- Email: [email protected]
1344 INFLUENCE OF PREOPERATIVE PELVIC FLOOR MUSCLE STRENGTH ON POST-PROSTATECTOMY INCONTINENCE
Vol. 187, No. 4S, Supplement, Monday, May 21, 2012
THE JOURNAL OF UROLOGY姞
e545
duces 15-25 year DFS rates (73%) calculated with PSA ⬍0.2 ng/ml that are comparable to those of radical prostatectomy when surgery was performed during the same time period (J Urol 168:1419, 2002; Urol 66:83,2005). Better 15 year results (80%) are noted in the PSA era with improved technique. To fully evaluate any treatment program for PC, 15 year follow up is needed and if a man’s PSA is ⬍0.20 ng/ml 15 years posttreatment, the chance of later recurrence will be rare. Source of Funding: None.
Urodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III Moderated Poster Monday, May 21, 2012
3:30 PM-5:30 PM
1344 INFLUENCE OF PREOPERATIVE PELVIC FLOOR MUSCLE STRENGTH ON POST-PROSTATECTOMY INCONTINENCE Source of Funding: None
1343 25-YEAR DISEASE FREE SURVIVAL RATES FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER CALCULATED WITH THE PROSTATE SPECIFIC ANTIGEN DEFINITION OF RECURRENCE USED FOR RADICAL PROSTATECTOMY Frank Critz*, James Benton, Keith Levinson, Philip Shrake, Mark Merlin, Frederick Schnell, Decatur, GA INTRODUCTION AND OBJECTIVES: In 2000, Dr. Patrick Walsh wrote that he doubted any form of radiotherapy could produce durable prostate cancer (PC) control for 20-30 years when calculated with prostate specific antigen (PSA) ⬍0.2 (J Urol 163:1802, 2000). To our knowledge, no one has responded to Dr. Walsh’s statement. The purpose of this report is to address this issue and to evaluate time to recurrence, especially late recurrence (⬎10 years posttreatment), after radiotherapy for PC. METHODS: From 1984-2000, 3,546 consecutive hormone naı¨ve stage T1-T3 men were treated for PC with an I-125 prostate seed implant followed by external beam irradiation (EBRT). The median pretreatment PSA was 6.9 ng/ml (range, 0.3-435 ng/ml). The initial 429 men had a retropubic implant and the remaining 3,117 were transperineally implanted beginning in 1992. Three weeks following implantation, all men received 4500 cGy EBRT to the prostate with a 750 cGy boost for intermediate and high risk men who were implanted transperineally. Men had follow up every six months for the first ten years posttreatment and then annually thereafter if the PSA was ⬍0.20 ng/ml. The median follow up is 10.5 years (range, 3 months-26.5 years). Recurrence is defined by the PSA definition used for radical prostatectomy (J Urol 177:540,2007) which means either failure to achieve PSA ⬍0.20 ng/ml or a PSA rise to ⬎0.20 ng/ml followed by a confirmatory PSA ⬎0.20 ng/ml with time of recurrence defined at ⬎0.20 ng/ml. RESULTS: The 10, 15, 20 and 25-year disease free survival (DFS) rate is 76%, 73%, 73% and 73%, respectively for all 3,546 men. The median time to recurrence was 3 years (range, 3 months-15.5 years). Of men treated ⬎15 years ago (1987 when PSA testing was begun - 1995), 317 recurred of which 5% (16/317) recurred 10.5-5.5 years after treatment. For men transperineally implanted since 1995, the 15 year overall DFS rate is 80% and is 93%, 80% and 49% according to low, intermediate and high risk group, respectively. CONCLUSIONS: We believe this report answers Dr. Walsh’s comment. This study documents that this form of radiotherapy pro-
Mary H. James*, Bethany B. Gibbs, Erin Glace, Robert W. Given, Norfolk, VA INTRODUCTION AND OBJECTIVES: Urinary incontinence following radical prostatectomy is a significant clinical problem that compromises patient quality of life. Pelvic floor muscle training (PFMT) has been shown to reduce continence recovery time. There is currently a lack of data regarding preoperative variables that may predict which patients will have earlier return to continence. The objective of this study was to determine whether preoperative pelvic floor strength influences the degree and duration of post-prostatectomy