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Vipul R Patel - One of the best experts on this subject based on the ideXlab platform.
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systematic review and meta analysis of studies reporting urinary Continence recovery after robot assisted radical prostatectomy
European Urology, 2012Co-Authors: Vincenzo Ficarra, Vipul R Patel, Giacomo Novara, Raymond C Rosen, Walter Artibani, Peter R Carroll, Anthony J Costello, Mani Menon, Francesco Montorsi, Jensuwe StolzenburgAbstract:Abstract Context Robot-assisted radical prostatectomy (RARP) was proposed to improve functional outcomes in comparison with retropubic radical prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). In the initial RARP series, 12-mo urinary Continence recovery rates ranged from 84% to 97%. However, the few available studies comparing RARP with RRP or LRP published before 2008 did not permit any definitive conclusions about the superiority of any one of these techniques in terms of urinary Continence recovery. Objective The aims of this systematic review were (1) to evaluate the prevalence and risk factors for urinary inContinence after RARP, (2) to identify surgical techniques able to improve urinary Continence recovery after RARP, and (3) to perform a cumulative analysis of all available studies comparing RARP versus RRP or LRP in terms of the urinary Continence recovery rate. Evidence acquisition A literature search was performed in August 2011 using the Medline, Embase, and Web of Science databases. The Medline search included only a free-text protocol using the term radical prostatectomy across the title and abstract fields of the records. The following limits were used: humans; gender (male); and publication date from January 1, 2008. Searches of the Embase and Web of Science databases used the same free-text protocol, keywords, and search period. Only comparative studies or clinical series including >100 cases reporting urinary Continence outcomes were included in this review. Cumulative analysis was conducted using the Review Manager v.4.2 software designed for composing Cochrane Reviews (Cochrane Collaboration, Oxford, UK). Evidence synthesis We analyzed 51 articles reporting urinary Continence rates after RARP: 17 case series, 17 studies comparing different techniques in the context of RARP, 9 studies comparing RARP with RRP, and 8 studies comparing RARP with LRP. The 12-mo urinary inContinence rates ranged from 4% to 31%, with a mean value of 16% using a no pad definition. Considering a no pad or safety pad definition, the incidence ranged from 8% to 11%, with a mean value of 9%. Age, body mass index, comorbidity index, lower urinary tract symptoms, and prostate volume were the most relevant preoperative predictors of urinary inContinence after RARP. Only a few comparative studies evaluated the impact of different surgical techniques on urinary Continence recovery after RARP. Posterior musculofascial reconstruction with or without anterior reconstruction was associated with a small advantage in urinary Continence recovery 1 mo after RARP. Only complete reconstruction was associated with a significant advantage in urinary Continence 3 mo after RARP (odds ratio [OR]: 0.76; p =0.04). Cumulative analyses showed a better 12-mo urinary Continence recovery after RARP in comparison with RRP (OR: 1.53; p =0.03) or LRP (OR: 2.39; p =0.006). Conclusions The prevalence of urinary inContinence after RARP is influenced by preoperative patient characteristics, surgeon experience, surgical technique, and methods used to collect and report data. Posterior musculofascial reconstruction seems to offer a slight advantage in terms of 1-mo urinary Continence recovery. Update of a previous systematic review of literature shows, for the first time, a statistically significant advantage in favor of RARP in comparison with both RRP and LRP in terms of 12-mo urinary Continence recovery.
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periurethral suspension stitch during robot assisted laparoscopic radical prostatectomy description of the technique and Continence outcomes
European Urology, 2009Co-Authors: Vipul R Patel, Rafael F Coelho, Kenneth J Palmer, Bernardo RoccoAbstract:Abstract Background Several studies have shown that robot-assisted laparoscopic radical prostatectomy (RALP) is feasible, with favorable complication rates and short hospital times. However, the early recovery of urinary Continence remains a challenge to be overcome. Objective We describe our technique of periurethral retropubic suspension stitch during RALP and report its impact on early recovery of urinary Continence. Design, setting, and participants We analyze prospectively 331 consecutive patients who underwent RALP, 94 without the placement of suspension stitch (group 1) and 237 with the application of the suspension stitch (group 2). Surgical procedure The only difference between the groups was the placement of the puboperiurethral stitch after the ligation of the dorsal venous complex (DVC). The periurethral retropubic stitch was placed using a 12-in monofilament polyglytone suture on a CT-1 needle. The stitch was passed from right to left between the urethra and DVC, and then through the periostium on the pubic bone. The stitch was passed again through the DVC, and then through the pubic bone in a figure eight, and then tied. Measurements Continence rates were assessed with a self-administered validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC]) at 1, 3, 6, and 12 mo after the procedure. Continence was defined as the use of no absorbent pads or no leakage of urine. Results and limitations In group 1, the Continence rate at 1, 3, 6, and 12 mo postoperatively was 33%, 83%, 94.7%, and 95.7%, respectively; in group 2, the Continence rate was 40%, 92.8%, 97.9%, and 97.9%, respectively. The suspension technique resulted in significantly greater Continence rates at 3 mo after RALP ( p =0.013). The median/mean interval to recovery of Continence was also statistically significantly shorter in the suspension group (median: 6wk; mean: 7.338wk; 95% confidence interval [CI]: 6.387–8.288) compared to the nonsuspension group (median: 7wk; mean: 9.585wk; 95% CI: 7.558–11.612; log rank test, p =0.02). Conclusions The suspension stitch during RALP resulted in a statistically significantly shorter interval to recovery of Continence and higher Continence rates at 3 mo after the procedure.
