For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
14
views
58
references
 Top references
cited by
15
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      131
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Anatomical, surgical and technical factors influencing continence after radical prostatectomy

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Radical prostatectomy (RP) is the most frequent treatment with curative intent performed for prostate cancer to date. Different surgical approaches (perineal, transperitoneal, and extraperitoneal) and techniques (laparoscopic and robot assisted) have been described to increase the efficiency and potentially diminish the postoperative complications of this procedure.

          The aim of this narrative review is to investigate and define the factors that influence postprostatectomy urinary continence. We highlighted the anatomical landmarks and the modifications of surgical techniques aimed at improving the continence rates and thus, patient quality of life.

          After RP, the long-term continence rates range from 84% to 97%. In order to achieve good continence rates, a careful dissection along with meticulous anatomical reconstruction is required. To this end, a detailed knowledge of the periprostatic anatomy is mandatory.

          Related collections

          Most cited references58

          • Record: found
          • Abstract: found
          • Article: not found

          Vattikuti Institute prostatectomy: contemporary technique and analysis of results.

          Michael Fumo, James Peabody, Ketan K Badani … (2007)
          Contemporary techniques of radical prostatectomy achieve excellent oncologic outcomes; erectile dysfunction is the most common adverse effect. We have modified our technique of robotic radical prostatectomy (Vattikuti Institute prostatectomy [VIP]) in an attempt to minimize decrease of erectile function while maintaining the excellent oncologic outcomes achieved by the radical retropubic prostatectomy. We present our current technique of VIP with preservation of the lateral prostatic fascia ("veil of Aphrodite"). A total of 2652 patients with localized carcinoma prostate underwent VIP. The salient features of our current technique are early transection of the bladder neck, preservation of the prostatic fascia, and control of the dorsal vein complex after dissection of the prostatic apex. Oncologic and functional outcomes were obtained through a questionnaire collected by a third party not involved in patient care. Complete follow-up information was obtained in 1142 patients with a minimum follow-up of 12 mo (range: 12-66 mo; median: 36 mo). The actuarial 5-yr biochemical recurrence rate was 8.4% and the actual biochemical recurrence rate was 2.3%. Median duration of incontinence was 4 wk; 0.8% patients had total incontinence at 12 mo. The intercourse rate was 93% in men with no preoperative erectile dysfunction undergoing veil nerve-sparing surgery, although only 51% returned to baseline function. VIP with veil nerve sparing offers oncologic and continence results that are comparable to the results of conventional nerve-sparing radical prostatectomy. Early potency results are encouraging.
          Article 0 comments Cited 87 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy.

            Ananthakrishnan Sivaraman, Geoff Coughlin, Marcelo Orvieto … (2011)
            Widespread use of prostate-specific antigen screening has resulted in younger and healthier men being diagnosed with prostate cancer. Their demands and expectations of surgical intervention are much higher and cannot be adequately addressed with the classic trifecta outcome measures. A new and more comprehensive method for reporting outcomes after radical prostatectomy, the pentafecta, is proposed. From January 2008 through September 2009, details of 1111 consecutive patients who underwent robot-assisted radical prostatectomy performed by a single surgeon were retrospectively analyzed. Of 626 potent men, 332 who underwent bilateral nerve sparing and who had 1 yr of follow-up were included in the study group. In addition to the traditional trifecta outcomes, two perioperative variables were included in the pentafecta: no postoperative complications and negative surgical margins. Patients who attained the trifecta and concurrently the two additional outcomes were considered as having achieved the pentafecta. A logistic regression model was created to evaluate independent factors for achieving the pentafecta. Continence, potency, biochemical recurrence-free survival, and trifecta rates at 12 mo were 96.4%, 89.8%, 96.4%, and 83.1%, respectively. With regard to the perioperative outcomes, 93.4% had no postoperative complication and 90.7% had negative surgical margins. The pentafecta rate at 12 mo was 70.8%. On multivariable analysis, patient age (p=0.001) was confirmed as the only factor independently associated with the pentafecta. A more comprehensive approach for reporting prostate surgery outcomes, the pentafecta, is being proposed. We believe that pentafecta outcomes more accurately represent patients' expectations after minimally invasive surgery for prostate cancer. This approach may be beneficial and may be used when counseling patients with clinically localized disease. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
            Article 0 comments Cited 72 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP).

