Category: Laparoscopic/ Robotic: Prostate

MP15-11 - Effect of nerve-sparing robot-assisted radical prostatectomy on lower urinary tract symptoms

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

Several groups have reported that the nerve-sparing (NS) radical prostatectomy contributes not only to the recovery of erectile function, but also to the improvement of urinary incontinence. However, there is a relative paucity of data on the impact of the NS procedure on lower urinary tract symptoms (LUTS) with the exception of urinary incontinence, especially in the context of robot-assisted radical prostatectomy (RARP). The purpose of this study was to investigate the impact of the NS procedure on LUTS, including urinary incontinence, after RARP.


Methods :

The participants in this prospective, clinical cohort, observational study were 280 consecutive patients who underwent RARP at our institution between October 2010 and January 2016. NS techniques were performed using a similar method according to the four grades of posterolateral resection of the prostate: grade 1, intrafascial dissection; grade 2, interfascial dissection; grade 3, extrafascial dissection; grade 4, wide dissection. In this study, NS was defined as NS grade 1 or 2 and non-NS was defined as NS grade 3 or 4. The International Prostate Symptom Score (IPSS), IPSS subscore including voiding and storage, The Overactive Bladder Symptom Score (OABSS), and urinary incontinence were assessed preoperatively and at 1, 3, 6, 9, and 12 months after RARP. Patients who used no pads were considered to be urinary continent and those who used one or more security liner pads per day were considered to be urinary incontinent.


Results :

Urinary continence rates at 1, 3, 6, 9, and 12 months after RARP were 33.5%, 51.5%, 67.8%, 79.1%, and 84.7%, respectively. There were significant differences in the recovery of urinary continence after RARP (log-rank test, P = 0.01): 12 month post-operative urinary incontinence rates were 14.3% (bilateral or unilateral NS group) and, 27.5% (non-NS group). No differences in the IPSS total scores, the IPSS voiding subscores, the IPSS storage subscores, and OABSS total scores at 1, 3, 6, 9, and 12 months were identified between the bilateral or unilateral NS group and non-NS group.


Conclusions :

The NS procedure in RARP has the possibility to improve urinary incontinence after surgery, although the NS procedure in RARP did not ameliorate LUTS, with the exception of urinary incontinence. Therefore, if possible, the NS procedure is recommended from the viewpoint of early improvement of urinary incontinence after RARP.

Masashi Honda

Associate Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Masashi Honda, M.D., Ph.D., Associate Professor in Div. of Urology, Dept. of Surgery, Tottori University Facluty of Medicine, Yonago, Japan

APPOINTMENTS/EMPLOYMENT
2017−present Associate Professor in Div. of Urology, Dept. of Surgery, Tottori University Faculty of Medicine.
2016−present Delegate of the Japanese Urological Association.
2016−present Delegate of the Japanese Society of Endourology.
2016−2017 Senior Assistant Professor in in Div. of Urology, Dept. of Surgery, Tottori University Faculty of Medicine.
2014−present Delegate of the Japanese Continence Society.
2011−2016 Senior Assistant Professor in Dept. of Urology, Tottori University Hospital.
2007−2011 Assistant Professor in Dept. of Urology, Tottori University Hospital.
2006−2007 Research Fellow in Dept. of Urology, University of Pittsburgh, Pittsburgh, USA.
2003−2006 Assistant Professor in Dept. of Urology, Tottori University Hospital.
1997−1998 Resident in Dept. of Urology, Tottori University Hospital.

EDUCATION
Entered Tottori University Faculty of Medicine, April, 1991, and graduated March, 1997, with the degree of Bachelor of Medicine.
Obtained an M.D.. May, 1997.
Entered Dept. of Urology, Tottori University Graduate School of Medicine, April, 1998, and graduated March, 2002, with the degree of Ph.D.

Panagiota Tsounapi

Program-Specific Researcher
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Yusuke Kimura

Assistant Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Bunya Kawamoto

Assistant Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Shuichi Morizane

Senior Lecturer
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

2001 M.D., Tottori University School of Medicine, Yonago, Japan
2006 Ph.D., Tottori University School of Medicine, Department of Urology
2006 Department of Urology, Tottori University Faculty of Medicine, Assistant Professor
2016 Department of Urology, Tottori University Faculty of Medicine, Senior Lecturer

Katsuya Hikita

Senior Lecturer
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan

Atsushi Takenaka

Professor
Department of Urology, Tottori University Faculty of Medicine
Yonago, Tottori, Japan