Manish I Patel - One of the best experts on this subject based on the ideXlab platform.
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preoperative membranous urethral length measurement and Continence recovery following radical prostatectomy a systematic review and meta analysis
European Urology, 2017Co-Authors: Sean F Mungovan, Oguz Akin, Jaspreet S Sandhu, Neil A Smart, Petra L Graham, Manish I PatelAbstract:Abstract Context Membranous urethral length (MUL) measured prior to radical prostatectomy (RP) has been identified as a factor that is associated with the recovery of Continence following surgery. Objective To undertake a systematic review and meta-analysis of all studies reporting the effect of MUL on the recovery of Continence following RP. Evidence acquisition A comprehensive search of PubMed, EMBASE, and Scopus databases up to September 2015 was performed. Thirteen studies comprising one randomized controlled trial and 12 cohort studies were selected for inclusion. Evidence synthesis Four studies (1738 patients) that reported hazard ratio results. Every extra millimeter (mm) of MUL was associated with a faster return to Continence (hazard ratio: 1.05; 95% confidence interval [CI]: 1.02–1.08, p p =0.004), 6 mo (OR: 1.12, 95% CI: 1.09–1.15, p p =0.006) following surgery. After adjusting for repeated measurements over time and studies with overlapping data, all OR data combined indicated that every extra millimeter of MUL was associated with significantly greater odds for return to Continence (OR: 1.09, 95% CI: 1.05–1.15, p Conclusions A greater preoperative MUL is significantly and positively associated with a return to Continence in men following RP. Magnetic resonance imaging measurement of MUL is recommended prior to RP. Patient summary We examined the effect that the length of a section of the urethra (called the membranous urethra) had on the recovery of Continence after radical prostatectomy surgery. Our results indicate that measuring the length of the membranous urethra via magnetic resonance imaging before surgery may be useful to predict a longer period of urinary inContinence after surgery, or to explain a delay in achieving Continence after surgery.
Bernardo Rocco - One of the best experts on this subject based on the ideXlab platform.
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periurethral suspension stitch during robot assisted laparoscopic radical prostatectomy description of the technique and Continence outcomes
European Urology, 2009Co-Authors: Vipul R Patel, Rafael F Coelho, Kenneth J Palmer, Bernardo RoccoAbstract:Abstract Background Several studies have shown that robot-assisted laparoscopic radical prostatectomy (RALP) is feasible, with favorable complication rates and short hospital times. However, the early recovery of urinary Continence remains a challenge to be overcome. Objective We describe our technique of periurethral retropubic suspension stitch during RALP and report its impact on early recovery of urinary Continence. Design, setting, and participants We analyze prospectively 331 consecutive patients who underwent RALP, 94 without the placement of suspension stitch (group 1) and 237 with the application of the suspension stitch (group 2). Surgical procedure The only difference between the groups was the placement of the puboperiurethral stitch after the ligation of the dorsal venous complex (DVC). The periurethral retropubic stitch was placed using a 12-in monofilament polyglytone suture on a CT-1 needle. The stitch was passed from right to left between the urethra and DVC, and then through the periostium on the pubic bone. The stitch was passed again through the DVC, and then through the pubic bone in a figure eight, and then tied. Measurements Continence rates were assessed with a self-administered validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC]) at 1, 3, 6, and 12 mo after the procedure. Continence was defined as the use of no absorbent pads or no leakage of urine. Results and limitations In group 1, the Continence rate at 1, 3, 6, and 12 mo postoperatively was 33%, 83%, 94.7%, and 95.7%, respectively; in group 2, the Continence rate was 40%, 92.8%, 97.9%, and 97.9%, respectively. The suspension technique resulted in significantly greater Continence rates at 3 mo after RALP ( p =0.013). The median/mean interval to recovery of Continence was also statistically significantly shorter in the suspension group (median: 6wk; mean: 7.338wk; 95% confidence interval [CI]: 6.387–8.288) compared to the nonsuspension group (median: 7wk; mean: 9.585wk; 95% CI: 7.558–11.612; log rank test, p =0.02). Conclusions The suspension stitch during RALP resulted in a statistically significantly shorter interval to recovery of Continence and higher Continence rates at 3 mo after the procedure.
Hedvig Hricak - One of the best experts on this subject based on the ideXlab platform.
