Bilateral subgaleal hematoma after a robot-assisted radical prostatectomy: an uncommon complication.

Robot-assisted radical prostatectomy is a relatively recent technique. Its advantages include less invasiveness and better pain management, but has specific anesthesia requirements, such as steep Trendelenburg position and pneumoperitoneum. Mild complications are common, e.g., transient hypotension or soft tissue edema. We present a case of a 62-year old male who developed subgaleal hematoma associated with transient neurologic impairment after surgery. Jugular vein insufficiency was suspected as the most likely cause. The patient recovered fully. Robot-assisted radical prostatectomy can be a challenging procedure due to the anesthesia requirements, but most complications are mild and transient. However, patients should be carefully assessed before surgery. We identified potential factors that may have led to this complication: the abnormal prolonged surgical time, the steep Trendelenburg, a non-assessed jugular vein insufficiency, and/or patient`s obesity.

Biochemical Recurrence and Risk of Mortality Following Radiotherapy or Radical Prostatectomy.

Importance: Stratifying patients with biochemical recurrence (BCR) after primary treatment for prostate cancer based on the risk of prostate cancer-specific mortality (PCSM) is essential for determining the need for further testing and treatments. Objective: To evaluate the association of BCR after radical prostatectomy or radiotherapy and its current risk stratification with PCSM. Design, Setting, and Participants: This population-based cohort study included a total of 16 311 male patients with 10 364 (64%) undergoing radical prostatectomy and 5947 (36%) undergoing radiotherapy with curative intent (cT1-3, cM0) and PSA follow-up in Stockholm, Sweden, between 2003 and 2019. Follow-up for all patients was until death, emigration, or end of the study (ie, December 31, 2018). Data were analyzed between September 2022 and March 2023. Main Outcomes and Measures: Primary outcomes of the study were the cumulative incidence of BCR and PCSM. Patients with BCR were stratified in low- and high-risk according to European Association of Urology (EAU) criteria. Exposures: Radical prostatectomy or radiotherapy. Results: A total of 16 311 patients were included. Median (IQR) age was 64 (59-68) years in the radical prostatectomy cohort (10 364 patients) and 69 (64-73) years in the radiotherapy cohort (5947 patients). Median (IQR) follow-up for survivors was 88 (55-138) months and 89 (53-134) months, respectively. Following radical prostatectomy, the 15-year cumulative incidences of BCR were 16% (95% CI, 15%-18%) for the 4024 patients in the low D'Amico risk group, 30% (95% CI, 27%-32%) for the 5239 patients in the intermediate D'Amico risk group, and 46% (95% CI, 42%-51%) for 1101 patients in the high D'Amico risk group. Following radiotherapy, the 15-year cumulative incidences of BCR were 18% (95% CI, 15%-21%) for the 1230 patients in the low-risk group, 24% (95% CI, 21%-26%) for the 2355 patients in the intermediate-risk group, and 36% (95% CI, 33%-39%) for the 2362 patients in the high-risk group. The 10-year cumulative incidences of PCSM after radical prostatectomy were 4% (95% CI, 2%-6%) for the 1101 patients who developed low-risk EAU-BCR and 9% (95% CI, 5%-13%) for 649 patients who developed high-risk EAU-BCR. After radiotherapy, the 10-year PCSM cumulative incidences were 24% (95% CI, 19%-29%) for the 591 patients in the low-risk EAU-BCR category and 46% (95% CI, 40%-51%) for the 600 patients in the high-risk EAU-BCR category. Conclusions and Relevance: These findings suggest the validity of EAU-BCR stratification system. However, while the risk of dying from prostate cancer in low-risk EAU-BCR after radical prostatectomy was very low, patients who developed low-risk EAU-BCR after radiotherapy had a nonnegligible risk of prostate cancer mortality. Improving risk stratification of patients with BCR is pivotal to guide salvage treatment decisions, reduce overtreatment, and limit the number of staging tests in the event of PSA elevations after primary treatment.

Effectiveness of artificial urinary sphincter to treat stress incontinence after prostatectomy: A meta-analysis and systematic review.

