W. De Blok

Role of Extent of Fascia Preservation and Erectile Function After Robot-assisted Laparoscopic Prostatectomy

OBJECTIVESnTo test a simple intraoperative scoring system for the circumferential extent of fascia preservation (FP) for the prediction of postoperative erectile function. With the advent of robotic and endoscopic surgery for prostate cancer, more extensive FP has emerged as a method to improve postoperative erectile function.nnnMETHODSnA total of 107 consecutive cases with normal preoperative erectile function were treated using robot-assisted laparoscopic prostatectomy for localized prostate cancer. The erectile, sexual, and global quality of life outcomes using the European Organization for Research and Treatment and Cancer Quality of Life questionnaire-C30 and prostate cancer-specific 25-item questionnaire were assessed at 6 months postoperatively.nnnRESULTSnAt 6 months postoperatively, 57 men (53%) reported no or minimal effects on erectile function with or without the use of a phosphodiesterase type 5 inhibitor. The patient age at surgery, prostate size, and FP score were associated with erectile function at 6 months postoperatively. The mean FP score was 9.2 +/- 2.8 and 4.7 +/- 2.4 for patients without and with erectile dysfunction postoperatively, respectively. On multivariate analysis, the FP score and patient age at surgery were the best predictors of postoperative erectile function. No correlation between the FP score and positive surgical resection margin rate was observed. A greater FP score predicted for greater questionnaire-based libido, sexual activity, and sexual function scores.nnnCONCLUSIONSnA scoring system for the extent of circumferential FP during prostatectomy is a stronger predictor of postoperative erectile function recovery than is laterality (bilateral or unilateral) or fascial depth (interfascial or intrafascial). More ventral FP significantly contributed to postoperative erectile function recovery.

Vas deferens urethral support improves early post-prostatectomy urine continence

Urine continence is often impaired after radical prostatectomy. Few randomized studies prove the efficacy of novel surgical approaches. Vas deferens urethral support (VDUS) during robot-assisted laparoscopic prostatectomy (RALP) was studied for improvement of early postoperative urine continence in a single-centre prospective double-blind randomized study with a power of 90% to detect a 30% decrease in early incontinence. 112 men were randomized, and 108 could be analyzed (VDUS nxa0=xa054, noVDUS nxa0=xa054). VDUS improved early continence by 40% at 1xa0month (59% vs. 35%, Pxa0=xa00.02); 6 months postoperatively this was 72% vs. 62%, Pxa0=xa00.41. A 24-h pad test at 1xa0day, 3xa0days, and 1xa0week showed decreased amounts of urine loss in the VDUS group. The ICIQ-SF score was significantly lower for the VDUS group within the first month after surgery. VDUS had no impact upon quality of life questionnaire analyses for overall and lower urinary tract symptom-related quality of life but showed a significant improvement in the social domain of the EORTC-QLQ-C30 questionnaire. VDUS moderately improved early urine continence within 1xa0month after RALP.

Heeft behandelvertraging tussen diagnose en prostatectomie bij laagrisicoprostaatkanker invloed op de uitkomsten

Tijdschrift voor Urologie november 2012 nr. 7 gelijkblijvende hoeveelheid tumor. Het is onwaarschijnlijk dat de PCA3-score daalt door de relatieve toename van benigne cellen ten opzichte van PCa-cellen, omdat de gemiddelde serum-PSA-(eiwit)waarde niet significant verschilde tussen de metingen. De verandering van de afzonderlijke RNA-niveaus van PCA3 en PSA verklaart niet de afname van de PCA3-score.

Extent of nodal dissection in robot assisted laparoscopic prostatectomy and functional recovery

