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How to optimize patient selection for robot-assisted radical prostatectomy: functional outcome analyses from a tertiary referral center.
J Endourol. 2014 Jul; 28(7):792-800.JE

Abstract

INTRODUCTION

The role of surgical approach on functional outcomes recovery in prostate cancer (PCa) patients treated with bilateral nerve-sparing radical prostatectomy (BNSRP) is still debated. In this study, we examine the association between the surgical approach and functional outcomes after BNSRP.

PATIENTS AND METHODS

The study included 609 patients treated with robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between June 2008 and January 2011. Erectile function recovery was defined as an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score ≥22. Urinary continence recovery was defined as being completely pad-free over a 24-hour period. Patients were stratified according to their probability of postoperative erectile dysfunction and urinary incontinence, according to previously published predictive models. Multivariable logistic regression tested the association between the surgical approach and functional outcomes recovery in the overall population after stratifying patients according to their risk of erectile dysfunction and urinary incontinence.

RESULTS

Patients treated with RARP had higher 2-year erectile function (52.1% vs 67.8%; P<0.001) and urinary continence (72.0% vs 87.4%; P<0.001) recovery rates as compared to their ORP counterparts. After stratification according to the erectile dysfunction risk, RARP led to higher erectile function recovery rates in the low- and intermediate-risk erectile dysfunction groups (all P<0.001).This did not hold true, however, in patients at high risk of erectile dysfunction (P=0.5). Similarly, when patients were stratified according to their urinary incontinence risk, RARP was associated with a higher probability of urinary continence recovery in the very low, low, and intermediate risk groups only (all P<0.001). This did not hold true, however, in the group of men at high risk of postoperative urinary incontinence (P=0.8).

CONCLUSIONS

RARP leads to higher urinary continence and erectile function recovery rates compared with ORP. Not all patients benefit from this approach to the same extent, however. Accurate preoperative patient selection would result in substantial savings for the health care system.

Authors+Show Affiliations

1 Urological Research Institute, Vita-Salute San Raffaele University , San Raffaele Scientific Institute, Milan, Italy .No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

24660774

Citation

Gandaglia, Giorgio, et al. "How to Optimize Patient Selection for Robot-assisted Radical Prostatectomy: Functional Outcome Analyses From a Tertiary Referral Center." Journal of Endourology, vol. 28, no. 7, 2014, pp. 792-800.
Gandaglia G, Suardi N, Gallina A, et al. How to optimize patient selection for robot-assisted radical prostatectomy: functional outcome analyses from a tertiary referral center. J Endourol. 2014;28(7):792-800.
Gandaglia, G., Suardi, N., Gallina, A., Zaffuto, E., Cucchiara, V., Vizziello, D., Shariat, S., Cantiello, F., Damiano, R., Guazzoni, G., Montorsi, F., & Briganti, A. (2014). How to optimize patient selection for robot-assisted radical prostatectomy: functional outcome analyses from a tertiary referral center. Journal of Endourology, 28(7), 792-800. https://doi.org/10.1089/end.2014.0007
Gandaglia G, et al. How to Optimize Patient Selection for Robot-assisted Radical Prostatectomy: Functional Outcome Analyses From a Tertiary Referral Center. J Endourol. 2014;28(7):792-800. PubMed PMID: 24660774.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - How to optimize patient selection for robot-assisted radical prostatectomy: functional outcome analyses from a tertiary referral center. AU - Gandaglia,Giorgio, AU - Suardi,Nazareno, AU - Gallina,Andrea, AU - Zaffuto,Emanuele, AU - Cucchiara,Vito, AU - Vizziello,Damiano, AU - Shariat,Shahrokh, AU - Cantiello,Francesco, AU - Damiano,Rocco, AU - Guazzoni,Giorgio, AU - Montorsi,Francesco, AU - Briganti,Alberto, Y1 - 2014/03/24/ PY - 2014/3/26/entrez PY - 2014/3/26/pubmed PY - 2014/10/9/medline SP - 792 EP - 800 JF - Journal of endourology JO - J Endourol VL - 28 IS - 7 N2 - INTRODUCTION: The role of surgical approach on functional outcomes recovery in prostate cancer (PCa) patients treated with bilateral nerve-sparing radical prostatectomy (BNSRP) is still debated. In this study, we examine the association between the surgical approach and functional outcomes after BNSRP. PATIENTS AND METHODS: The study included 609 patients treated with robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between June 2008 and January 2011. Erectile function recovery was defined as an International Index of Erectile Function-Erectile Function domain (IIEF-EF) score ≥22. Urinary continence recovery was defined as being completely pad-free over a 24-hour period. Patients were stratified according to their probability of postoperative erectile dysfunction and urinary incontinence, according to previously published predictive models. Multivariable logistic regression tested the association between the surgical approach and functional outcomes recovery in the overall population after stratifying patients according to their risk of erectile dysfunction and urinary incontinence. RESULTS: Patients treated with RARP had higher 2-year erectile function (52.1% vs 67.8%; P<0.001) and urinary continence (72.0% vs 87.4%; P<0.001) recovery rates as compared to their ORP counterparts. After stratification according to the erectile dysfunction risk, RARP led to higher erectile function recovery rates in the low- and intermediate-risk erectile dysfunction groups (all P<0.001).This did not hold true, however, in patients at high risk of erectile dysfunction (P=0.5). Similarly, when patients were stratified according to their urinary incontinence risk, RARP was associated with a higher probability of urinary continence recovery in the very low, low, and intermediate risk groups only (all P<0.001). This did not hold true, however, in the group of men at high risk of postoperative urinary incontinence (P=0.8). CONCLUSIONS: RARP leads to higher urinary continence and erectile function recovery rates compared with ORP. Not all patients benefit from this approach to the same extent, however. Accurate preoperative patient selection would result in substantial savings for the health care system. SN - 1557-900X UR - https://www.unboundmedicine.com/medline/citation/24660774/How_to_optimize_patient_selection_for_robot_assisted_radical_prostatectomy:_functional_outcome_analyses_from_a_tertiary_referral_center_ DB - PRIME DP - Unbound Medicine ER -