BACKGROUND: Artificial Urinary Sphincter (AUS) has always been considered the gold standard for surgical treatment of male non-neurogenic Stress Urinary Incontinence (SUI). The purpose of this meta-analysis was to evaluate AUS's effectiveness in treating male SUI, as described in the literature. METHODS: Two independent reviewers used PubMed, EMBASE, Web of Science, CNKI, WanFang Data, and VIP databases, to find the efficacy of artificial urethral sphincter in treating SUI after male prostate surgery. We excluded studies on female urinary incontinence. The main purpose of this study was to evaluate the clinical efficacy based on the degree of dry rate after AUS AMS 800™: postoperative complete dry was defined as no pad use per day. Postoperative social dry was defined as 0-1 pad per day. The secondary goal was to analyze the use of AUS AMS 800™ to improve SUI and to calculate the degree of influence by analyzing the number of pads and postoperative quality of life. And methodologic quality of the overall body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) guidelines. RESULTS: The data in this paper are mostly based on prospective or retrospective cohort studies without control groups. Fortunately, most studies have the same criteria to assess effectiveness. The pooled data of 1271 patients from 19 studies (6 prospective cohort studies, 12 retrospective cohort studies, and 1 randomized controlled trial) showed that: the number of pads used (pads/ day) after AUS was significantly reduced by about 4 (P < 0.001) and the quality of life was improved (P < 0.001).In addition, data analysis showed a high degree of heterogeneity between studies. According to the severity of baseline SUI, subgroup analysis was performed on the postoperative dry rate and social dry rate. Although heterogeneity was reduced, I2 is still above 50%, considering that heterogeneity may not be related to the severity of SUI. The random effect model was used for data analysis: the dry rate was about 52% (P < 0.001), and the social dry rate was about 82% (P < 0.001). The evidence level of GRADE of dry rate is very low, the evidence level of social dry rate and Pads use (pads/day) is Moderate, and the evidence level of Quality of life is low. CONCLUSION: Although the evidence in this paper is based on descriptive studies and limited follow-up, the results show that AUS is effective in treating urinary incontinence and can improve patients' quality of life.

Electrical Acupoint Stimulation with Low-Frequency Pulse in the Treatment of Urinary Incontinence after Prostatectomy.

OBJECTIVE: This study aimed to explore the clinical effect of electrical acupoint stimulation with low-frequency pulse in the treatment of urinary incontinence after prostatectomy. METHODS: This study selected 104 patients who underwent radical prostatectomy in Pujiang People Hospital from April 2019 to April 2022 as the research subjects, and they were divided into the study group (SG, n = 51, electrical acupoint stimulation with low-frequency pulse) and the control group (CG, n = 53, traditional pelvic floor muscle exercise) in accordance with the therapeutic regimen. In addition, clinical and follow-up data were analysed, and the number of urine pads used before and after treatment, recovery time of urinary continence, scores of 36-Item Short-form Health Survey (SF-36), clinical curative efficacy and incidence of adverse reactions in both groups were compared. RESULTS: Before treatment, no remarkable difference in the number of urine pads used was observed between the two groups (p > 0.05). After treatment, the number of urine pads used in the two groups was less than that before treatment, and the number of urine pads used in the SG was less than that in the CG (p < 0.001). The SG had overtly shorter recovery time of urinary continence, higher scores in eight dimensions of SF-36 and higher treatment efficiency than the CG (all p < 0.05), with no remarkable difference in the incidence of adverse reactions in both groups (p > 0.05). CONCLUSIONS: Electrical acupoint stimulation with low-frequency pulse, as a safe and ideal treatment, can shorten the recovery time of postoperative urinary continence ability, reduce the incidence of urinary incontinence and improve the quality of life of patients.

Elevated periprostatic venous testosterone correlates with prostate cancer progression after radical prostatectomy.