Samenvattingxa0Uitgebreidere pelviene klierdissectie is gerelateerd aan verminderd seksueel functieherstel na prostatectomieDoel:Richtlijnen adviseren een uitgebreide klierdissectie bij patiënten met een verhoogd risico op kliermetastasen tijdens een prostatectomie. Hierbij dienen ook de klieren in de regio iliaca interna te worden verwijderd. Aangezien deze klieren dicht bij de hypogastrische zenuwplexus liggen, onderzochten wij de invloed van meer uitgebreide klierdissectie op seksueel functieherstel na robotgeassisteerde laparoscopische prostatectomie (RALP).Methode:In een serie van 798 RALP-procedures, ondergingen 325 (40,7%) patiënten een lymfeklierdissectie. Continentie en seksuele functie worden voor en na de ingreep geëvalueerd met de ICIQ-SF- en IIEF-15-vragenlijsten.Resultaten:Gemiddelde ICIQ-SF- en IIEF-15-scores voor de ingreep waren gelijk bij mannen met en zonder een klierdissectie. Een normale preoperatieve erectiele functie (IIEF-EF > 20) werd gevonden bij 29,6% van de mannen. Een bilaterale of unilaterale zenuwsparing werd uitgevoerd bij 38,8% en 30,8% van de mannen. Normale postoperatieve erectiele functie na 6 maanden werd gerapporteerd door 1,7%, 9,1%, en 50,4% van de mannen zonder of met unilaterale of bilaterale zenuwsparing en normale preoperatieve erectiele functie.Bij 70 van 325 (21%) patiënten met een klierdissectie werden meer dan 10 klieren verwijderd. Kliermetastasen werden gevonden bij 5,9% en 15,7% van de patiënten bij wie £ 10 klieren en > 10 klieren werden verwijderd (p = 0,005). Alle domeinen van de IIEF-15-score 6 maanden na RALP waren negatief gecorreleerd met het aantal verwijderde lymfeklieren. In een multivariate analyse waren de volgende onafhankelijke variabelen gecorreleerd met IIEF-EF-score: fascia preservatiescore (FP-score), preoperatieve IIEF-EF-score en het aantal verwijderde lymfeklieren.Conclusie:Een meer uitgebreide klierdissectie was geassocieerd met een hoger percentage positieve klieren en een verminderd herstel van de seksuele functies; dit gold niet voor continentie na RALP.SummaryObjective:Considering the anatomical proximity of the internal iliac lymph nodes and the pelvic plexus it may be expected that more extensive pelvic nodal dissection is associated with an increased risk of damage to the small pelvis neural and vascular structures. Here we evaluate whether nodal dissection is associated with functional outcome after robot assisted laparoscopic prostatectomy (RALP).Method:In a series of 798 RALP procedures, 325 (40.7%) patients underwent a lymph node dissection. Continence was assessed using the ICIQ-SF questionnaire. Sexual function was recorded using the IIEF-15 questionnaire prior to and at 6 months intervals after RALP.Results:Mean preoperative ICIQ-SF, IIEF-15 and IIEF-EF scores were similar for men with and without nodal dissection. Normal preoperative erectile function (IIEF-EF > 20) was found in 29.6% of men. Bilateral and unilateral nerve preservation was performed in 38.8% and 30.8% respectively. Normal postoperative erectile function at 6 months was reported by 1.7%, 9.1%, and 50.4% of men with no, unilateral, and bilateral nerve preservation and normal preoperative erectile function.In 70 of 325 (21%) cases with nodal dissection more than 10 nodes were removed. Nodal metastases were found in 5.9% and 15.7% of men with ≤10 nodes and > 10 nodes removed (p = 0.005). All domains of the IIEF-15 score showed a negative correlation with the number of removed lymph nodes. In a multivariate analysis, extent of fascia preservation (FPscore), preoperative IIEF-EF and number of removed nodes were the strongest predictors of postoperative erectile function recovery.Conclusion:More extensive nodal dissection was associated with an increased node positivity rate and impaired postoperative sexual function recovery but not continence after prostatectomy.

409 ROLE OF THE EXTENT OF FASCIA PRESERVATION AND ERECTILE FUNCTION AFTER ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY

Objectives To test a simple intraoperative scoring system for the circumferential extent of fascia preservation (FP) for the prediction of postoperative erectile function. With the advent of robotic and endoscopic surgery for prostate cancer, more extensive FP has emerged as a method to improve postoperative erectile function. Methods A total of 107 consecutive cases with normal preoperative erectile function were treated using robot-assisted laparoscopic prostatectomy for localized prostate cancer. The erectile, sexual, and global quality of life outcomes using the European Organization for Research and Treatment and Cancer Quality of Life questionnaire-C30 and prostate cancer-specific 25-item questionnaire were assessed at 6 months postoperatively. Results At 6 months postoperatively, 57 men (53%) reported no or minimal effects on erectile function with or without the use of a phosphodiesterase type 5 inhibitor. The patient age at surgery, prostate size, and FP score were associated with erectile function at 6 months postoperatively. The mean FP score was 9.2 ± 2.8 and 4.7 ± 2.4 for patients without and with erectile dysfunction postoperatively, respectively. On multivariate analysis, the FP score and patient age at surgery were the best predictors of postoperative erectile function. No correlation between the FP score and positive surgical resection margin rate was observed. A greater FP score predicted for greater questionnaire-based libido, sexual activity, and sexual function scores. Conclusions A scoring system for the extent of circumferential FP during prostatectomy is a stronger predictor of postoperative erectile function recovery than is laterality (bilateral or unilateral) or fascial depth (interfascial or intrafascial). More ventral FP significantly contributed to postoperative erectile function recovery.