Re: An Easy Prediction of Urinary Incontinence Duration After Retropubic Radical Prostatectomy Based on Urine Loss the First Day After Catheter Withdrawal

2010 ◽  
Vol 183 (1) ◽  
pp. 399-400
Author(s):  
Yoichi Arai
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Retropubic Radical Prostatectomy ◽  
Urine Loss

scholarly journals Injectable Bulking Agent to Treat Postprostatectomy Urinary Incontinence: A Safety and Effectiveness Pilot Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Janneke I. M. van Uhm ◽  
Marloes Vermeer ◽  
Henk W. Elzevier ◽  
Joop W. Noordzij ◽  
Evert L. Koldewijn ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pilot Study ◽  
Radical Prostatectomy ◽  
Treatment Option ◽  
Short Form ◽  
Treatment Success ◽  
Bulking Agent ◽  
International Consultation ◽  
Weight Test ◽  
Urine Loss

Objectives. To evaluate the safety and effectiveness of the injectable bulking agent Opsys® (Promedon, Cordoba, Argentina) for treating minimal postprostatectomy stress urinary incontinence (SUI). Patients and Methods. Single-centre, pilot study on ten male patients with SUI, < 30 g urine loss/ 24 h, more than 1 year after radical prostatectomy. Patients were treated by endoscopic transurethral injections of bulking agent in the presphincteric zone of the urethral submucosa. The results were evaluated using a pad weight test to quantify the differences in urine loss at 1, 3, and 6 months after intervention. Subsequently, the results of treatment were also evaluated by International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory Short Form (UDI-6-SF), and the Patient Global Impression of Improvement (PGI-I) at 1, 3, and 6 months after intervention. Results. The primary outcome was the absolute result of the 24-hour pad weight test after treatment. Treatment success was defined as <3 g urine loss/24 h, improvement as ≥50% decrease in urine loss/ 24h, failure as <50% decrease in urine loss/24 h, or worsening of urine loss. Success was demonstrated in one, improvement in one, and failure in eight patients one month after treatment. One patient improved and 9 failed 3 and 6 months after treatment. The median 24-hour pad weight test was higher at all three moments of follow-up (1, 3, and 6 months after treatment). The median 24-hour pad weight test was before treatment 17.3g (6.4-20.9) and 1, 3, and 6 months after treatment, respectively, 40.3g (5.9-130.6) p= 0.038, 38.3g (18.3-202.1) p= 0.014, 55.0g (16.5-314.6) p= 0.028. The ICIQ-SF was significantly higher at 3 and 6 months, respectively 15.0 (12.0-18.5) p= 0.007 and 16.0 (12.5-17.5) p=0.012 versus 10.0 (9.0-12.0) before injection. No significant differences were found between IIQ-7, UDI-6-SF, and PGI-I before and after injection. Complications occurred in four patients: two patients reported spontaneously resolved haematuria and two patients reported urinary frequency. All complications were classified as Clavien–Dindo 1. Conclusion. Injection therapy with Opsys® bulking agent is not an effective treatment option for male SUI after radical prostatectomy. It is not a safe treatment option, due to worsening urine loss after treatment.

Retropubic Radical Prostatectomy and Immediate Continence

1998 ◽  
Vol 65 (1_suppl) ◽  
pp. 7-10
Author(s):  
A. Simonato ◽  
S. Galli ◽  
A. Romagnoli ◽  
P. Traverso ◽  
R. Pizzorno ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Radical Prostatectomy ◽  
Bladder Neck ◽  
Saline Solution ◽  
Prostatic Adenocarcinoma ◽  
Prostatic Urethra ◽  
New Technique ◽  
Retropubic Radical Prostatectomy ◽  
A New Technique

Aim Temporary urinary incontinence after removing the catheter in patients who have undergone radical prostatectomy is commonly accepted and considered inevitable. Detailed information can be found in literature regarding continence at 3, 6 and 12 months after operation, but few reports mention the immediate results upon removing the catheter. We have collected together data from our patients regarding continence upon removal of the catheter, in order to assess this important aspect. Materials and methods Between November ‘94 and August ‘98, 156 patients underwent retropubic radical prostatectomy for histologically diagnosed prostatic adenocarcinoma (average age 65 years, range 49–74). Out of 156 patients, the bladder neck was removed in 72 (46%) (RCV), in 43 (28%) the bladder neck circular fibres (CCV) were preserved and in 41 (26%) a new technique was used to anatomically dissect the bladder-prostate junction, preserving the mucous of the prostatic urethra (CUP). Continence immediately after removal of the catheter was assessed in all patients in orthostatism and under stress by filling the bladder with 150 cc of saline solution. Results Upon removal of the catheter, 59/130 patients (45.5%) were perfectly continent. Of these 26/72 (36%) had undergone ample removal of the bladder neck, the bladder neck circular fibres were spared in 18/43 (43%), whilst the proximal tract of the prostatic urethra had been preserved in 26/41 (63%). There was infiltration of the bladder neck in 11/156 patients (7%), none of whom had the bladder neck circular fibres or the end section of the prostatic urethra spared. Conclusions Our experience shows that in correctly selected patients, if the bladder neck circular fibres and the proximal tract of the prostatic urethra are preserved, the possibility of immediate continence is high without increasing the oncological risk.

Retropubic TFS Minisling for Postprostatectomy Male Incontinence: First Report

2022 ◽  
pp. 1-7
Author(s):  
Sidi Muctar ◽  
David Ende ◽  
Peter Petros
Keyword(s):  
Urinary Incontinence ◽  
Bladder Neck ◽  
Male Incontinence ◽  
The Core ◽  
Pubourethral Ligament ◽  
Urethral Closure ◽  
Retropubic Radical Prostatectomy ◽  
The Mean ◽  
Urine Loss ◽  
Ultrasound Testing

<b><i>Hypothesis:</i></b> A structurally sound puboprostatic ligament (PPL), like the pubourethral ligament in the female, is the core structure for control of stress urinary incontinence (SUI) in males. <b><i>Methods:</i></b> The hypothesis was tested at several levels. Twelve transperineal ultrasound examinations were performed to confirm reflex directional closure vectors around the PPL, with digital support for the PPL rectally and cadaveric testing with a tissue fixation system (TFS) minisling, and finally, 22 cases of postprostatectomy incontinence were addressed only with retropubic insertion of a 7-mm TFS sling between the bladder neck and perineal membrane to reinforce the PPL. <b><i>Results:</i></b> On ultrasound testing, 3 urethral closure muscles were confirmed to act reflexively around the PPL to close the urethra distally and at the bladder neck. A finger was inserted rectally, pressed against the symphysis only on one side of the urethra at the origin of the PPL that controlled urine loss on coughing. The mean pre-op pad loss was 3.8 pads at 9 months; the mean post-op loss was 0.7 pads; 13/22 (59%) patients were 100% improved; 7/22 (31%) improved &#x3e;50% but &#x3c;100%; 2/22 (9.1%) improved &#x3c;50%. <b><i>Conclusions:</i></b> The 7-mm-wide TFS minisling is the first retropubic minisling for postprostatectomy urinary incontinence. It differs significantly from transobturator male operations surgically and in modus operandi. As in the female, reconstruction of the PPL alone was sufficient to cure/improve SUI, suggesting that preservation of the PPL is of critical importance during retropubic radical prostatectomy.

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