Postprostatectomy Incontinence and Self-management for Urinary Incontinence After Laparoscopic Radical Prostatectomy: A Cross-sectional Study.

PURPOSE: The purpose of this study was to describe postprostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), self-management strategies for managing incontinence, and factors influencing self-management. DESIGN: A descriptive, cross-sectional study. SUBJECTS AND SETTING: The sample comprising 37 males with prostate cancer who underwent LRP was recruited within first 2 years. The study setting was a tertiary care hospital in Beijing, China. An additional 78 individuals who responded to a mailed invitation sent from September 2015 to October 2016 participated in the study. METHODS: Participants completed a questionnaire that queried demographic and pertinent clinical data. The questionnaire also included 2 validated instruments. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was used to assess urinary incontinence (UI) following radical prostatectomy and its severity. The Strategy and Effectiveness of Symptom Self-Management questionnaire of Postprostatectomy Incontinence (SESSM-PPI) was used to evaluate self-management of UI, including strategies used and their perceived effectiveness. RESULTS: Data analysis was based on 115 respondents who completed all components of the questionnaire; 95 (82.6%) indicated having UI. Forty-one patients (43.2%) indicated mild UI, 47 (49.5%) indicated moderate UI, and 7 (7.4%) indicated severe UI. The mean score of the SESSM-PPI was 14.04 ± 7.92, indicating a low level of self-management.The top 5 strategies with moderate effectiveness were in the following order: "use pads or adult diapers"; "pelvic floor muscle training"; "avoid extracting heavy objects"; "avoid drinking"; and "eat more fruit to prevent constipation." The Spearman correlation analysis revealed a positive correlation between the frequency of use of self-management strategies and incontinence severity. CONCLUSIONS: Urinary incontinence is prevalent among males with prostate cancer managed by radical prostatectomy. Respondents tended to report mild to moderate UI severity. Self-management of UI among respondents is low.

The impact of catheter removal time on urinary continence and overactive bladder symptoms after robot-assisted radical prostatectomy: a retrospective analysis of consecutive 432 cases from a single institution.

Background: After radical prostatectomy, the optimal length of postoperative catheterization time remains to be determined. This study investigates the impact of catheter removal time on urinary continence and overactive bladder (OAB) symptoms after robot-assisted radical prostatectomy (RARP). Methods: Four hundred and thirty-two consecutive patients underwent RARP by a single surgeon between Nov 2020 and Oct 2021. Time to catheter removal was categorized into 7, 10, and ≥14 days. Continence was defined as no more than 1 pad used or no more than 20 g of urine leakage per 24 hours. The patients' continence rates and overactive bladder symptom score (OABSS) were assessed at 48 hours, 1 week, 4, 12, and 24 weeks after catheter removal. Results: Overall, continence rates were 37.3% 48 hours after catheter removal, 54.4% 1 week, 77.5% 4 weeks, 92.1% 12 weeks, and 97.9% 24 weeks after catheter removal. The median time to regain continence was 1 week. At 4 weeks after catheter removal, the continence rate in the ≥14 days group (70.5%) was significantly lower than the 7 days group (86.3%) and 10 days group (83.0%) (P=0.001). In a univariate Cox regression analysis, the presence of diabetes, higher pre-operative OABSS, and a catheterization time of 10 days were associated with worse continence recovery. The mean OABSS of patients in the continent group were significantly lower than the incontinent group at 48 hours, 4, 12 and 24 weeks after catheter removal. At 24 weeks after catheter removal, the mean OABSS in the 7 days group was significantly lower than in other groups. Conclusions: Early catheter removal (7 days) was associated with better continence results and lower OABSS at 4 and 24 weeks after catheter removal respectively.

The quality of guidelines for diabetic foot ulcers: A critical appraisal using the AGREE II instrument.

This study aims to evaluate the quality of clinical practice guidelines(CPGs) for patients with diabetic foot worldwide. A search of guidelines websites, databases and academic institutions websites was performed from January 1st, 2010, until June 30th, 2018. Four assessors independently rated the quality of each CPG using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Twelve CPGs satisfied the inclusion criteria. The median scores for the 6 AGREE II domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence) were 92.5%, 72.5%, 71.5%, 89%, 47%, and 77%, respectively. The overall quality of the CPGs was good since the majority of the CPGs reached an overall guideline quality between 5 and 7 points. Different CPGs had widely varying scores in the same area, ranging from 25 to 94 points.