Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

ABSTRACT Purpose To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other. Materials and methods The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free uroflowmetry. Results There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free uroflowmetry (p <0001; c=-0.26); and between IPSS and free uroflowmetry (p <0001, c=-0.21) were observed. Conclusion In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH. As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

Correlation between overactive bladder symptom score and neuropsychological parameters in Alzheimer's disease patients with lower urinary tract symptom

ABSTRACT Purpose To examine an association between the overactive bladder symptom score (OABSS) and neuropsychological parameters. Moreover, we investigate the factors that affect each item in the questionnaire. Materials and Methods A total of 376 patients (males: 184; females: 192) with probable Alzheimer’s disease (AD) were recruited. Cognitive testing was conducted using the Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR) scale, Global Deterioration Scale (GDS), and Barthel Activities of Daily Living (ADL). Lower urinary tract symptom (LUTS) was assessed using OABSS and voiding diary. Results The prevalence of overactive bladder (OAB) (defined as OABSS ≥3 with an urgency score of ≥2) in patients with AD was 72.6%. Among the OAB subjects, the most common severity of symptom was moderate (72.6%), followed by mild (21.2%), and severe (5.8%). It was found that OABSS had a very high correlation with aging (r=0.75; p<0.001). When compared with neuropsychological parameters, it was found that OABSS was highly correlated with the CDR scores (r=0.446; p<0.001). However, no significant correlation was found between the changes in OABSS scores and those in other neuropsychological parameters. Based on the individual symptom scores, urgency incontinence was highly correlated with the CDR scores (r=0.43; p<0.001). Conclusions OABSS is a useful tool in assessing AD patients with LUTS. There was a consistent positive association between OABSS severity, including urgency incontinence, and CDR scores.

Assessment of satisfaction and Quality of Life using self - reported questionnaires after urethroplasty: a prospective analysis

ABSTRACT Objectives To assess patient satisfaction and quality of life after urethroplasty using two different self-reported outcome measures and to compare it with objective clinical data. Materials and Methods We prospectively collected data from 35 consecutive patients who underwent urethroplasty from January 2013 to September 2014. Patient demographics, International Prostate Symptom Score (IPSS), quality of life score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate (Qmax) and post-void residual urine were collected before, two and eight months after surgery. Failure occurred when any postoperative instrumentation was performed. General estimation equation was used to compare the results and linear regression analysis to correlate both questionnaires with objective data. Results Mean age was 61 years. Urethroplasties were equally divided between anastomotic and buccal mucosa grafts and 19 patients (59.3%) had a previous urethral procedure. Overall success rate was 87.5%. IPSS improved from a mean 19 at baseline to 5.32 at 8 months (p <0.001). The mean USS-PROM score also improved from 13.21 preoperatively to 3.36 after surgery (p <0.001) and 84.3% of patients were satisfied or very satisfied with surgical results. Mean Qmax increased from 4.64mL/s to 11mL/s (p <0.001). Strong negative correlation was found respectively between flow rate and USS-PROM (r=-0.531, p <0.001) and with IPSS (r=-0.512, p <0.001). Conclusions Significant improvements in urinary symptoms and in quality of life are expected after urethroplasty and they are correlated with objective measures.

Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study

ABSTRACT Introduction This study compared percutaneous tibial nerve stimulation (PTNS) versus electrical stimulation with pelvic floor muscle training (ES + PFMT) in women with overactive bladder syndrome (OAB). Materials and Methods 60 women with OAB were enrolled. Patients were randomized into two groups. In group A, women underwent ES with PFMT, in group B women underwent PTNS. Results A statistically significant reduction in the number of daily micturitions, episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS; voided volume increased in both groups. Quality of life improved in both groups, whereas patient perception of urgency improved only in women treated with PTNS. Global impression of improvement revealed a greater satisfaction in patients treated with PTNS. Conclusion This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB, but greater improvements were found with PTNS.

Incontinência urinária no idoso / Aged urinary incontinence

A incontinência urinária é freqüente no idoso. Sua presença produz múltiplos problemas médicos, psicológicos e sócio-econômicos, afetando de forma significativa qualidade de vida do idoso. A IU contribui para a ocorrência de doenças, transtornos psicológicos e psiquiátricos, transtornos de relacionamento familiar e social, isolamento social e de institucionalização