incontinence. METHODS: All patients scheduled for robotic assisted laparoscopic radical prostatectomy were referred to a certified pelvic floor physical therapist. Pelvic floor strength was assessed using EMG evaluation with perianal electrodes. Strength parameters collected included the resting, average and maximum measurements during quick and sustained contractions as well as maximum contraction during valsalva. Patients were educated and given a home training program. Chart review was performed to obtain post-operative continence data from 6 week and 3 month visits measured by reported pad per day (PPD) usage. Continence was defined in two ways: PPD⫽0 and PPDⱕ1. Baseline values for each parameter were compared in men who were continent versus not continent at each visit using independent t-tests. RESULTS: Baseline data was available for 213 patients. There were 181 patients with 6 week follow-up and 170 patients with 6 week and 3 month follow-up. When defining continence as PPD⫽0 a higher resting tone was associated with return to continence at 6 week follow up (p⫽0.043) but did not hold true at 3 months. However, when defining continence as PPDⱕ1 a higher resting tone was associated with return to continence at the 3 month mark. (p⫽0.023). In this group the mean preoperative resting tone for those patients who had achieved continence was 4.5 microvolts compared to 3.4 microvolts in those patients with persistent incontinence. CONCLUSIONS: Post-prostatectomy incontinence (PPI) is a common complication following radical prostatectomy that significantly affects patient quality of life. PFMT in the pre and post-operative setting has been shown to decrease the time to recovery of continence. In this study a higher pelvic floor muscle resting tone was associated improved achievement of continence at 6 weeks when defining continence as PPD⫽0 and at 3 months when defining continence as PPDⱕ1. This information could be useful for additional preoperative counseling regarding continence outcomes following prostatectomy. Source of Funding: None
THE JOURNAL OF UROLOGY姞
e545
duces 15-25 year DFS rates (73%) calculated with PSA ⬍0.2 ng/ml that are comparable to those of radical prostatectomy when surgery was performed during the same time period (J Urol 168:1419, 2002; Urol 66:83,2005). Better 15 year results (80%) are noted in the PSA era with improved technique. To fully evaluate any treatment program for PC, 15 year follow up is needed and if a man’s PSA is ⬍0.20 ng/ml 15 years posttreatment, the chance of later recurrence will be rare. Source of Funding: None.
Urodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III Moderated Poster Monday, May 21, 2012
3:30 PM-5:30 PM
1344 INFLUENCE OF PREOPERATIVE PELVIC FLOOR MUSCLE STRENGTH ON POST-PROSTATECTOMY INCONTINENCE Source of Funding: None
1343 25-YEAR DISEASE FREE SURVIVAL RATES FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER CALCULATED WITH THE PROSTATE SPECIFIC ANTIGEN DEFINITION OF RECURRENCE USED FOR RADICAL PROSTATECTOMY Frank Critz*, James Benton, Keith Levinson, Philip Shrake, Mark Merlin, Frederick Schnell, Decatur, GA INTRODUCTION AND OBJECTIVES: In 2000, Dr. Patrick Walsh wrote that he doubted any form of radiotherapy could produce durable prostate cancer (PC) control for 20-30 years when calculated with prostate specific antigen (PSA) ⬍0.2 (J Urol 163:1802, 2000). To our knowledge, no one has responded to Dr. Walsh’s statement. The purpose of this report is to address this issue and to evaluate time to recurrence, especially late recurrence (⬎10 years posttreatment), after radiotherapy for PC. METHODS: From 1984-2000, 3,546 consecutive hormone naı¨ve stage T1-T3 men were treated for PC with an I-125 prostate seed implant followed by external beam irradiation (EBRT). The median pretreatment PSA was 6.9 ng/ml (range, 0.3-435 ng/ml). The initial 429 men had a retropubic implant and the remaining 3,117 were transperineally implanted beginning