Feasibility and continence outcomes of extended prostatic urethral preservation during robot-assisted radical prostatectomy
| Autor: | Eric C. Kauffman, Gaybrielle James, Ahmed A. Hussein, Kristopher Attwood, Luciano A. Nunez Bragayrac, Christine Murekeysoni, Jennifer Osei, Elena Pop |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Article 03 medical and health sciences Prostate cancer 0302 clinical medicine Robotic Surgical Procedures Urethra Prostatic urethra Humans Medicine Survival rate Aged Retrospective Studies Prostatectomy Univariate analysis Urinary continence business.industry Margins of Excision Prostatic Neoplasms Retrospective cohort study Middle Aged Prognosis medicine.disease Surgery Survival Rate Log-rank test Urinary Incontinence medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Feasibility Studies business Organ Sparing Treatments Follow-Up Studies |
| Zdroj: | Prostate Cancer Prostatic Dis |
| ISSN: | 1476-5608 1365-7852 |
| Popis: | BACKGROUND: The prostatic urethra is conventionally resected during robot-assisted radical prostatectomy (RARP). We describe the technical feasibility and urinary continence outcomes of extended prostatic urethral preservation (EPUP) during RARP. METHODS: A single surgeon at a National Comprehensive Cancer Network institute performed 48 consecutive RARP operations using EPUP from March 2014 to March 2016, during which time 177 conventional non-EPUP RARP operations were performed by other surgeons. Prior to this period, the EPUP surgeon had performed 17 non-EPUP RARP operations over 15 months. Total intracorporeal urethral length (IUL) preserved during EPUP was measured intraoperatively. Associations of EPUP and IUL with continence recovery rates and/or times were tested in Fisher’s exact and log rank univariate analyses and Cox logistic regression multivariable analyses. RESULTS: Median IUL preserved during EPUP was 4.0 cm (range 2.5–6.0 cm), and urethral dissections typically spanned the prostatic apex to mid-gland or base. 7-week continence rates were significantly higher with versus without EPUP. EPUP patient rates of using 0 or 0–1 pads per day immediately after catheter removal were 19% and 35%, respectively. These rates increased significantly (53% and 76%, respectively), as did the IUL preserved (median 5.0 cm), among more recent EPUP patients (n=17), which suggested a learning curve. In multivariable analyses including all patients, an EPUP approach was an independent predictor of faster continence recovery. In multivariable analyses of the EPUP subset, a longer IUL preserved was independently associated with faster continence recovery. No EPUP patient had a urethral fossa positive margin, and apical positive margins were similarly infrequent among EPUP and non-EPUP patients. CONCLUSIONS: EPUP is technically feasible during RARP and associated with faster continence recovery. Future investigation into the generalizability of these findings and the oncologic safety of EPUP is warranted. |
| Databáze: | OpenAIRE |
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