BACKGROUNDGenerally, clinical assessment of gonadal testosterone (T) in human physiology is determined using concentrations measured in peripheral blood. Prostatic T exposure is similarly thought to be determined from peripheral T exposure. Despite the fact that androgens drive prostate cancer, peripheral T has had no role in the clinical evaluation or treatment of men with localized prostate cancer.METHODSTo assess the role of local androgen delivery in prostate cancer, we obtained blood from the (periprostatic) prostatic dorsal venous complex in 266 men undergoing radical prostatectomy from July 2014 to August 2021 and compared dorsal T (DT) levels with those in circulating peripheral blood (PT) and prostatic tissue. Comprehensive targeted steroid analysis and unbiased metabolomics analyses were performed. The association between the DT/PT ratio and progression-free survival after prostatectomy was assessed.RESULTSSurprisingly, in some men, DT levels were enriched several-fold compared with PT levels. For example, 20% of men had local T concentrations that were at least 2-fold higher than peripheral T concentrations. Isocaproic acid, a byproduct of androgen biosynthesis, and 17-OH-progesterone, a marker of intratesticular T, were also enriched in the dorsal vein of these men, consistent with testicular shunting. Men with enriched DT had higher rates of prostate cancer recurrence. DT/PT concentration ratios predicted worse outcomes even when accounting for known clinical predictors.CONCLUSIONSThese data suggest that a large proportion of men have a previously unappreciated exposure to an undiluted and highly concentrated T supply. Elevated periprostatic T exposure was associated with worse clinical outcomes after radical prostatectomy.FUNDINGNational Cancer Institute (NCI), NIH grants R01CA172382, R01CA236780, R01CA261995, R01CA249279, and R50CA251961; US Army Medical Research and Development Command grants W81XWH2010137 and W81XWH-22-1-0082.

Cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Revisión sistemática de la literatura científica / Cytoreductive surgery in patients with oligometastatic prostate cancer. systematic review of the scientific literature

Introducción La aparición de pruebas de imagen más específicas y sensibles, junto con el empleo cada vez más extendido de técnicas mínimamente invasivas, ha centrado el interés urológico sobre el cáncer de próstata oligometastásico. A pesar de esto, aún queda por determinar el manejo óptimo de esta patología. Objetivo Evaluar la eficacia y seguridad de la cirugía citorreductora en pacientes con cáncer de próstata oligometastásico. Adquisición de la evidencia Revisión sistemática de la literatura científica (01/01/2010-31/12/2021) en las bases de datos Medline, Embase, Cochrane Library, CINAHL, Scopus, Agencias de Evaluación de Tecnologías Sanitarias y ClinicalTrials.gov. Los descriptores utilizados han sido prostatectomy, prostatic neoplasm, radical prostatectomy, y los términos de búsqueda libre prostatectomy y oligomestastasicprostate. Los criterios de inclusión fueron estudios con pacientes con cáncer de próstata oligometastásico e intervenidos mediante prostatectomía radical citorreductora (CRP). Síntesis de la evidencia La revisión sistemática incluyó cuatro estudios observacionales, dos ensayos clínicos y dos series de casos, de calidad moderada. Los resultados observados sugieren un beneficio en cuanto a eficacia en aquellos pacientes oligometastásico sometidos a una cirugía de próstata citorreductora. Por otro lado, la mayoría de estos estudios revelan una reducción en el número de las complicaciones locales cuando se compara con los mejores tratamientos sistémicos. Conclusiones La cirugía citorreductora en este grupo de pacientes, es un procedimiento seguro que reduce las complicaciones locales, que ofrece resultados prometedores en cuanto a supervivencia. Hasta la fecha, la falta de ensayos prospectivos limita el papel de esta opción terapéutica a entornos experimentales (AU)

Introduction Interest in oligometastatic prostate cancer has spiked due to the emergence of new evidence regarding more specific and accurate imaging, and the wider use of minimally invasive techniques. Nevertheless, the optimal management of this pathology is yet to be determined. Objective Assess the efficacy and safety of cytoreductive surgery in patients suffering from oligometastatic prostate cancer. Evidence gathering Systematic review of the scientific literature (01/01/2010-31/12/2021) within the MedLine, Embase, Cochrane Library, Cinahl, Scopus, Spanish Healthcare Technology Assessment Agencies (AETS, Agencias de Evaluación de Tecnologías Sanitarias) and ClinicalTrials.gov databases. The keywords used were prostatectomy, prostatic neoplasm, radical prostatectomy; the free search terms were prostatectomy and oligometastaticprostate. The inclusion criteria comprised studies on patients with oligometastatic prostate cancer who had been operated on using radical cytoreductive prostatectomy. Evidence synthesis The systematic review included 4 observational studies, 2 clinical trials, and 2 case series, of moderate quality. The results observed suggest that oligometastatic prostate cancer patients who had undergone cytoreductive prostate surgery obtained a benefit in terms of efficacy. Conversely, the majority of these studies showed a reduction in the number of localized complications, when compared to the best systemic treatments. Conclusions Cytoreductive surgery in this group of patients is a safe procedure that reduces the incidence of localized complications and that presents promising results with regard to survival rates. To date, the lack of prospective trials limits the use of this therapeutic option to experimental environments (AU)

