Category: Laparoscopic/ Robotic: Prostate
Introduction & Objective :
Earlier continence recovery is estimated in robotic-assisted radical prostatectomy (RARP) compared with open radical prostatectomy. However, delayed continence recovery in RARP is still problematic in some patients. In the current study, we evaluated the prognostic factors for early continence recovery following RARP.
We evaluated 160 patients who underwent RARP for their organ-confined prostate cancer at Chiba-Nishi General Hospital between May 2016 and March 2018. We performed RARP with da Vinci Xi (Intuitive Surgical Inc., Sunnyvale, CA, USA). We defined “using one or less pad per day” as “continence recovery”. We evaluated the prognostic factors for continence recovery through multivariate analysis with Cox-proportional hazard model using parameters including operative period, age, body mass index (BMI), pathological stage, and preoperative androgen deprivation (ADT).
Median age was 71 years (range 50-82). Median PSA level was 9.72ng/ml(3.62-127), and median prostate volume was 34.8g(13-88). Median console time was 108 minutes (56-327), and median operative time was 150 minutes (88-495). Median blood loss was 145ml (0-1880). Median follow-up period was 6.9 months (0-22.3). Median BMI was 23.4kg/m2(15.9-31.8). Preoperative ADT was done in 43 cases (26.9%). Nerve-sparing was done bilaterally in 53, and unilaterally in 62. We used parameters including age 65 years or less, the first 50 cases of RARP or not, pathological stage, BMI 25 or less, nerve-sparing or not, and preoperative ADT. Cox proportional hazard model showed that without ADT was only predictive factor for continence recovery (p=0.019, OR2.03, 95%CI 1.119-3.835).
The contributing factor for continence recovery following RARP in our series was not using preoperative ADT. For the early continence recovery, we should utilize preoperative ADT with caution for the patients who undergo RARP.
Masato Uetani– Resident, Chiba-Nishi General Hospital, Matsudo, Chiba, Japan
Yozo Mitsui– , Matsudo, Chiba, Japan
Takao Natsuyama– , Matsudo, Chiba, Japan
Shigeyuki Ohta– , Matsudo, Chiba, Japan
Shinji Shiozawa– , Matsudo, Chiba, Japan
Shinichi Hisasue– , Matsudo, Chiba, Japan
Chiba-Nishi General Hospital
Matsudo, Chiba, Japan
Masato Uetani, MD., Resident at Dept. of Urology of Chiba-Nishi General Hospital.