were retrospectively analyzed, in which 53 had undergone SFUR while the other 109 had undergone conventional RARP procedures. Immediate, 2-week, 1-month and 3-month continence recovery and other perioperative data were compared to evaluate short-term surgical and functional outcome. Results The median age was 68 and 67 years in the experimental group and control group, respectively ( p =0.206), with a median prostate-specific antigen (PSA) of 13.6 ng/mL (interquartile range [IQR], 8.46–27.32 ng/mL) in the experimental group and 13.84 ng/mL (IQR, 9.12–26.80 ng/mL) in control group ( p =0.846). Immediate, 2-week, 1-month and 3-month continence recovery rates between the groups were 34.0% vs. 3.7%, 50.9% vs. 14.7%, 62.3% vs. 27.5%, and 79.2% vs. 63.3% (all p <0.05). The morphological changes made by the new reconstruction technique were maintained on magnetic resonance imaging (MRI) 3 months postoperatively. Nerve-sparing procedures and adoption of the new reconstruction technique were significantly relevant to continence recovery on logistics regression model ( p <0.001). Conclusions SFUR is a safe and easy-to-handle modification that may contribute to early continence return for RARP. Long-term follow-up and prospective studies are required to further evaluate its value in postoperative quality-of-life improvement.

Pad Weight, Pad Number and Incontinence-Related Patient-Reported Outcome Measures After Radical Prostatectomy

“…In our study, we found a moderate correlation between pad number and 24-hour pad weight at 3 weeks and 6 weeks postoperatively. This is in line with previous studies reporting that the pad number is not a reliable measure of incontinence [4,5,21]. Patients may change pads for a variety of reasons, including differing acceptable hygiene and pad wetness levels, convenience, and financial or physical access to pads.…”

“…Our study focuses on the early postoperative period, as technical modifications, improvements in surgical technique, and the increasing use of robotic surgery have accelerated continence recovery [4,5,22,23]. Definitions of continence in the literature regarding the early postoperative period vary greatly.…”

“…Organ-confined disease is treated surgically by radical prostatectomy (RP). Despite improvement in surgical technique, post-prostatectomy incontinence (PPI) affects 49% to 63% of patients in the early postoperative period (first 6 weeks) [2][3][4][5]. Estimates of the incidence of PPI and continence recovery time vary because of the lack of a universally accepted definition of continence, the variety of assessment methods used to determine severity of PPI, and variability in PPI assessment time points.…”

Sustainable functional urethral reconstruction improves early urinary continence after robot‐assisted radical prostatectomy: a randomised controlled trial

“…Determination of sample size was based on the observed 1‐month UC recovery rates of 62.3% and 27.5% in the SFUR and standard groups, respectively, in our previous retrospective study [14]. With the power set at 0.9, two‐sided alpha level at 0.05, and non‐response rate at 20%, the optimal sample size was calculated to be 96 subjects (48 in each arm, calculated with Power Analysis and Sample Size [PASS] software, version 15).…”

“…Patients were randomly assigned (1:1 allocation) to either the SFUR or standard group by a randomisation sequence, which was created by an independent statistician using Stata Statistical Software Release 16.0 (Stata Corp., College Station, TX, USA). Randomisation was stratified by nerve‐sparing procedures (yes vs no) considering that they were statistically relevant with better UC recovery in the retrospective study [14]. The allocation sequence was concealed in sequentially numbered, opaque, and sealed envelopes.…”