              Ashutosh K Tewari, Abhishek Srivastava, Michael Huang … (2011)
              • To report the potency and oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) using a risk-stratified approach based on layers of periprostatic fascial dissection. • We also describe the surgical technique of complete hammock preservation or nerve sparing grade 1. • This is a retrospective study of 2317 patients who had robotic prostatectomy by a single surgeon at a single institution between January 2005 and June 2010. • Included patients were those with ≥ 1 year of follow-up and who were potent preoperatively, defined as having a sexual health inventory for men (SHIM) questionnaire score of >21; thus, the final number of patients in the study cohort was 1263. • Patients were categorized pre-operatively by a risk-stratified approach into risk grades 1-4, where risk grade 1 patients received nerve-sparing grade 1 or complete hammock preservation and so on for risk grades 2-4, as long as intraoperative findings permitted the planned nerve sparing. • We considered return to sexual function post-operatively by two criteria: i) ability to have successful intercourse (score of ≥ 4 on question 2 of the SHIM) and ii) SHIM >21 or return to baseline sexual function. • There was a significant difference across different NS grades in terms of the percentages of patients who had intercourse and returned to baseline sexual function (P < 0.001), with those that underwent NS grade 1 having the highest rates (90.9% and 81.7%) as compared to NS grades 2 (81.4% and 74.3%), 3 (73.5% and 66.1%), and 4 (62% and 54.5%). • The overall positive surgical margin (PSM) rates for patients with NS grades 1, 2, 3, and 4 were 9.9%, 8.1%, 7.2%, and 8.7%, respectively (P = 0.636). • The extraprostatic extension rates were 11.6%, 14.3%, 29.3%, and 36.2%, respectively (P < 0.001). • Similarly, in patients younger than 60, intercourse and return to baseline sexual function rates were 94.9% and 84.3% for NS grade 1 as compared to 85.5% and 77.2% for NS grades 2, 76.9% and 69% for NS grades 3, and 64.8% and 57.7% for NS Grade 4 (P < 0.001). • The risk-stratified approach and anatomical technique of neural-hammock sparing described in the present manuscript was effective in improving potency outcomes of patients without compromising cancer control. • Patients with greater degrees of NS had higher rates of intercourse and return to baseline sexual function without an increase in PSM rates. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
              Article 0 comments Cited 51 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Contributors
                Carlos Arroyo
                Alberto Martini
                Joanna Wang
                Ashutosh K. Tewari
                Journal
                Journal ID (nlm-ta): Ther Adv Urol
                Journal ID (iso-abbrev): Ther Adv Urol
                Journal ID (publisher-id): TAU
                Journal ID (hwp): sptau
                Title: Therapeutic Advances in Urology
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 1756-2872
                ISSN (Electronic): 1756-2880
                Publication date (Electronic): 08 January 2019
                Publication date Collection: Jan-Dec 2019
                Volume: 11
                Electronic Location Identifier: 1756287218813787
                Affiliations
                [1-1756287218813787]Department of Urology, Hospital Ángeles Puebla, Universidad Anahuac, School of Medicine, Puebla, c.p.72820, Puebla, Mexico
                [2-1756287218813787]Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
                [3-1756287218813787]Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
                [4-1756287218813787]Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
                Author notes
                Article
                Publisher ID: 10.1177_1756287218813787
                DOI: 10.1177/1756287218813787
                PMC ID: 6329031
                PubMed ID: 30671134
                SO-VID: b5b5aa98-e627-4c0f-91e3-3a248c65a430
                Copyright © © The Author(s), 2019
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 12 July 2018
                Date accepted : 17 October 2018
                Categories
                Subject: Review
                Custom metadata
                cover-date January-December 2019

                Keywords: radical prostatectomy,laparoscopic radical prostatectomy,robot assisted radical prostatectomy,secondary incontinence,radical prostatectomy complications
                Data availability:
                Keywords: radical prostatectomy, laparoscopic radical prostatectomy, robot assisted radical prostatectomy, secondary incontinence, radical prostatectomy complications

                Comments

                Comment on this article

                scite_

                Similar content131

                See all similar

                Cited by15

                See all cited by

                Most referenced authors689

                See all reference authors