World J Mens Health.  2013 Aug;31(2):163-169.

The Surgical Procedure Is the Most Important Factor Affecting Continence Recovery after Laparoscopic Radical Prostatectomy

Affiliations
  • 1Department of Urology, Pusan National University Hospital, Busan, Korea. hongkooha@pusan.ac.kr

Abstract

PURPOSE
We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy.
MATERIALS AND METHODS
Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery.
RESULTS
Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06+/-2.56 and 11.81+/-2.87 mm, and prostatic urethral lengths were 36.39+/-6.15 and 37.45+/-7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25+/-0.06 and 0.24+/-0.06, and prostatic-posterior urethral length ratios were 0.75+/-0.06 and 0.76+/-0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence.
CONCLUSIONS
The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.

Keyword

Laparoscopy; Prostatic neoplasms; Urinary incontinence

MeSH Terms

Humans
Laparoscopy
Magnetic Resonance Imaging
Multivariate Analysis
Neoplasm Grading
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Urinary Incontinence
Urodynamics
Prostate-Specific Antigen

Reference

1. So BK, Choi JD, Lee SY, Kim HS, Park SY, Seo SI. Experience of 100 laparoscopic radical prostatectomies performed by a single surgeon: an analysis of surgical and functional outcomes. Korean J Urol. 2011; 52:517–523.
Article
2. Rassweiler J, Schulze M, Teber D, Seemann O, Frede T. Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol. 2004; 14:75–82.
Article
3. Steiner MS, Morton RA, Walsh PC. Impact of anatomical radical prostatectomy on urinary continence. J Urol. 1991; 145:512–514.
Article
4. Hammerer P, Huland H. Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy. J Urol. 1997; 157:233–236.
Article
5. Lepor H, Kaci L, Xue X. Continence following radical retropubic prostatectomy using self-reporting instruments. J Urol. 2004; 171:1212–1215.
Article
6. Gacci M, Carini M, Simonato A, Imbimbo C, Gontero P, Briganti A, et al. Factors predicting continence recovery 1 month after radical prostatectomy: results of a multicenter survey. Int J Urol. 2011; 18:700–708.
7. Majoros A, Bach D, Keszthelyi A, Hamvas A, Romics I. Urinary incontinence and voiding dysfunction after radical retropubic prostatectomy (prospective urodynamic study). Neurourol Urodyn. 2006; 25:2–7.
Article
8. Coakley FV, Eberhardt S, Kattan MW, Wei DC, Scardino PT, Hricak H. Urinary continence after radical retropubic prostatectomy: relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging. J Urol. 2002; 168:1032–1035.
Article
9. Hwang JJ, Kim BY, Uchio EM. Improving urinary continence after radical prostatectomy: review of surgical modifications. Korean J Urol. 2009; 50:935–941.
Article
10. Narayan P, Konety B, Aslam K, Aboseif S, Blumenfeld W, Tanagho E. Neuroanatomy of the external urethral sphincter: implications for urinary continence preservation during radical prostate surgery. J Urol. 1995; 153:337–341.
Article
11. Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, et al. Risk factors for urinary incontinence after radical prostatectomy. J Urol. 1996; 156:1707–1713.
Article
12. Wei JT, Dunn RL, Marcovich R, Montie JE, Sanda MG. Prospective assessment of patient reported urinary continence after radical prostatectomy. J Urol. 2000; 164:744–748.
Article
13. Oefelein MG. Prospective predictors of urinary continence after anatomical radical retropubic prostatectomy: a multivariate analysis. World J Urol. 2004; 22:267–271.
Article
14. Schlomm T, Heinzer H, Steuber T, Salomon G, Engel O, Michl U, et al. Full functional-length urethral sphincter preservation during radical prostatectomy. Eur Urol. 2011; 60:320–329.
Article
15. Borin JF, Skarecky DW, Narula N, Ahlering TE. Impact of urethral stump length on continence and positive surgical margins in robot-assisted laparoscopic prostatectomy. Urology. 2007; 70:173–177.
Article
16. Kleinhans B, Gerharz E, Melekos M, Weingärtner K, Kälble T, Riedmiller H. Changes of urodynamic findings after radical retropubic prostatectomy. Eur Urol. 1999; 35:217–221.
Article
17. Giannantoni A, Mearini E, Zucchi A, Costantini E, Mearini L, Bini V, et al. Bladder and urethral sphincter function after radical retropubic prostatectomy: a prospective long-term study. Eur Urol. 2008; 54:657–664.
Article
Full Text Links
  • WJMH
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr