The relationship between continence and perineal body tone before and after radical prostatectomy: a pilot study.

INTRODUCTION: Recent preliminary studies showed that tonic-trophic characteristics of the pelvic muscles are related to postoperative male urinary incontinence. The aim of the current study was to test whether perineal body tone (PBT), evaluated using the Beco perineometer (Perineocaliper), is related to urinary continence recovery after robot-assisted laparoscopic prostatectomy (RALP). MATERIALS AND METHODS: The study population consisted of 48 patients who underwent RALP between January and July 2009. Surgical interventions were performed by a single surgeon and patients were evaluated by a single physiotherapist. All patients were taught pelvic floor muscle exercises (PFME). PBT was evaluated in each patient preoperatively, as well 30 days and 3 months after surgery. In addition, patients were evaluated with a 24-hr pad-test and the International Consultation on Incontinence-questionnaire (ICI-Q). RESULTS: Mean age at surgery was 65.5 years (range 46-63). Twenty-four patients underwent a bilateral nerve-sparing procedure (50%). One-month after surgery, 25 (52.1%) patients were continent while 23 (47.9%) patients were still incontinent. A statistically significant difference in preoperative perineometric measures was observed between continent and incontinent patients (mean 1.36 cm vs. 0.80 cm; P < 0.001). This difference was even more pronounced when comparing postoperative perineometric measures (mean 1.24 cm vs. 0.43 cm; P < 0.001). Evaluation of patients 3 months after surgery showed an increase in perineometric measures (mean increase 0.76 cm). The increase was significantly higher in patients who became continent after 3 months relative to patients who were still incontinent despite PFME (mean perineometric measures 1.45 cm vs. 1.00 cm; P = 0.021). CONCLUSIONS: Our results demonstrate that urinary continence recovery is related to PBT recovery. Further studies are needed to confirm whether perineometric measures may be used as a predictive tool for the risk-stratification of postoperative UI.

Preoperative pelvic floor muscle exercise for early continence after radical prostatectomy: a randomised controlled study.

BACKGROUND: Despite improvements in surgical techniques, urinary incontinence (UI) is not uncommon after radical prostatectomy (RP), and it may dramatically worsen quality of life (QoL). OBJECTIVE: To determine the benefit of starting pelvic floor muscle exercise (PFME) 30d before RP and of continuing PFME postoperatively for early recovery of continence. DESIGN, SETTING, AND PARTICIPANTS: A randomised, prospective study was designed. Men with localised prostate cancer (PCa) who underwent an open radical retropubic prostatectomy (RRP) at our department of urology were included. INTERVENTION: Patients were randomised to start PFME preoperatively and continue postoperatively (active group: A) or to start PFME postoperatively alone (control group: B). MEASUREMENTS: The primary outcome measure was self-reported continence after surgery. Secondary outcome measures were assessed by degree of UI based on a 24-h pad test and QoL instruments (International Continence Society [ICS] male short form [SF]). RESULTS AND LIMITATIONS: Of 143 men evaluated for the study, 118 were randomised either to start PFME preoperatively and continue postoperatively (group A; n=59) or to start postoperative PFME (group B; n=59). After 1 mo, 44.1% (26 of 59) of patients were continent in group A, while 20.3% (12 of 59) were continent in group B (p=0.018). At 3 mo, 59.3% (35 of 59) and 37.3% (22 of 59) patients were continent in group A and group B, respectively (p=0.028). The ICS male SF mean score showed better results in group A than in group B patients at both 1 mo (14.6 vs 18.3) and 3 mo (8.1 vs 12.2) after RP (p=0.002). In age-adjusted logistic regression analyses, patients who performed preoperative PFME had a 0.41-fold lower risk of being incontinent 1 mo after RP and a 0.38-fold lower risk of being incontinent 3 mo after RP (p≤0.001). CONCLUSIONS: Preoperative PFME may improve early continence and QoL outcomes after RP. Further studies are needed to corroborate our results.

Intra- and peri-operative outcomes comparing radical retropubic and laparoscopic radical prostatectomy: results from a prospective, randomised, single-surgeon study.

OBJECTIVES: To prospectively compare intra- and peri-operative outcomes of open radical retropubic prostatectomy (RRP) and laparoscopic prostatectomy (LRP) by a single surgeon. PATIENTS AND METHODS: One-hundred-twenty, consecutive, age-matched patients diagnosed with clinically localized prostate cancer were eligible for surgery. Sixty patients underwent RRP and 60, LRP. Intra- and peri-operative parameters, pathologic findings and early complications were recorded. A validated visual analogue scale was used to assess pain in the recovery room, 3 h after the operation and on post-operative days 1, 2 and 3. A cystogram was performed on post-operative day 5. RESULTS: Operating time was significantly shorter in the RRP group versus the LRP group (mean+/-SD, 170+/-34. 2 vs 235+/-49.9 min, p<0.001). Blood loss was significantly less in the LRP group versus the RRP group (mean+/-SD, 853.3+/-485 vs 257.3+/-177 ml, p<0.001), but no patient in either group underwent early re-intervention for bleeding. The RRP group showed a trend for higher use of analgesia. A watertight anastomosis was shown at cystourethrography and the catheter removed in 86% and 66% of LRP and RRP patients, respectively. The overall percentage of post-operative complications and positive margins were comparable. CONCLUSION: Laparoscopic prostatectomy is an attractive alternative to open prostatectomy, offering the advantages of reduced blood loss and safe early catheter removal. Furthermore, the laparoscopic procedure proved to be safe oncologically. Long-term follow-up is required to compare functional results in terms of continence and potency.