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358 A novel risk classification tool to estimate urinary incontinence after robotic-assisted radical prostatectomy
Title
358
A novel risk classification tool to estimate urinary incontinence after robotic-assisted radical prostatectomy Eur Urol Suppl 2015;14/2;e358
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Honda M. 1 , Kawamoto B. 1 , Morizane S. 1 , Hikita K. 1 , Muraoka K. 1 , Panagiota T.1 , Shimizu S. 2 , Saito M. 2 , Sejima T.3 , Takenaka A. 3 1 Tottori
University Faculty Of Medicine, Dept. of Urology, Yonago, Japan, 2 Kochi University Faculty of Medicine, Dept. of Pharmacology,
Yonago, Japan, 3 Tottori University Faculty of Medicine, Dept. of Urology, Yonago, Japan INTRODUCTION & OBJECTIVES: Urinary incontinence (UI) is not uncommon after radical prostatectomy, and may dramatically worsen quality of life. However, few preoperative tools are available to quantify risk of postoperative UI after robotic-assisted radical prostatectomy (RARP). The objective was to develop a novel preoperative risk classification tool to estimate the risk of UI after RARP. MATERIAL & METHODS: Participants comprised 122 men who underwent RARP at our hospital between May 2011 and July 2013. At baseline, patient-related variables were age at surgery, body mass index (BMI), serum PSA value, clinical stage, National Comprehensive Cancer Network (NCCN) classification, biopsy Gleason score, preoperative filling cystometry and pressure flow study results, preoperative magnetic resonance imaging (MRI), International Index of Erectile Function – Erectile Function domain (IIEF-EF) score and type of nerve sparing (unilateral or non-nerve sparing vs. bilateral). Filling cystometry and pressure flow study evaluated preoperative maximum cystometric capacity, detrusor pressure at maximum flow, maximum detrusor pressure, bladder compliance, and presence of detrusor overactivity. Preoperative MRI evaluated membranous urethral length, urethral width, levator thickness, and prostate volume. Patients who used no pad were considered to show urinary continence, and those who used a security liner or ≥1 pad daily were considered to show urinary incontinence. Initially, all preoperative factors underwent univariate logistic regression analysis. Factors that univariate logistic regression analysis identified as associated with recovery of postoperative UI at 1, 3 or 6 months were subjected to multivariate logistic regression analysis. Kaplan-Meier curve estimates were used to assess UI risk in each subgroup at 1, 3 and 6 months after RARP. RESULTS: At 1, 3 and 6 months, UI rates were 59.3%, 37.0% and 26.9%, respectively. Uni- and multivariate logistic regression analysis revealed significant associations between membranous urethral length or levator thickness and UI at 3 and 6 months. The stratification process resulted in two UI risk groups: high (membranous urethral length < 9.5 mm or levator thickness < 9.0 mm) and low (membranous urethral length ≥ 9.5 mm and levator thickness ≥ 9.0 mm). One-month UI rates in these groups were 89.8% and 33.8%, 3-month UI rates were 71.4% and 8.5%, and 6-month UI rates were 57.1% and 1.7%, respectively. The observed differences in UI rate between groups were significant (log-rank test, P < 0.001). CONCLUSIONS: We developed a risk classification tool based on preoperative patient data that allows accurate estimation of postoperative UI rate in patients treated with RARP. This risk classification tool may help improve patient counselling and optimize patient expectations of functional status after RARP.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/358.html[19/02/2015 08:11:46]
358
A novel risk classification tool to estimate urinary incontinence after robotic-assisted radical prostatectomy Eur Urol Suppl 2015;14/2;e358
Print! Print!
Honda M. 1 , Kawamoto B. 1 , Morizane S. 1 , Hikita K. 1 , Muraoka K. 1 , Panagiota T.1 , Shimizu S. 2 , Saito M. 2 , Sejima T.3 , Takenaka A. 3 1 Tottori
University Faculty Of Medicine, Dept. of Urology, Yonago, Japan, 2 Kochi University Faculty of Medicine, Dept. of Pharmacology,
Yonago, Japan, 3 Tottori University Faculty of Medicine, Dept. of Urology, Yonago, Japan INTRODUCTION & OBJECTIVES: Urinary incontinence (UI) is not uncommon after radical prostatectomy, and may dramatically worsen quality of life. However, few preoperative tools are available to quantify risk of postoperative UI after robotic-assisted radical prostatectomy (RARP). The objective was to develop a novel preoperative risk classification tool to estimate the risk of UI after RARP. MATERIAL & METHODS: Participants comprised 122 men who underwent RARP at our hospital between May 2011 and July 2013. At baseline, patient-related variables were age at surgery, body mass index (BMI), serum PSA value, clinical stage, National Comprehensive Cancer Network (NCCN) classification, biopsy Gleason score, preoperative filling cystometry and pressure flow study results, preoperative magnetic resonance imaging (MRI), International Index of Erectile Function – Erectile Function domain (IIEF-EF) score and type of nerve sparing (unilateral or non-nerve sparing vs. bilateral). Filling cystometry and pressure flow study evaluated preoperative maximum cystometric capacity, detrusor pressure at maximum flow, maximum detrusor pressure, bladder compliance, and presence of detrusor overactivity. Preoperative MRI evaluated membranous urethral length, urethral width, levator thickness, and prostate volume. Patients who used no pad were considered to show urinary continence, and those who used a security liner or ≥1 pad daily were considered to show urinary incontinence. Initially, all preoperative factors underwent univariate logistic regression analysis. Factors that univariate logistic regression analysis identified as associated with recovery of postoperative UI at 1, 3 or 6 months were subjected to multivariate logistic regression analysis. Kaplan-Meier curve estimates were used to assess UI risk in each subgroup at 1, 3 and 6 months after RARP. RESULTS: At 1, 3 and 6 months, UI rates were 59.3%, 37.0% and 26.9%, respectively. Uni- and multivariate logistic regression analysis revealed significant associations between membranous urethral length or levator thickness and UI at 3 and 6 months. The stratification process resulted in two UI risk groups: high (membranous urethral length < 9.5 mm or levator thickness < 9.0 mm) and low (membranous urethral length ≥ 9.5 mm and levator thickness ≥ 9.0 mm). One-month UI rates in these groups were 89.8% and 33.8%, 3-month UI rates were 71.4% and 8.5%, and 6-month UI rates were 57.1% and 1.7%, respectively. The observed differences in UI rate between groups were significant (log-rank test, P < 0.001). CONCLUSIONS: We developed a risk classification tool based on preoperative patient data that allows accurate estimation of postoperative UI rate in patients treated with RARP. This risk classification tool may help improve patient counselling and optimize patient expectations of functional status after RARP.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/358.html[19/02/2015 08:11:46]