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35 Nerve sparing procedure improves early return of continence after robot-assisted radical prostatectomy
posters / european urology supplements 10 (2011) 531–556
respectively 2, 3, 0, 2 and 9 of the cases in the LSCP group vs. 29, 0, 2, 1 and 6 of the cases in the RASCP group. The median time of surgery (incision to closure) was 182 min in the LSCP group vs 132 min in the RASCP group (t-test p < 0.05). The median blood loss was 40 cc and 35 cc (t-test p = 0.5). In the LSCP group 17 had no, 10 had mild and 9 had severe urgency before intervention, this changed to 29, 4 and 3 respectively after surgery. For the RASCP group the numbers were 17, 12 and 7 before and 30, 4 and 2 after surgery. (chi square p = 0.01 for LSCP and p = 0.006 for RASCP). 1 Patient experienced de novo urge after the surgery and received anticholinergics. 3 Patients experienced temporarily urge problems after RASCP. In the LSCP group 19 patients had no stress incontinence before surgery, 3 needed surgery after 3 months for de novo stress incontinence compared to 5 out of 32 for the RASCP. In both groups 8 patients had complaints of constipation before surgery, in 6 out of 8 troubles improved significantly for both LSCP and RASCP. After 1 year FU for both groups 1 anterior and 1 posterior recurrence was found in the LSCP compared to one anterior recurrence in the RASCP. Conclusion: Even in the learning curve of RASCP the early and mid-term results compared favourably with standard LSCP. The operating time was significantly shorter. 34 Initial experience of bilateral robotic single-site surgery I.Y. Seo1 , J.W. Lee2 , S.C. Park2 , J.S. Rim2 . 1 Dept. of Urology, Wonkwang University Hospital, Iksan, Republic of Korea; 2 Dept. of Urology, Wonkwang University School of Medicine, Iksan, Republic of Korea We present initial experiences of the bilateral robotic singlesite surgeries. First case was bilateral partial nephrectomy on a 51-year-old man with bilateral renal tumors. Left partial nephrectomy without renal arterial clamping and right partial nephrectomy with a warm ischemic time of 29 minutes were performed through a single umbilical port and one additional port. The total operative time was 350 minutes including 238 minutes of robotic console time. Second case was bilateral pyeloplasty on a 64-year-old female with bilateral ureteropelvic junction strictures. Right pyeloplasty included pyelolithotomy. Total operative time was 322 minutes including 181 minutes of robotic console time. Both transperitoneal operations were performed with home-made port. There were no operative complications and no open conversions. Our report shows the technical feasibility of bilateral robotic single-site surgeries. 35 Nerve sparing procedure improves early return of continence after robot-assisted radical prostatectomy Y.H. Ko1 , R.F. Chelho2 , S. Chauhan3 , A. Sivaraman3 , O. Schatloff3 , R.J.V. Carrio3 , J. Cheon4 , V.R. Patel3 . 1 Global Robotics Institute, FHCH, FL, USA/Korea University Department of Urology, Seoul, Republic of Korea; 2 Global Robotics Institute, FHCH, FL, USA/Instituto do Cˆ ancer do Estado de S˜ ao Paulo, S˜ ao Paulo, SP, Brazil; 3 Global Robotics Institute, FHCH, FL, USA; 4 Korea University, Department of Urology, Seoul, Republic of Korea Objectives: Despite several technical modifications, early recovery of urinary continence after radical prostatectomy remains a challenge. The purpose of this study was to identify preoperative or intraoperative factors responsible for early return of continence (within 3 months) after robot-assisted radical prostatectomy (RARP) using data from a high volume center. Patients and Methods: Data from 1,299 patients who underwent RARP by a single experienced surgeon from January 2008 to June 2010 were collected prospectively and analyzed retrospectively. Patients were categorized according
543
to whether they regained continence within 3 months or not; variables were then compared. A self-administered validated questionnaire (Expanded Prostate Cancer Index Composite) was used for assessment of continence status and the time to recovery. Continence was defined as the use of no absorbent pads or no leakage of urine. Multivariate Cox regression analyses were used for identification of independent factors associated with continence after adjusting for baseline characteristics. Results: Within 3 months after surgery, 86.3% of patients (1,121/1,299) had recovered their continence. When divided into two groups based on continence status, patients who had not regained continence were significantly older (mean [interquartile range]; 62.8 [10] vs. 59.7 [10] years old), and had longer operative time (77.8 [15] vs. 75.4 [10] minutes), a prolonged catheterization period (5.4 [2] vs. 5.2 [2] days), increased estimated blood loss (118.4 [50] vs. 112.8 [0] ml]), and a higher proportion of the median lobe (25.3% vs. 17.9%) and non nerve-sparing (NNS; 18.1% vs. 7.6%), compared with their continent counterparts. Univariate Cox