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recovery of urinary Continence after radical prostatectomy association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging
European Urology, 2009Co-Authors: Philippe Paparel, Peter T Scardino, Hedvig Hricak, Oguz Akin, Jaspreet S Sandhu, Javier Romero Otero, Angel M Serio, Bertrand GuillonneauAbstract:Abstract Background Limited data on endorectal magnetic resonance imaging (MRI) features and urinary Continence after radical prostatectomy (RP) are available. Objective To assess whether recovery of urinary Continence after RP is associated with endorectal MRI findings regarding preoperative and postoperative membranous urethral length (MUL), percent change in MUL, and postoperative urethral and periurethral fibrosis. Design, setting, and participants Sixty-four patients who received an MRI scan before and after RP for localized prostate cancer were evaluated in a retrospective study at a single institution. Intervention All patients underwent RP. Measurements The postoperative scan was performed to detect local recurrence in patients with rising levels of prostate-specific antigen. Urinary Continence was graded on a five-point scale. MUL was measured on T2-weighted images. Urethral and periurethral fibrosis was graded from 0 to III based on axial T2-weighted images. Univariate Cox proportional hazards regression was performed to assess variables associated with Continence. Results and limitations Forty-eight patients regained Continence following surgery. The median follow-up for patient who were incontinent at their last assessment was 7 mo. The median interval from RP to postoperative endorectal MRI was 10 mo. A longer preoperative or postoperative MUL was associated with superior Continence (both p p =0.02). Patients with a high grade of postoperative periurethral fibrosis tended to have worse postoperative Continence; nevertheless a statistical correlation was not reached (hazard ratio: 0.64, p =0.16). This is a retrospective study. Conclusions Preoperative and postoperative MUL and the MUL loss ratio are related to the recovery time and level of urinary Continence after RP. Therefore, preservation of urethral length during surgery is recommended. Periurethral fibrosis might impede the recovery of Continence after RP by altering the elasticity of the external sphincter.
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urinary Continence after radical retropubic prostatectomy relationship with membranous urethral length on preoperative endorectal magnetic resonance imaging
The Journal of Urology, 2002Co-Authors: Fergus V Coakley, Steven C Eberhardt, Michael W Kattan, David C Wei, Peter T Scardino, Hedvig HricakAbstract:ABSTRACTPurpose: We determined whether membranous urethral length on preoperative magnetic resonance imaging (MRI) is predictive of urinary Continence after radical retropubic prostatectomy.Materials and Methods: Membranous urethral length was measured on preoperative endorectal MRI in 211 consecutive patients with newly diagnosed prostate cancer before radical retropubic prostatectomy performed by a single surgeon. Neurovascular bundle resection was done in 60 cases. After surgery the time to stable postoperative Continence was recorded in 180 cases and the level of stable Continence was graded on a 5-point scale of 1—complete Continence to 5—complete inContinence.Results: After controlling for age and surgical technique multivariate analysis showed that membranous urethral length was related to time to stable postoperative Continence (p = 0.02), such that a longer membranous urethra was associated with a shorter time to stable Continence. For example, 1 year after surgery 120 of the 134 patients (89%) w...
Rafael F Coelho - One of the best experts on this subject based on the ideXlab platform.
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periurethral suspension stitch during robot assisted laparoscopic radical prostatectomy description of the technique and Continence outcomes
European Urology, 2009Co-Authors: Vipul R Patel, Rafael F Coelho, Kenneth J Palmer, Bernardo RoccoAbstract:Abstract Background Several studies have shown that robot-assisted laparoscopic radical prostatectomy (RALP) is feasible, with favorable complication rates and short hospital times. However, the early recovery of urinary Continence remains a challenge to be overcome. Objective We describe our technique of periurethral retropubic suspension stitch during RALP and report its impact on early recovery of urinary Continence. Design, setting, and participants We analyze prospectively 331 consecutive patients who underwent RALP, 94 without the placement of suspension stitch (group 1) and 237 with the application of the suspension stitch (group 2). Surgical procedure The only difference between the groups was the placement of the puboperiurethral stitch after the ligation of the dorsal venous complex (DVC). The periurethral retropubic stitch was placed using a 12-in monofilament polyglytone suture on a CT-1 needle. The stitch was passed from right to left between the urethra and DVC, and then through the periostium on the pubic bone. The stitch was passed again through the DVC, and then through the pubic bone in a figure eight, and then tied. Measurements Continence rates were assessed with a self-administered validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC]) at 1, 3, 6, and 12 mo after the procedure. Continence was defined as the use of no absorbent pads or no leakage of urine. Results and limitations In group 1, the Continence rate at 1, 3, 6, and 12 mo postoperatively was 33%, 83%, 94.7%, and 95.7%, respectively; in group 2, the Continence rate was 40%, 92.8%, 97.9%, and 97.9%, respectively. The suspension technique resulted in significantly greater Continence rates at 3 mo after RALP ( p =0.013). The median/mean interval to recovery of Continence was also statistically significantly shorter in the suspension group (median: 6wk; mean: 7.338wk; 95% confidence interval [CI]: 6.387–8.288) compared to the nonsuspension group (median: 7wk; mean: 9.585wk; 95% CI: 7.558–11.612; log rank test, p =0.02). Conclusions The suspension stitch during RALP resulted in a statistically significantly shorter interval to recovery of Continence and higher Continence rates at 3 mo after the procedure.
