Cargando…
Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae
BACKGROUND: Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has improved urinary function compared with standard robotic-assisted radical prostatectomy (S-RARP). As RS-RARP spares the dorsal vascular complex, pelvic fascia, and anterior abdominal fascia, it may also lower the incide...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317841/ https://www.ncbi.nlm.nih.gov/pubmed/34337474 http://dx.doi.org/10.1016/j.euros.2020.09.004 |
_version_ | 1783730130830491648 |
---|---|
author | Kowalczyk, Keith J. Davis, Meghan O’Neill, John Lee, Harry Orzel, Joanna Rubin, Rachel S. Hu, Jim C. |
author_facet | Kowalczyk, Keith J. Davis, Meghan O’Neill, John Lee, Harry Orzel, Joanna Rubin, Rachel S. Hu, Jim C. |
author_sort | Kowalczyk, Keith J. |
collection | PubMed |
description | BACKGROUND: Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has improved urinary function compared with standard robotic-assisted radical prostatectomy (S-RARP). As RS-RARP spares the dorsal vascular complex, pelvic fascia, and anterior abdominal fascia, it may also lower the incidence of “neglected” postprostatectomy sequelae such as penile shortening, Peyronie’s disease, and inguinal hernias. OBJECTIVE: To determine whether there are patient-perceived differences in penile shortening, Peyronie’s disease, and inguinal hernia rates among men undergoing RS-RARP versus S-RARP. DESIGN, SETTING, AND PARTICIPANTS: Researchers uninvolved in clinical care and blinded to surgical approach surveyed 60 RS-RARP versus 57 S-RARP men with validated patient-reported items to assess penile shortening, Peyronie’s disease, and inguinal hernia sequelae following surgery. INTERVENTION: RS-RARP versus S-RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariate differences between the two cohorts were analyzed using Student t test. Logistic regression was used to analyze variables associated with postoperative penile shortening. Cox proportional hazards models were used to assess the risk of developing Peyronie’s disease and inguinal hernia postoperatively. RESULTS AND LIMITATIONS: RS-RARP was associated with less patient-reported penile shortening (41.7% vs 64.9%, p = 0.012), Peyronie’s disease (0% vs 8.7%, p = 0.020), and inguinal hernia (0.0% vs 13.0%, p = 0.004). In adjusted analyses, RS-RARP (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.09–0.63, p = 0.004) was associated with lower odds of penile shortening, while a higher body mass index was associated with increased odds of penile shortening (OR 1.13, 95% CI 1.01–1.26, p = 0.037). RS-RARP was not associated with a decreased risk of Peyronie’s disease on Cox proportion hazard model; however, these models are limited due to a limited number of events in our cohort. Limitations include retrospective design, patient-reported outcomes, and small cohorts. CONCLUSIONS: RS-RARP is associated with less patient-reported penile shortening and may decrease the risk of Peyronie’s disease and postoperative inguinal hernia development. These new findings add to research, showing improved urinary continence and quality of life following RS-RARP; however, a prospective study is needed to validate these findings. PATIENT SUMMARY: Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) is an evolving surgical technique for prostate cancer treatment, which has shown improved postoperative urinary control compared with the standard technique, likely due to preservation of natural pelvic anatomy. Our findings suggest that the preservation of normal pelvic anatomy during RS-RARP may also reduce the risk of postprostatectomy penile shortening, Peyronie’s disease, and inguinal hernia. |
format | Online Article Text |
id | pubmed-8317841 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-83178412021-07-29 Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae Kowalczyk, Keith J. Davis, Meghan O’Neill, John Lee, Harry Orzel, Joanna Rubin, Rachel S. Hu, Jim C. Eur Urol Open Sci Prostate Cancer BACKGROUND: Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has improved urinary function compared with standard robotic-assisted radical prostatectomy (S-RARP). As RS-RARP spares the dorsal vascular complex, pelvic fascia, and anterior abdominal fascia, it may also lower the incidence of “neglected” postprostatectomy sequelae such as penile shortening, Peyronie’s disease, and inguinal hernias. OBJECTIVE: To determine whether there are patient-perceived differences in penile shortening, Peyronie’s disease, and inguinal hernia rates among men undergoing RS-RARP versus S-RARP. DESIGN, SETTING, AND PARTICIPANTS: Researchers uninvolved in clinical care and blinded to surgical approach surveyed 60 RS-RARP versus 57 S-RARP men with validated patient-reported items to assess penile shortening, Peyronie’s disease, and inguinal hernia sequelae following surgery. INTERVENTION: RS-RARP versus S-RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariate differences between the two cohorts were analyzed using Student t test. Logistic regression was used to analyze variables associated with postoperative penile shortening. Cox proportional hazards models were used to assess the risk of developing Peyronie’s disease and inguinal hernia postoperatively. RESULTS AND LIMITATIONS: RS-RARP was associated with less patient-reported penile shortening (41.7% vs 64.9%, p = 0.012), Peyronie’s disease (0% vs 8.7%, p = 0.020), and inguinal hernia (0.0% vs 13.0%, p = 0.004). In adjusted analyses, RS-RARP (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.09–0.63, p = 0.004) was associated with lower odds of penile shortening, while a higher body mass index was associated with increased odds of penile shortening (OR 1.13, 95% CI 1.01–1.26, p = 0.037). RS-RARP was not associated with a decreased risk of Peyronie’s disease on Cox proportion hazard model; however, these models are limited due to a limited number of events in our cohort. Limitations include retrospective design, patient-reported outcomes, and small cohorts. CONCLUSIONS: RS-RARP is associated with less patient-reported penile shortening and may decrease the risk of Peyronie’s disease and postoperative inguinal hernia development. These new findings add to research, showing improved urinary continence and quality of life following RS-RARP; however, a prospective study is needed to validate these findings. PATIENT SUMMARY: Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) is an evolving surgical technique for prostate cancer treatment, which has shown improved postoperative urinary control compared with the standard technique, likely due to preservation of natural pelvic anatomy. Our findings suggest that the preservation of normal pelvic anatomy during RS-RARP may also reduce the risk of postprostatectomy penile shortening, Peyronie’s disease, and inguinal hernia. Elsevier 2020-10-21 /pmc/articles/PMC8317841/ /pubmed/34337474 http://dx.doi.org/10.1016/j.euros.2020.09.004 Text en © 2020 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Prostate Cancer Kowalczyk, Keith J. Davis, Meghan O’Neill, John Lee, Harry Orzel, Joanna Rubin, Rachel S. Hu, Jim C. Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae |
title | Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae |
title_full | Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae |
title_fullStr | Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae |
title_full_unstemmed | Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae |
title_short | Impact of Retzius-sparing Versus Standard Robotic-assisted Radical Prostatectomy on Penile Shortening, Peyronie’s Disease, and Inguinal Hernia Sequelae |
title_sort | impact of retzius-sparing versus standard robotic-assisted radical prostatectomy on penile shortening, peyronie’s disease, and inguinal hernia sequelae |
topic | Prostate Cancer |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317841/ https://www.ncbi.nlm.nih.gov/pubmed/34337474 http://dx.doi.org/10.1016/j.euros.2020.09.004 |
work_keys_str_mv | AT kowalczykkeithj impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae AT davismeghan impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae AT oneilljohn impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae AT leeharry impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae AT orzeljoanna impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae AT rubinrachels impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae AT hujimc impactofretziussparingversusstandardroboticassistedradicalprostatectomyonpenileshorteningpeyroniesdiseaseandinguinalherniasequelae |