regression revealed that age, gland size, American Urological Association (AUA) symptom score, preoperative Sexual Health Inventory for men (SHIM) score, operative time, catheter indwelling period, presence of the median lobe, and difference in distribution of patients according to NS status were associated with continence status with 3 months. Multivariate analysis indicated that only age (p < 0.001, odds ratio = 0.982, 95% confidential interval [CI] = 0.973–0.990) and performance of the NS procedure were independent predictors. After adjusting for potential covariates, the odds ratio (95% CI) was 1.603 (1.222–2.101, p = 0.002) for partial NS (PNS), and 1.419 (1.079–1.888, p = 0.012) for bilateral NS (BNS) relative to the NNS group. The median (95% CI) time to recovery of continence was also prolonged in older patients and in the NNS group (both p < 0.001, by log-rank test); 6 weeks (5.723–6.277), 5 weeks (4.730–5.270), and 4 weeks (3.645–4.355) for each age stratification (over 65 years, 55–65, and below 55 years old, respectively); 6 weeks (5.117–6.883), 4 weeks (3.601–4.399), and 5 weeks (4.702–5.298) in the NNS, PNS, and BNS groups, respectively. Comparison of PNS and BNS showed no statistical difference (p = 0.249). Conclusions: Findings from this analysis indicate that age and NS status are independent predictors of early recovery of continence. The likelihood of postoperative urinary control and the time required for recovery of continence were significantly higher and shorter in younger patients and when an NS procedure was performed. 36 Initial experience with a randomised controlled trial of open, robotic, and laparoscopic (CORAL) radical cystectomy: an interim report A. Patel1 , F. Ismail1 , J. Watkins1 , T. O’Brien1 , P. Rimington2 , P. Dasgupta1 , M.S. Khan1 . 1 Department or Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 2 Department of Urology, Eastbourne General Hospital, Eastbourne, UK Introduction: Open radical cystectomy (ORC) is the gold standard for treatment of muscle invasive bladder cancer. Laparoscopic (LC) and robot-assisted (RALC) Radical cystectomy have now emerged as viable alternatives to ORC. There is limited evidence of the relative benefits of one technique over another. We report our experience in recruitment, and the interim results in terms of the complication rates, peri-operative and short term oncological outcomes. Methods: We have designed a single-centre prospective randomised trial to include all patients with high-risk bladder cancer, and fit for all approaches to RC with curative intent. 42 patients met the inclusion criteria, and 33(71%) agreed to
respectively 2, 3, 0, 2 and 9 of the cases in the LSCP group vs. 29, 0, 2, 1 and 6 of the cases in the RASCP group. The median time of surgery (incision to closure) was 182 min in the LSCP group vs 132 min in the RASCP group (t-test p < 0.05). The median blood loss was 40 cc and 35 cc (t-test p = 0.5). In the LSCP group 17 had no, 10 had mild and 9 had severe urgency before intervention, this changed to 29, 4 and 3 respectively after surgery. For the RASCP group the numbers were 17, 12 and 7 before and 30, 4 and 2 after surgery. (chi square p = 0.01 for LSCP and p = 0.006 for RASCP). 1 Patient experienced de novo urge after the surgery and received anticholinergics. 3 Patients experienced temporarily urge problems after RASCP. In the LSCP group 19 patients had no stress incontinence before surgery, 3 needed surgery after 3 months for de novo stress incontinence compared to 5 out of 32 for the RASCP. In both groups 8 patients had complaints of constipation before surgery, in 6 out of 8 troubles improved significantly for both LSCP and RASCP. After 1 year FU for both groups 1 anterior and 1 posterior recurrence was found in the LSCP compared to one anterior recurrence in the RASCP. Conclusion: Even in the learning curve of RASCP the early and mid-term results compared favourably with standard LSCP. The operating time was significantly shorter. 34 Initial experience of bilateral robotic single-site surgery I.Y. Seo1 , J.W. Lee2 , S.C. Park2 , J.S. Rim2 . 1 Dept. of Urology, Wonkwang University Hospital, Iksan, Republic of Korea; 2 Dept. of Urology, Wonkwang University School of Medicine, Iksan, Republic of Korea We present initial experiences of the bilateral robotic singlesite surgeries. First case was bilateral partial nephrectomy on a 51-year-old man with bilateral renal tumors. Left partial nephrectomy without renal arterial clamping and right partial nephrectomy with a warm ischemic time of 29 minutes were performed through a single umbilical port and one additional port. The total operative time was 350 minutes including 238 minutes of robotic console time. Second case was bilateral pyeloplasty on a 64-year-old female with bilateral ureteropelvic junction strictures. Right pyeloplasty included pyelolithotomy. Total operative time was 322 minutes including 181 minutes of robotic console time. Both transperitoneal operations were performed with home-made port. There were no operative complications and no open conversions. Our report shows the technical feasibility of bilateral robotic single-site surgeries. 