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Inicio Actas Urológicas Españolas (English Edition) Continence definition and prognostic factors for early urinary continence recove...
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Vol. 46. Issue 3.
Pages 159-166 (April 2022)
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Vol. 46. Issue 3.
Pages 159-166 (April 2022)
Original article
Continence definition and prognostic factors for early urinary continence recovery in posterior rhabdosphincter reconstruction after robot-assisted radical prostatectomy. Post-hoc analysis of a randomised controlled trial
Definición de continencia y factores pronósticos para la recuperación temprana de la continencia urinaria en la prostatectomía radical robótica con reconstrucción posterior del rabdoesfínter. Análisis post hoc de un ensayo clínico aleatorizado
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A. Salazara,
Corresponding author
aina.salazar@gmail.com

Corresponding author.
, L. Regisa, J. Planasa, A. Celmaa, E. Trillaa,b, J. Morotea,b
a Servicio de Urología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Departament de Cirurgia, Universitat Autònoma de Barcelona, Barcelona, Spain
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Tables (4)
Table 1. Baseline characteristics of patients of the whole cohort and by groups.
Table 2. Pathological findings of radical prostatectomy.
Table 3. Evolution of continence rates according to different continence definitions and continence-related questions in questionnaires evaluated pre-surgery and at 1, 7, 15, 30, 90, 180 and 360 days after catheter removal.
Table 4. Multivariant analysis of urinary continence recovery predictors at 30 days post catheter removal.
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Abstract
Introduction

Urinary incontinence after radical prostatectomy (RP) is an adverse event with high impact on patient’s quality of life. Nowadays there is no standardized method for urinary continence measurement. Posterior rhabdosphincter reconstruction (PRR) is a surgical step that can improve early urinary continence after RP. Our objective was to analyse different continence definitions and predictors of urinary continence recovery after robot-assisted RP (RARP).

Material and methods

We conducted a double-blind, randomised controlled trial (NCT03302169) including 152 consecutive patients with localized prostate cancer subjected to RARP. Patients were randomised to single urethrovesical anastomosis (control arm) or PRR before urethrovesical anastomosis (PRR arm). Urinary continence was measured with the EPIC-26 and ICIQ-SF validated questionnaires, and pad use (0-1 pads and no pads), at 7, 15, 30, 90, 180 and 365 days after catheter removal. Prognostic factors for early urinary continence recovery were analysed.

Results

72 patients were included in the control arm and 80 in the PRR arm. Baseline characteristics were similar between arms, except body mass index, which was higher in PRR arm. “No pad” was the only definition assessing the benefit of PRR at 30 days, 33.8% in PRR arm and 18.1% in control arm, p = 0.022; and at 90 days, 58.8 and 43.1% respectively, p = 0.038. Questionnaires did not detect differences in terms of continence recovery. PRR was the only predictor for early continence recovery, p = 0.03.

Conclusions

PRR increased early urinary continence recovery after RARP. Continence definition was critical to assess benefit. The only predictive factor for early continence recovery was PRR.

Keywords:
Early urinary continence recovery
Posterior rhabdosphincter reconstruction
Robot assisted radical prostatectomy
Resumen
Introducción

La incontinencia urinaria después de la prostatectomía radical es un efecto adverso con gran impacto en la calidad de vida. Actualmente no disponemos de medidas estandarizadas para su evaluación. La reconstrucción posterior del rabdoesfínter (RPR) puede mejorar la incontinencia urinaria precoz. Nuestro objetivo fue analizar diferentes definiciones y factores pronósticos de continencia urinaria precoz después de prostatectomía radical robótica (PRR).

Materiales y métodos

Realizamos un ensayo clínico aleatorizado (NCT03302169) incluyendo 152 pacientes con cáncer de próstata localizado sometidos a PRR y aleatorizados en anastomosis uretrovesical simple (grupo control) y RPR previa a la anastomosis (grupo RPR). La continencia urinaria se evaluó mediante cuestionarios específicos (EPIC-26 y ICIQ-SF), y la utilización de compresas (0-1 compresa y 0 compresas) a los 7, 15, 30, 90, 180 y 365 días tras la retirada de la sonda vesical. Se analizaron factores predictores para recuperación de continencia urinaria precoz.

Resultados

Se incluyeron 72 pacientes en el grupo control y 80 en el grupo RPR. Las características basales fueron similares entre grupos excepto el índice de masa corporal, mayor en el grupo RPR. La definición «0 compresas» fue la única que demostró beneficio de la RPR a los 30 días, con continencia del 33,8% en el grupo RPR y 18,1% en el grupo control, p = 0,022, y a los 90 días, 58,8% y 43,1%, respectivamente, p = 0,038. Los cuestionarios no mostraron diferencias entre grupos. La RPR fue el único factor predictor de continencia urinaria precoz.

Conclusiones

La RPR mejora las tasas de continencia urinaria precoz, pero la definición de continencia es determinante. El único factor predictor de continencia urinaria precoz fue la RPR.

Palabras clave:
Continencia urinaria precoz
Reconstrucción posterior del rabdoesfínter
Prostatectomía radical robótica

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