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Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center

Background: The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academi...

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Autores principales: Sessa, Francesco, Nicoletti, Rossella, Pecoraro, Alessio, Polverino, Paolo, Rivetti, Anna, Conte, Francesco Lupo, Lo Re, Mattia, Belmonte, Mario, Alberti, Andrea, Dibilio, Edoardo, Gallo, Maria Lucia, Manera, Alekseja, Gacci, Mauro, Sebastianelli, Arcangelo, Vignolini, Graziano, Serni, Sergio, Campi, Riccardo, Li Marzi, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962972/
https://www.ncbi.nlm.nih.gov/pubmed/36835893
http://dx.doi.org/10.3390/jcm12041358
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author Sessa, Francesco
Nicoletti, Rossella
Pecoraro, Alessio
Polverino, Paolo
Rivetti, Anna
Conte, Francesco Lupo
Lo Re, Mattia
Belmonte, Mario
Alberti, Andrea
Dibilio, Edoardo
Gallo, Maria Lucia
Manera, Alekseja
Gacci, Mauro
Sebastianelli, Arcangelo
Vignolini, Graziano
Serni, Sergio
Campi, Riccardo
Li Marzi, Vincenzo
author_facet Sessa, Francesco
Nicoletti, Rossella
Pecoraro, Alessio
Polverino, Paolo
Rivetti, Anna
Conte, Francesco Lupo
Lo Re, Mattia
Belmonte, Mario
Alberti, Andrea
Dibilio, Edoardo
Gallo, Maria Lucia
Manera, Alekseja
Gacci, Mauro
Sebastianelli, Arcangelo
Vignolini, Graziano
Serni, Sergio
Campi, Riccardo
Li Marzi, Vincenzo
author_sort Sessa, Francesco
collection PubMed
description Background: The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academic center. Methods: Data from patients undergoing RALP between January 2017 and March 2021 were prospectively collected. RALP was performed by three highly experienced surgeons following the principles of the Montsouris technique, with a bladder-neck-sparing intent and maximal preservation of the membranous urethra (if oncologically safe) without any anterior/posterior reconstruction. (Self-assessed urinary incontinence (UI) was defined as the need of one or more pads per die (excluding the need for a safety pad/die. Univariable and multivariable logistic regression analysis was used to assess the independent predictors of early incontinence among routinely collected patient- and tumor-related variables). Results: A total of 925 patients were included; of these, 353 underwent RALP (38.2%) without nerve-sparing intent. The median patient age and BMI were 68 years (IQR 63–72) and 26 (IQR 24.0–28.0), respectively. Overall, 159 patients (17.2%) reported early (30 d) incontinence. In multivariable analysis adjusting for patient- and tumor-related features, a non-nerve-sparing procedure (OR: 1.57 [95% CI: 1.03–2.59], p = 0.035) was independently associated with the risk of urinary incontinence in the short-term period, while the absence of cardiovascular diseases before surgery (OR: 0.46 [95% CI: 0.320.67], p ≤ 0.01) was a protective factor for this outcome. At a median follow-up of 17 months (IQR 10–24), 94.5% of patients reported to be continent. Conclusions: In experienced hands, most patients fully recover urinary continence after RALP at mid-term follow-up. On the contrary, the proportion of patients who reported early incontinence in our series was modest but not negligible. The implementation of surgical techniques advocating anterior and/or posterior fascial reconstruction might improve the early continence rate in candidates for RALP.
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spelling pubmed-99629722023-02-26 Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center Sessa, Francesco Nicoletti, Rossella Pecoraro, Alessio Polverino, Paolo Rivetti, Anna Conte, Francesco Lupo Lo Re, Mattia Belmonte, Mario Alberti, Andrea Dibilio, Edoardo Gallo, Maria Lucia Manera, Alekseja Gacci, Mauro Sebastianelli, Arcangelo Vignolini, Graziano Serni, Sergio Campi, Riccardo Li Marzi, Vincenzo J Clin Med Article Background: The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academic center. Methods: Data from patients undergoing RALP between January 2017 and March 2021 were prospectively collected. RALP was performed by three highly experienced surgeons following the principles of the Montsouris technique, with a bladder-neck-sparing intent and maximal preservation of the membranous urethra (if oncologically safe) without any anterior/posterior reconstruction. (Self-assessed urinary incontinence (UI) was defined as the need of one or more pads per die (excluding the need for a safety pad/die. Univariable and multivariable logistic regression analysis was used to assess the independent predictors of early incontinence among routinely collected patient- and tumor-related variables). Results: A total of 925 patients were included; of these, 353 underwent RALP (38.2%) without nerve-sparing intent. The median patient age and BMI were 68 years (IQR 63–72) and 26 (IQR 24.0–28.0), respectively. Overall, 159 patients (17.2%) reported early (30 d) incontinence. In multivariable analysis adjusting for patient- and tumor-related features, a non-nerve-sparing procedure (OR: 1.57 [95% CI: 1.03–2.59], p = 0.035) was independently associated with the risk of urinary incontinence in the short-term period, while the absence of cardiovascular diseases before surgery (OR: 0.46 [95% CI: 0.320.67], p ≤ 0.01) was a protective factor for this outcome. At a median follow-up of 17 months (IQR 10–24), 94.5% of patients reported to be continent. Conclusions: In experienced hands, most patients fully recover urinary continence after RALP at mid-term follow-up. On the contrary, the proportion of patients who reported early incontinence in our series was modest but not negligible. The implementation of surgical techniques advocating anterior and/or posterior fascial reconstruction might improve the early continence rate in candidates for RALP. MDPI 2023-02-08 /pmc/articles/PMC9962972/ /pubmed/36835893 http://dx.doi.org/10.3390/jcm12041358 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sessa, Francesco
Nicoletti, Rossella
Pecoraro, Alessio
Polverino, Paolo
Rivetti, Anna
Conte, Francesco Lupo
Lo Re, Mattia
Belmonte, Mario
Alberti, Andrea
Dibilio, Edoardo
Gallo, Maria Lucia
Manera, Alekseja
Gacci, Mauro
Sebastianelli, Arcangelo
Vignolini, Graziano
Serni, Sergio
Campi, Riccardo
Li Marzi, Vincenzo
Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center
title Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center
title_full Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center
title_fullStr Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center
title_full_unstemmed Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center
title_short Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center
title_sort urinary continence recovery after robotic radical prostatectomy without anterior or posterior reconstruction: experience from a tertiary referral center
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962972/
https://www.ncbi.nlm.nih.gov/pubmed/36835893
http://dx.doi.org/10.3390/jcm12041358
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