35 Nerve sparing procedure improves early return of continence after robot-assisted radical prostatectomy Y.H. Ko1 , R.F. Chelho2 , S. Chauhan3 , A. Sivaraman3 , O. Schatloff3 , R.J.V. Carrio3 , J. Cheon4 , V.R. Patel3 . 1 Global Robotics Institute, FHCH, FL, USA/Korea University Department of Urology, Seoul, Republic of Korea; 2 Global Robotics Institute, FHCH, FL, USA/Instituto do Cˆ ancer do Estado de S˜ ao Paulo, S˜ ao Paulo, SP, Brazil; 3 Global Robotics Institute, FHCH, FL, USA; 4 Korea University, Department of Urology, Seoul, Republic of Korea Objectives: Despite several technical modifications, early recovery of urinary continence after radical prostatectomy remains a challenge. The purpose of this study was to identify preoperative or intraoperative factors responsible for early return of continence (within 3 months) after robot-assisted radical prostatectomy (RARP) using data from a high volume center. Patients and Methods: Data from 1,299 patients who underwent RARP by a single experienced surgeon from January 2008 to June 2010 were collected prospectively and analyzed retrospectively. Patients were categorized according
543
to whether they regained continence within 3 months or not; variables were then compared. A self-administered validated questionnaire (Expanded Prostate Cancer Index Composite) was used for assessment of continence status and the time to recovery. Continence was defined as the use of no absorbent pads or no leakage of urine. Multivariate Cox regression analyses were used for identification of independent factors associated with continence after adjusting for baseline characteristics. Results: Within 3 months after surgery, 86.3% of patients (1,121/1,299) had recovered their continence. When divided into two groups based on continence status, patients who had not regained continence were significantly older (mean [interquartile range]; 62.8 [10] vs. 59.7 [10] years old), and had longer operative time (77.8 [15] vs. 75.4 [10] minutes), a prolonged catheterization period (5.4 [2] vs. 5.2 [2] days), increased estimated blood loss (118.4 [50] vs. 112.8 [0] ml]), and a higher proportion of the median lobe (25.3% vs. 17.9%) and non nerve-sparing (NNS; 18.1% vs. 7.6%), compared with their continent counterparts. Univariate Cox regression revealed that age, gland size, American Urological Association (AUA) symptom score, preoperative Sexual Health Inventory for men (SHIM) score, operative time, catheter indwelling period, presence of the median lobe, and difference in distribution of patients according to NS status were associated with continence status with 3 months. Multivariate analysis indicated that only age (p < 0.001, odds ratio = 0.982, 95% confidential interval [CI] = 0.973–0.990) and performance of the NS procedure were independent predictors. After adjusting for potential covariates, the odds ratio (95% CI) was 1.603 (1.222–2.101, p = 0.002) for partial NS (PNS), and 1.419 (1.079–1.888, p = 0.012) for bilateral NS (BNS) relative to the NNS group. The median (95% CI) time to recovery of continence was also prolonged in older patients and in the NNS group (both p < 0.001, by log-rank test); 6 weeks (5.723–6.277), 5 weeks (4.730–5.270), and 4 weeks (3.645–4.355) for each age stratification (over 65 years, 55–65, and below 55 years old, respectively); 6 weeks (5.117–6.883), 4 weeks (3.601–4.399), and 5 weeks (4.702–5.298) in the NNS, PNS, and BNS groups, respectively. Comparison of PNS and BNS showed no statistical difference (p = 0.249). Conclusions: Findings from this analysis indicate that age and NS status are independent predictors of early recovery of continence. The likelihood of postoperative urinary control and the time required for recovery of continence were significantly higher and shorter in younger patients and when an NS procedure was performed. 36 Initial experience with a randomised controlled trial of open, robotic, and laparoscopic (CORAL) radical cystectomy: an interim report A. Patel1 , F. Ismail1 , J. Watkins1 , T. O’Brien1 , P. Rimington2 , P. Dasgupta1 , M.S. Khan1 . 1 Department or Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 2 Department of Urology, Eastbourne General Hospital, Eastbourne, UK Introduction: Open radical cystectomy (ORC) is the gold standard for treatment of muscle invasive bladder cancer. Laparoscopic (LC) and robot-assisted (RALC) Radical cystectomy have now emerged as viable alternatives to ORC. There is limited evidence of the relative benefits of one technique over another. We report our experience in recruitment, and the interim results in terms of the complication rates, peri-operative and short term oncological outcomes. Methods: We have designed a single-centre prospective randomised trial to include all patients with high-risk bladder cancer, and fit for all approaches to RC with curative intent. 42 patients met the inclusion criteria, and 33(71%) agreed to