Urinary Symptoms After Robotic Prostatectomy in Men with Median Lobes

Shah, Satyan K.; Fleet, Trisha; Skipper, Betty

doi:10.4293/108680813x13693422519910

Cited by 5 publications

(13 citation statements)

References 15 publications

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“…Shah et al 11 It is interesting that the subscore for storage symptoms also initially increased in both cohorts followed by progressive declines of −16% in NoML and −25% in ML from their respective baselines by 6 months postoperatively. In contrast, there was a continuous and greater improvement in subscores for voiding symptoms in both groups by 6 months postoperatively (−57% in NoML and −68% in ML).…”

Section: Discussionmentioning

confidence: 90%

“…To the best of our knowledge, our study is the largest series to date comparing preoperative and postoperative symptoms in patients with ML who underwent RARP. 5,[9][10][11] Previous studies have not demonstrated differences in the rate of continence at mid-and long-term follow-up between patients with or without ML. Several investigators have shown differences at early follow up which resolved later.…”

Section: Discussionmentioning

confidence: 96%

“…Several investigators have shown differences at early follow up which resolved later. 11 Hamidi et al 12 reported a higher rate of continence in NoML patients at their first-month visit (49.2% vs. 56.5%, p = .03). Jo et al 13 found that the presence and size of an ML as measured preoperatively by way of an index of prostatic protrusion is strongly correlated to the time interval to continence recovery.…”

Section: Discussionmentioning

confidence: 97%

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Impact of median lobe on urinary function after robotic prostatectomy

et al. 2021

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Background: Enlarged median lobes (ML) can be technically challenging, particularly during bladder-neck dissection, and may affect urinary functional outcomes of robotic radical prostatectomy (RARP). If known, the impact of potentially larger bladder necks on continence and chronic obstruction on postoperative urinary symptoms might aid patient counseling. We assessed the impact of intraoperatively identified median lobes (ML) on urinary function.Methods: We reviewed our prospective RP database from 2013 to 2020. AUA symptoms scores (AUA-SS) were assessed preoperatively and at 1, 3, and 6 months.We compared patients with and without ML (NoML). Bladder-neck sparing was routine to avoid reconstruction.Results: Of 663 patients who completed AUA-SS questionnaires at all time points, 202 (30%) had ML. There were no significant differences in demographics, PSA, or clinical stage. Only two patients in ML and one in NoML group required bladder-neck reconstruction (1.2% and 0.2%). There was no immediate or long-term difference in continence rates between groups. Baseline mean AUA-SS was higher in ML patients and showed more improvement postoperatively (−5.5 vs. −3.6, p < .05) with greatest improvement in ML patients with severe preoperative symptoms (−15.1). There was no difference in AUA-SS between groups by 6 months. Conclusions:The presence of enlarged ML does not increase the risk of incontinence after RARP and it appears that ML patients have greater improvements in postsurgical urinary functions. Preoperative diagnosis of ML and lower urinary tract symptoms assessment could be helpful in counseling patients undergoing RARP regarding their expected postoperative urinary outcomes.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

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Impact of median lobe on urinary function after robotic prostatectomy

et al. 2021

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“…Quantifying OML can be a challenge; there are no standardized criteria for measuring the size or degree of obstruction. This could be due in part to the fact that there is wide variation in the severity and morphology of middle lobe enlargement [15]. One measurement approach that has been shown to correlate well with BOO is intravesical prostatic protrusion (IPP), an ultrasonic measurement of prostatic protrusion into the bladder [16–19].…”

Section: Introductionmentioning

confidence: 99%

“…Treating OML can be a challenge. Middle lobe enlargement and the related IPP are associated with a higher risk of urinary retention and a higher failure rate of medical therapy for LUTS due to BPH [15, 19]. There is also a risk of greater surgical difficulty with this anatomy, particularly when the IPP is severe or there is a high bladder neck [21].…”

Section: Introductionmentioning

confidence: 99%

Prostatic Urethral Lift (PUL) for obstructive median lobes: 12 month results of the MedLift Study

Rukstalis

Grier

Stroup

et al. 2018

Prostate Cancer Prostatic Dis

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Evidence indicating Prostatic Urethral Lift (PUL) delivers significant improvement in symptomatic BPH with low morbidity is based on subjects with lateral lobe (LL) enlargement only. MedLift was an FDA IDE extension of the L.I.F.T. randomized study designed to examine safety and efficacy of PUL for treatment of obstructive middle lobes (OML). Inclusion criteria for this non-randomized cohort were identical to the L.I.F.T. randomized study, except for requiring an OML: ≥ 50 years of age, IPSS ≥ 13, and Qmax ≤ 12 ml/s. Primary endpoint analysis quantified improvement in IPSS over baseline and rate of post-procedure serious complications. Quantification of symptom relief, quality of life, flow rate, and sexual function occurred through 12 months. Outcomes were compared to historical L.I.F.T LL results and were combined to demonstrate the full effectiveness of PUL. Of the 71 screened subjects, 45 were enrolled. At 1, 3, 6, and 12 months, mean IPSS improved from baseline at least 13.5 points (p < 0.0001). Quality of life and BPHII were similarly improved (>60% and >70%, respectively at 3, 6, and 12 months, p < 0.0001). Mean Qmax improvement ranged from 90 to 129% (p < 0.0001). At 1 month, 86% (CI 73–94%) reported ≥70 on the Quality of Recovery scale, 80% (CI 66–89%) reported being “much” or “very much better,” and 89% (CI 76–95%) would recommend the procedure. Compared to LL subjects, OML subjects’ symptoms improved at least as much at every time point (OML range 13.5–15.9, LL range 9.9–11.1, p ≤ 0.01). On combining OML with LL data, >70% (range CI 63–81%) of subjects demonstrated ≥ 8 point improvement in IPSS through 12 months. Analysis of the combined dataset indicates ≥ 40% (CI 30–51%) of sexually active men improved the minimal clinically important difference in erectile function through 12 months. Prostates, including those with middle lobe obstruction, can be treated with the PUL procedure safely and effectively.

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