Electrical Acupoint Stimulation with Low-Frequency Pulse in the Treatment of Urinary Incontinence after Prostatectomy

Objective: This study aimed to explore the clinical effect of electrical acupoint stimulation with low-frequency pulse in the treatment of urinary incontinence after prostatectomy. Methods: This study selected 104 patients who underwent radical prostatectomy in Pujiang People Hospital from April 2019 to April 2022 as the research subjects, and they were divided into the study group (SG, n = 51, electrical acupoint stimulation with low-frequency pulse) and the control group (CG, n = 53, traditional pelvic floor muscle exercise) in accordance with the therapeutic regimen. In addition, clinical and follow-up data were analysed, and the number of urine pads used before and after treatment, recovery time of urinary continence, scores of 36-Item Short-form Health Survey (SF-36), clinical curative efficacy and incidence of adverse reactions in both groups were compared. Results: Before treatment, no remarkable difference in the number of urine pads used was observed between the two groups (p > 0.05). After treatment, the number of urine pads used in the two groups was less than that before treatment, and the number of urine pads used in the SG was less than that in the CG (p < 0.001). The SG had overtly shorter recovery time of urinary continence, higher scores in eight dimensions of SF-36 and higher treatment efficiency than the CG (all p < 0.05), with no remarkable difference in the incidence of adverse reactions in both groups (p > 0.05). Conclusions: Electrical acupoint stimulation with low-frequency pulse, as a safe and ideal treatment, can shorten the recovery time of postoperative urinary continence ability, reduce the incidence of urinary incontinence and improve the quality of life of patients (AU)

Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy.

BACKGROUND: Patients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP. METHODS: 3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression. RESULTS: 10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02-1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28-2.24), depressive symptoms (OR 2.32, 1.52-3.53), and prevalent PSA anxiety (OR 1.88,1.17-3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41-0.86). CONCLUSIONS: PC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.

Outcome comparison of radical prostatectomy versus seed brachytherapy for clinically localized prostate cancer using two biochemical recurrence definitions.

OBJECTIVE: We compared the outcome of radical prostatectomy (RP) with seed brachytherapy (BT) in clinically localized prostate cancer (LPCa) using two different biochemical recurrence (BCR) definitions. METHODS: Clinical data of 1117 patients with non-metastatic prostate cancer (PCa) treated with either RP or BT as the basis of the multimodal therapy from a single tertiary hospital between 2007 and 2021 were retrospectively analyzed. 843 LPCa patients (RP = 737, BT = 106) with at least one prostate-specific antigen (PSA) test after treatment were finally included. The BCR survival was evaluated by direct comparison and one-to-one propensity score matching (PSM) analysis using surgical definition (PSA ≥ 0.2ng/ml) for RP and surgical/Phoenix definition (PSA nadir + 2ng/ml ) for BT. The propensity score (PS) was calculated by multivariable logistic regression based on the clinicopathological parameters. RESULTS: Median follow-up was 43 months for RP patients and 45 months for BT patients. Kaplan-Meier analysis did not show any statistically significant differences in terms of BCR-free survival (BFS) between the two groups when using Phoenix definition for BT (P > 0.05). Similar results were obtained in all D'Amico risk groups when stratified analyses were conducted. However, RP achieved improved BFS compared to BT in the whole cohort and all risk groups with the surgical definition for BT(P < 0.05). After adjusting PS, 192 patients were divided into RP and BT groups (96 each). RP presented a better BFS than BT when using the surgical definition (P < 0.001), but no significant difference was found when using the Phoenix definition (P = 0.609). CONCLUSION: Inconsistent BCR-free survival outcomes were acquired using two different BCR definitions for BT patients. RP provided comparable BFS with BT using the Phoenix definition but better BFS using the surgical definition, regardless of whether the PSM was performed. Our findings indicated that an exact BCR definition was critical for prognostic assessment. The corresponding results will assist physicians in pretreatment consultation and treatment selection.

The influence of secondary resection using NeuroSAFE-technique on sexual function in unilateral nerve-sparing robot-assisted laparoscopic prostatectomies.

OBJECTIVE: To demonstrate the surgical influence of secondary resection on sexual function in finally unilateral nerve-sparing robot- assisted laparoscopic prostatectomies (RALPs) performed with the 'neurovascular structure-adjacent frozen-section examination' (NeuroSAFE) technique by prospectively collecting EPIC-26-questionnaires. MATERIAL & METHODS: Sexual function status measured by the sexual-symptom-score (SexSS) in the EPIC-26-questionnaires was collected preoperatively and 12 months after RALP from 378 patients between 09/2019 and 04/2021. Cohorts of interest were defined as those patients undergoing unilateral nerve-sparing by secondary resection of the other neurovascular bundle (NVB), and as those patients undergoing primarily planned and successful unilateral nerve-sparing (unilateral nerve-sparing without secondary resection) in ≤cT2 prostate cancer. NeuroSAFE frozen section technique was performed in all nerve-sparing RALPs, and in case of cancer-positive surgical margins, the complete NVB was resected. RESULTS: In 109 RALPs with unilateral nerve-sparing (48 primarily vs. 61 by secondary resection), analyses showed a significant difference in postoperative SexSS for 'unilateral nerve-sparing by secondary resection' compared with 'unilateral nerve-sparing without secondary resection' (43 [interquartile range (IQR): 14;50] vs. 26 [IQR: 22;62], P = 0.04). In multivariable analyses, the preoperative SexSS was predictive for postoperative erectile dysfunction (OR = 0.96, 95% confidence interval: 0.93-0.98, P < 0.001). Oncological safety was not compromised by secondary resection (prostate-specific antigen after 12 months 0.01 ng/mL vs. 0.01 ng/mL [P = 0.3] for unilateral nerve-sparing by secondary resection vs. unilateral nerve-sparing without secondary resection). CONCLUSION: The results of this study suggest that nerve-sparing attempts applying the NeuroSAFEtechnique should be generously performed since a unilateral complete secondary resection leading to a unilateral nerve-sparing RALP did not seem to have a negative influence on sexual function and did not seem to compromise oncological safety compared with primarily performed and successful unilateral nerve-sparing RALP.

Role of puboperinealis and rectourethralis muscles as a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy.

The present study investigated the role of a urethral support system to maintain urinary continence after robot-assisted radical prostatectomy (RARP), with a focus on pelvic floor muscles, such as the puboperinealis muscle (PPM) and rectourethralis muscle (RUM). Finally, 323 patients who underwent RARP were analyzed in this study. All patients performed a one-hour pad test 1, 3, 6, 9, and 12 months after RARP to assess urinary incontinence and MRI before and 9 months after RARP to evaluate the pelvic anatomical structure. The preoperative cross-sectional area of PPM (2.21 ± 0.69 cm2) was significantly reduced by 19% after RARP (1.79 ± 0.60 cm2; p < 0.01). Positive correlations were observed between the amount of urinary leakage according to the 1-h pad test 1, 3, 6, 9, and 12 months after RARP and the change in the cross-sectional area of PPM by RARP (p < 0.01, < 0.001, < 0.001, < 0.001, and < 0.001, respectively). A positive correlation was also noted between the amount of urinary leakage 6 and 12 months after RARP and the preoperative RUM diameter (p < 0.05). The amount of urinary leakage 1, 3, 6, 9, and 12 months after RARP negatively correlated with the change in the antero-posterior diameter of the membranous urethra (MU diameter) from the static to dynamic phases during the Valsalva maneuver by cine MRI. Furthermore, the change in the MU diameter negatively correlated with the change in the cross-sectional area of PPM (p < 0.05). PPM and RUM play significant roles as a supportive mechanism to maintain urinary continence by functioning as a urethral support.

Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients undergoing prostatectomy: a multicentre, prospective, observational cohort study protocol.

INTRODUCTION: Symptom monitoring and alerting based on patient-reported outcomes have proven valuable in a postoperative setting. However, the parameters of the implemented patient-centred symptom management system for patients with prostate cancer (PC) remain unclear. This study aims to develop a perioperative symptom scale (PSS) to monitor symptoms, determine the appropriate timing for symptom assessment and establish intervention criteria for physicians. METHODS AND ANALYSIS: We will prospectively recruit 387 patients undergoing PC surgery in 3 hospitals. The Chinese version of the MD Anderson Symptom Inventory (MDASI) will be used for longitudinal symptom data collection, presurgery and 1, 2, 3, 5, 7, 14, 21, 28, 42 and 90 days post surgery. A PSS will be generated when symptoms change significantly over time. A linear mixed model will be used to determine appropriate follow-up time points. The functional status determined by MDASI interference can then be used to establish alarm thresholds. ETHICS AND DISSEMINATION: This study was approved by the Lishui Municipal Central Hospital Ethics Committee on 13 April 2022 (No. LSMCHEC-2022-54) and the Ethics Committee of Huzhou Central Hospital on 5 July 2023 (No. HZCHEC-202306017-01), the Ethics Committee of the First Affiliated Hospital of Huzhou Normal College on 20 June 2023 (No. HZYYEC-2023KYLL055). The latest protocol used in this study was V.2.0, dated on 25 February 2023. Before publication in a peer-reviewed journal, our findings will be presented and discussed at relevant medical conferences. TRIAL REGISTRATION NUMBER: ChiCTR2200059110.

Can dexamethasone improve postoperative sleep and postoperative delirium in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy? Protocol for a prospective, randomized, double-blind, controlled study.

BACKGROUND: Perioperative sleep disorders (PSD) are an independent risk factor for postoperative delirium (POD), which is a common complication after surgery. Elderly patients who undergo robot-assisted radical prostatectomy (RARP) often experience perioperative sleep disorders (PSD). Dexamethasone, a medication that works by inhibiting the hypothalamic-pituitary-suprarenal cortical axis, can reduce the negative effects of surgical stress. The objective of this study was to determine whether intravenous administration of dexamethasone at the time of anesthesia induction could improve postoperative sleep quality in elderly patients, thereby indirectly reducing the risk of postoperative cognitive impairment and accelerating postoperative rehabilitation. METHODS/DESIGN: This study is a randomized, double-blind, placebo-controlled trial that was conducted at a single center. A sample size of 116 patients was determined through calculation, and these patients were randomly assigned to either the dexamethasone group (group D, n = 58) or the blank control group (group C, n = 58). On the day of surgery, the anesthesia nurse prepared either diluted dexamethasone or saline in advance, according to the patient's assigned group. The blinded anesthesiologist administered the medication during induction, and a dedicated person followed up with the patient for three consecutive postoperative days. All other aspects of care were managed equally between the two groups. The primary outcome measure was sleep quality, while secondary outcome measures included postoperative sleep time, postoperative delirium (POD), pain scores, and other complications. Relevant test measures were recorded for analysis. DISCUSSION: This study aims to investigate the impact of intravenous dexamethasone on sleep quality and duration of patients undergoing robot-assisted radical prostatectomy (RARP). If the findings of this study protocol are affirmative, it could enhance the sleep quality of elderly patients after surgery, thereby minimizing the risk of postoperative delirium (POD), and providing substantial evidence for the perioperative enhanced recovery management of elderly patients. TRIAL REGISTRATION: Chinese clinical trial registry: ChiCTR2200063488, Registered on 5 October 2022.

Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis.

Objective: We performed a systematic review and meta-analysis to evaluate the effect of preoperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy. Methods: We searched the literature for randomized controlled trials evaluating the diagnostic analysis of preoperative pelvic floor muscle exercise (PFME) and postprostatectomy incontinence in the MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, China Biomedical Literature Database, China Journal Full-text Database, Wanfang Database and Weipu Database. The retrieval time limit is from the establishment of the database to January 2023. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Results: Twelve studies were included based on the selection criteria. The total number of patients included in the final analysis was 1,365. At 1th month, there was no difference in continence rates between the groups [odds ratio (OR): 0.47; 95% confidence interval (CI), 0.22-1.02, p = 0.06]. At 3th month, there was statistically significant difference in PFME group before operation (OR: 0.61; 95% CI, 0.37-0.98, p = 0.04). At 6th and 12th months, there was no difference between groups (OR: 0.57; 95% CI, 0.28-1.17, p = 0.13), (OR: 0.56; 95% CI, 0.27-1.15, p = 0.12). Conclusion: Preoperative pelvic floor muscle exercise can improve postoperative urinary incontinence at 3rd months after radical prostatectomy, but it cannot improve urinary incontinence at 6th months or longer after surgery, which indicates that preoperative PFME can improve early continence rate, but cannot improve long-term urinary incontinence continence rate.

Pelvic floor muscle exercise with or without duloxetine for postprostatectomy urinary incontinence: A retrospective single-center study.

This study aimed to evaluate the effectiveness of combined pelvic floor muscle exercise (PFME) and duloxetine treatment in the recovery from postprostatectomy urinary incontinence (PPUI). Participants were patients who underwent radical prostatectomy (RP) between 2018 and 2021 and who were able to attend follow-up appointments every 3 months for at least 12 months. Continence was defined as the use of ≤1 pad per day. PPUI was compared at each follow-up period by dividing the participants into the PFME group (PFME only after RP) and the PFME + DUL group (PFME and 30 mg duloxetine daily after RP). A total of 197 patients were included. No significant differences were observed in the baseline characteristics between the 2 groups. In the PFME group (n = 127), the PPUI was 77.17%, 27.56%, 17.32%, 12.60%, and 9.45% at 2 weeks, 3 months, 6 months, 9 months, and 12 months, respectively. In the PFME + DUL group (n = 70), the PPUI was 62.50%, 17.86%, 12.50%, 8.93%, and 5.36%, respectively, at the same follow-up period. At 2 weeks, the PFME + DUL group demonstrated a better incontinence rate than the PFME group (P = .019). However, no significant differences were found in the incontinence rates between the 2 groups at each follow-up period after 3 months. Compared to PFME monotherapy, the combination therapy of PFME and duloxetine has short-term effectiveness in improving PPUI, but it does not have a significant long-term impact. Therefore, for early recovery from PPUI, duloxetine should be administered for a short period during PFME.

Lateral single incision laparoscopic totally extraperitoneal hernioplasty (L-SILTEP) after laparoscopic radical prostatectomy: A rare case report with literature review.

INTRODUCTION: Single-incision laparoscopic totally extraperitoneal hernioplasty is a commonly used surgical procedure for the treatment of inguinal hernia. However, it is difficult to use traditional single incision laparoscopic totally extraperitoneal hernioplasty to treat inguinal hernia after laparoscopic radical prostatectomy. We successfully and smoothly cured a patient with left inguinal hernia after laparoscopic radical prostatectomy using lateral single incision laparoscopic totally extraperitoneal hernioplasty. CASE PRESENTATION: We report the case of a 70-year-old man who underwent laparoscopic radical prostatectomy 2 years earlier and had an evanescent mass in the left inguinal region for 1 month. DIAGNOSIS: On the basis of preoperative abdominal computed tomography and intraoperative findings, the patient was diagnosed with a left indirect inguinal hernia, and post-laparoscopic radical prostatectomy. INTERVENTIONS: The patient underwent lateral single incision laparoscopic totally extraperitoneal hernioplasty. OUTCOMES: The patient recovered well after the operation, and there were no postoperative complications or recurrence of inguinal hernia 3 months after the operation. CONCLUSION: For patients who have undergone laparoscopic radical prostatectomy, lateral single-incision laparoscopic totally extraperitoneal hernioplastycan be performed.