in 1992. Three weeks following implantation, all men received 4500 cGy EBRT to the prostate with a 750 cGy boost for intermediate and high risk men who were implanted transperineally. Men had follow up every six months for the first ten years posttreatment and then annually thereafter if the PSA was ⬍0.20 ng/ml. The median follow up is 10.5 years (range, 3 months-26.5 years). Recurrence is defined by the PSA definition used for radical prostatectomy (J Urol 177:540,2007) which means either failure to achieve PSA ⬍0.20 ng/ml or a PSA rise to ⬎0.20 ng/ml followed by a confirmatory PSA ⬎0.20 ng/ml with time of recurrence defined at ⬎0.20 ng/ml. RESULTS: The 10, 15, 20 and 25-year disease free survival (DFS) rate is 76%, 73%, 73% and 73%, respectively for all 3,546 men. The median time to recurrence was 3 years (range, 3 months-15.5 years). Of men treated ⬎15 years ago (1987 when PSA testing was begun - 1995), 317 recurred of which 5% (16/317) recurred 10.5-5.5 years after treatment. For men transperineally implanted since 1995, the 15 year overall DFS rate is 80% and is 93%, 80% and 49% according to low, intermediate and high risk group, respectively. CONCLUSIONS: We believe this report answers Dr. Walsh’s comment. This study documents that this form of radiotherapy pro-
Mary H. James*, Bethany B. Gibbs, Erin Glace, Robert W. Given, Norfolk, VA INTRODUCTION AND OBJECTIVES: Urinary incontinence following radical prostatectomy is a significant clinical problem that compromises patient quality of life. Pelvic floor muscle training (PFMT) has been shown to reduce continence recovery time. There is currently a lack of data regarding preoperative variables that may predict which patients will have earlier return to continence. The objective of this study was to determine whether preoperative pelvic floor strength influences the degree and duration of post-prostatectomy incontinence. METHODS: All patients scheduled for robotic assisted laparoscopic radical prostatectomy were referred to a certified pelvic floor physical therapist. Pelvic floor strength was assessed using EMG evaluation with perianal electrodes. Strength parameters collected included the resting, average and maximum measurements during quick and sustained contractions as well as maximum contraction during valsalva. Patients were educated and given a home training program. Chart review was performed to obtain post-operative continence data from 6 week and 3 month visits measured by reported pad per day (PPD) usage. Continence was defined in two ways: PPD⫽0 and PPDⱕ1. Baseline values for each parameter were compared in men who were continent versus not continent at each visit using independent t-tests. RESULTS: Baseline data was available for 213 patients. There were 181 patients with 6 week follow-up and 170 patients with 6 week and 3 month follow-up. When defining continence as PPD⫽0 a higher resting tone was associated with return to continence at 6 week follow up (p⫽0.043) but did not hold true at 3 months. However, when defining continence as PPDⱕ1 a higher resting tone was associated with return to continence at the 3 month mark. (p⫽0.023). In this group the mean preoperative resting tone for those patients who had achieved continence was 4.5 microvolts compared to 3.4 microvolts in those patients with persistent incontinence. CONCLUSIONS: Post-prostatectomy incontinence (PPI) is a common complication following radical prostatectomy that significantly affects patient quality of life. PFMT in the pre and post-operative setting has been shown to decrease the time to recovery of continence. In this study a higher pelvic floor muscle resting tone was associated improved achievement of continence at 6 weeks when defining continence as PPD⫽0 and at 3 months when defining continence as PPDⱕ1. This information could be useful for additional preoperative counseling regarding continence outcomes following prostatectomy. Source of Funding: None