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Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures.
BJU Int. 2019 09; 124(3):477-486.BI

Abstract

OBJECTIVES

To present the functional and oncological outcomes after ≥1 year of follow-up, following an experience of >1000 robot-assisted radical prostatectomies (RARPs) with our standardised total anatomical reconstruction (TAR) technique. To evaluate which factors influence postoperative continence recovery in order to obtain a nomogram to predict the risk of postoperative urinary incontinence (UI).

PATIENTS AND METHODS

The enrolment phase began in June 2013 and ended in May 2017. Patients were prospectively included in the study with the following inclusion criteria: (i) localised prostate cancer (clinical stages cT1-3, cN0, cM0); (ii) indication for RP; and (iii) preoperative multiparametric prostate magnetic resonance imaging. All patients underwent RARP with the TAR technique done at the end of the demolitive phase. The continence rates were assessed at 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal. Patients were defined as continent if they answered 'zero pad' or 'one safety pad' per day. A logistic regression model was used to evaluate the potential impact of some pre- and intraoperative factors on postoperative urinary continence recovery. Model discrimination was assessed using an area under (AUC) the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of postoperative UI after RARP with the TAR technique was generated based on the logistic model.

RESULTS

In all, 1008 patients were enrolled in our study. At 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal, 621 (61.61%), 594 (58.93%), 803 (79.66%), 912 (90.48%), 950 (94.25%) and 956 (94.84%) patients were continent, respectively. In the logistic regression model, the variables analysed had a higher impact on continence recovery at 4 and 12 weeks. At 4 weeks, the postoperative odds of urinary continence recovery increased with the absence of diabetes [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.41-5.41] and D'Amico low vs high risk (OR 2.01, 95% CI 1.01-3.99). At 12 weeks, urinary continence increased with the absence of diabetes (OR 3.01, 95% CI 1.23-7.35), D'Amico low vs high risk (OR 4.04, 95% CI 1.56-10.47), and D'Amico intermediate vs high risk (OR 3.33, 95% CI 1.66-6.70). ROC curves were drawn and an AUC value of 61.9% (95% CI 57.49-66.36) at 4 weeks and 63.8% (95% CI 58.03-69.65) at 12 weeks were computed. Based on these parameters, two nomograms (at 4 and 12 weeks postoperatively) were generated.

CONCLUSION

The TAR technique conferred excellent results in the early recovery of urinary continence. Two nomograms were created, to predict preoperatively the postoperative odds of urinary continence recovery at 4 and 12 weeks after RARP by integrating the presence of diabetes and D'Amico risk classification.

Authors+Show Affiliations

Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy.Department of Public Health and Pediatric Sciences, School of Medicine, University of Turin, Turin, Italy.Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30801887

Citation

Manfredi, Matteo, et al. "Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Focus On Urinary Continence Recovery and Related Complications After 1000 Procedures." BJU International, vol. 124, no. 3, 2019, pp. 477-486.
Manfredi M, Checcucci E, Fiori C, et al. Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures. BJU Int. 2019;124(3):477-486.
Manfredi, M., Checcucci, E., Fiori, C., Garrou, D., Aimar, R., Amparore, D., De Luca, S., Bombaci, S., Stura, I., Migliaretti, G., & Porpiglia, F. (2019). Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures. BJU International, 124(3), 477-486. https://doi.org/10.1111/bju.14716
Manfredi M, et al. Total Anatomical Reconstruction During Robot-assisted Radical Prostatectomy: Focus On Urinary Continence Recovery and Related Complications After 1000 Procedures. BJU Int. 2019;124(3):477-486. PubMed PMID: 30801887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Total anatomical reconstruction during robot-assisted radical prostatectomy: focus on urinary continence recovery and related complications after 1000 procedures. AU - Manfredi,Matteo, AU - Checcucci,Enrico, AU - Fiori,Cristian, AU - Garrou,Diletta, AU - Aimar,Roberta, AU - Amparore,Daniele, AU - De Luca,Stefano, AU - Bombaci,Sabrina, AU - Stura,Ilaria, AU - Migliaretti,Giuseppe, AU - Porpiglia,Francesco, Y1 - 2019/03/15/ PY - 2019/2/26/pubmed PY - 2020/5/19/medline PY - 2019/2/26/entrez KW - anatomical reconstruction KW - continence recovery KW - nomogram KW - prostate cancer KW - radical prostatectomy KW - robot-assisted surgery SP - 477 EP - 486 JF - BJU international JO - BJU Int. VL - 124 IS - 3 N2 - OBJECTIVES: To present the functional and oncological outcomes after ≥1 year of follow-up, following an experience of >1000 robot-assisted radical prostatectomies (RARPs) with our standardised total anatomical reconstruction (TAR) technique. To evaluate which factors influence postoperative continence recovery in order to obtain a nomogram to predict the risk of postoperative urinary incontinence (UI). PATIENTS AND METHODS: The enrolment phase began in June 2013 and ended in May 2017. Patients were prospectively included in the study with the following inclusion criteria: (i) localised prostate cancer (clinical stages cT1-3, cN0, cM0); (ii) indication for RP; and (iii) preoperative multiparametric prostate magnetic resonance imaging. All patients underwent RARP with the TAR technique done at the end of the demolitive phase. The continence rates were assessed at 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal. Patients were defined as continent if they answered 'zero pad' or 'one safety pad' per day. A logistic regression model was used to evaluate the potential impact of some pre- and intraoperative factors on postoperative urinary continence recovery. Model discrimination was assessed using an area under (AUC) the receiver operating characteristic (ROC) curve. A nomogram to predict the risk of postoperative UI after RARP with the TAR technique was generated based on the logistic model. RESULTS: In all, 1008 patients were enrolled in our study. At 24 h, and 1, 4, 12, 24 and 48 weeks after catheter removal, 621 (61.61%), 594 (58.93%), 803 (79.66%), 912 (90.48%), 950 (94.25%) and 956 (94.84%) patients were continent, respectively. In the logistic regression model, the variables analysed had a higher impact on continence recovery at 4 and 12 weeks. At 4 weeks, the postoperative odds of urinary continence recovery increased with the absence of diabetes [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.41-5.41] and D'Amico low vs high risk (OR 2.01, 95% CI 1.01-3.99). At 12 weeks, urinary continence increased with the absence of diabetes (OR 3.01, 95% CI 1.23-7.35), D'Amico low vs high risk (OR 4.04, 95% CI 1.56-10.47), and D'Amico intermediate vs high risk (OR 3.33, 95% CI 1.66-6.70). ROC curves were drawn and an AUC value of 61.9% (95% CI 57.49-66.36) at 4 weeks and 63.8% (95% CI 58.03-69.65) at 12 weeks were computed. Based on these parameters, two nomograms (at 4 and 12 weeks postoperatively) were generated. CONCLUSION: The TAR technique conferred excellent results in the early recovery of urinary continence. Two nomograms were created, to predict preoperatively the postoperative odds of urinary continence recovery at 4 and 12 weeks after RARP by integrating the presence of diabetes and D'Amico risk classification. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/30801887/Total_anatomical_reconstruction_during_robot_assisted_radical_prostatectomy:_focus_on_urinary_continence_recovery_and_related_complications_after_1000_procedures_ L2 - https://doi.org/10.1111/bju.14716 DB - PRIME DP - Unbound Medicine ER -