Simple vs six-branches autologous suburethral sling during robot-assisted radical prostatectomy to improve early urinary continence recovery: prospective randomized study.

We have recently described the use of a retropubic suburethral autologous sling created and placed during robotic radical prostatectomy (RARP). In this study, we assess the effectiveness of newly designed six-branches compared to two-branches suburethral autologous sling in improving early urinary continence (UC) recovery. 120 patients submitted to RARP were prospectively randomized according to the intraoperative positioning of six-branches (group 1, n = 60) or two-branches autologous sling (group 2, n = 60) obtained by different configuration of a same tract of vas deferens removed. Early UC recovery was assessed at 5 (catheter removal), 10 and 30 days postoperatively through the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. UC was defined as the non-use of pad. Chi square test and Wilcoxon test were used to investigate UC recovery between the two groups. Moreover, post-voiding residual was evaluated in each patient at the same time. At catheter removal, UC rate was in groups 1 and 2, 60 and 35% (p = 0.02); at 10 days 70 and 46% (p = 0.03); at 30 days 87 and 70% (p = 0.04), respectively. One patient in group 1 experienced acute urinary retention at the time of catheter removal and was treated uneventfully with a further 7-day catheterization. These preliminary data indicate that newly designed six-branches suburethral autologous sling is able to increase the rate of early UC recovery compared to the two-arms sling previously described by us.

Retropubic Intracorporeal Placement of a Suburethral Autologous Sling During Robot-Assisted Radical Prostatectomy to Improve Early Urinary Continence Recovery: Preliminary Data.

BACKGROUND AND PURPOSE: Urinary continence (UC) recovery remains bothersome for patients even after robot-assisted radical prostatectomy (RARP). We describe the first retropubic suburethral autologous sling created and placed during RARP. The surgical technique and preliminary data regarding its effectiveness in improving early UC recovery are presented. PATIENTS AND METHODS: Between November 2013 and February 2014, 60 patients who underwent RARP at a single high-volume center were prospectively randomized into sling and nonsling groups. Early UC was assessed at 5 days (time of catheter removal), 10 days, and 30 days postoperatively by the daily number of pads used and the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score. Sling-related operative time and urethral erosion were also analyzed. Chi-square and independent sample t tests were used to investigate surgical and functional outcomes between groups. RESULTS: Complete data were available for all patients. Mean ± standard deviation (SD) numbers of pads used daily in nonsling and sling groups, respectively, were 1.9 ± 1.2 versus 1.7 ± 1.4 (P = 0.5) at 5 days, 1.8 ± 1.3 versus 1.3 ± 1.3 (P = 0.1) at 10 days, and 1.1 ± 1.2 versus 0.4 ± 0.8 (P = 0.01) at 30 days. At 1 month, mean ± SD ICIQ-UI-SF scores in nonsling and sling groups, respectively, were 4.8 ± 4.6 versus 1.8 ± 3.4 (P = 0.01); sling patients were associated with pad-free status (76% vs 46%, P = 0.03). The advantage in UC recovery was also observed in sling patients at 3, 6, and 12 months postoperatively. Surgical time did not differ between groups, and in sling patients, no cases of urethral erosion or uroflowmetry suggestive of urinary obstruction were found. Limitations included the small sample size and the lack of assessment of morphologic and urodynamic changes produced by the sling. CONCLUSIONS: The suburethral autologous sling is technically feasible and may improve early UC recovery after RARP. These preliminary results should be confirmed in a larger sample of patients.

Use of the Prostate Health Index for the Detection of Aggressive Prostate Cancer at Radical Prostatectomy.

INTRODUCTION: In current study, we compared the accuracy of the PSA isoform p2PSA and its derivatives, the percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI) in the detection of prostate cancer (PC) characteristics at the xFB01;nal pathology with respect to reference standards. MATERIALS AND METHODS: This was an observational prospective study evaluating 43 consecutive PC patients treated with laparoscopic/robotic radical prostatectomy (RP). Logistic regression models were fitted to test the predictors of pT3 stage, pathologic Gleason score ≥ 8 or Gleason score upgrading, margin status, lymph node invasion, and the presence of high-risk disease (pT3 disease and/or Gleason score ≥ 8 and/or positive lymph node). The comparative base model included tPSA, clinical stage, biopsy Gleason score, and percentage of positive core. RESULTS: Seventeen patients (39.5%) were affected by pT3 disease or had a pathologic Gleason score ≥ 8; positive margins were detected in 12 patients (27.9%), lymph node invasion was found in 2 patients (4.7%), and 15 patients (34.8%) harbored high-risk disease. In the univariate analysis, p2PSA, %p2PSA, and PHI were significant predictors of pT3 disease, pathologic Gleason score, and the presence of high-risk disease (all p < 0.05), whereas only PHI was an independent predictor of pT3 disease, margin status, and presence of high-risk disease, increasing the accuracy of a base multivariable model by 6.3% (p < 0.05) and 4.2% (p < 0.05) for the prediction of pT3 and high-risk disease, respectively. CONCLUSIONS: p2PSA and its derivatives, primarily PHI, were significant predictors of unfavorable PC characteristics as detected at the xFB01;nal pathology, thus improving the clinical performance of standard prognostic factors for aggressive disease.

Urodynamic evaluation after high-intensity focused ultrasound for patients with prostate cancer.

This prospective study assesses the impact of high-intensity focused ultrasound (HIFU) on lower urinary tract by comparing pre- and postoperative symptoms and urodynamic changes. Thirty consecutive patients with clinically organ-confined prostate cancer underwent urodynamic study before HIFU and then at 3-6 months after surgery. Continence status and symptoms were analyzed by means of International Prostate Symptoms Score IPSS and International Index Erectile Function IIEF5. As a result, there were a significant improvement in bladder outlet, maximum flow at uroflowmetry, and reduction in postvoid residual PVR at 6-month follow-up and a concomitant significant reduction of detrusor pressure at opening and at maximum flow. De novo overactive bladder and impaired bladder compliance were detected in 10% of patients at 3 months, with progressive improvement at longer follow-up. Baseline prostate volume and length of the procedure were predictors of 6-month IPSS score and continence status. In conclusion, following HIFU detrusor overactivity, decreased bladder compliance and urge incontinence represent de novo dysfunction due to prostate and bladder neck injury during surgery. However, urodynamic study shows a progressive improvement in all storage and voiding patterns at 6-month follow-up. Patients with high prostate volume and long procedure length suffered from irritative symptoms even at long term.