Improved urinary continence in radical retropubic prostatectomy after preparation of a long intraprostatic ureteral stump - results of a questionnaire in 575 consecutive cases

274

273 EFFECT OF PELVIC MUSCLE EXERCISES BIOFEEDBACK STIMULATION AND PROSTATECTOMY Wille Sebastian, Rainer Department

Sobottka

Axel, Varga Zoltan,

of Urology, Philipps-University

WITH ELECTRICAL AFTER RADICAL

Heidenreich

Axel, Hofmann

of Marburg, Marbug.

RADICAL

PROSTATECTOMY:

ACCORDING

LOCATION

TO SURGICAL

Salomon

Laurent’.

Antony’,

Chopin Dominique’,

Levrel

OF SURGICAL

MARGINS

APPROACH

Olivier’,

Saint Fabien’,

Hoznek

And&‘,

Cicco

Abbou Claude’

Germany

INTRODUCTION & OBJECTIVES: To asses the effectiveness of pelvic muscle exercises (PME) and electrical stimulation (ES) and biofeedback (BFB) on urinary incontinence after radical retropubic prostatectomy (RRP). MATERIALS & METHODS: We randomised 139 patients who underwent RRP into 3 groups: Group I received verbal and written instruction about postoperative PME from a physiotherapist. Group 2 received same instructions and electrical stimulation for I5 minutes twice a day. Patients in group 3 were additionally treated with BFB for I5 minutes twice a day. Treatment was started immediately after catheter removal and performed for three months. Outcome was assessed using the 20 minutes pad test. a urine symptom inventory, all obtained preoperative and three months postoperative. Surgery was performed by two surgeons only. Results at three months were available for 120 (symptom inventory) and 79 patients (padtest) respectively.

‘Urologic,

CHU H Mondor.

Creteil,

France.

‘Pathologic,

CHU H Mondor,

Creteil, France

INTRODUCTION

& OBJECTIVES:

margins after retropubic.

MATERIALS by retropubic

approach)

To compare

perineal and laparoscopic

& METHODS: approach.

were analysed

484 specimen

I I9 by perineal

the location

of surgical

radical prostatectomy

of radical prostatectomies

approach

(145

and 220 by laparoscopic

in terms of the location of positive surgical margins

and its rate.

RESULTS: treatment

RESULTS:

Group 1

Group 2

Group 3

PME

PME+ES

PME+ES+BFB

Group I vs. 2

and

3 not simificant

Group 2 vs. 3 not sismficant

Overall subjective continence at 3 months (questionnaire)

357~ (n=42)

60%

Overall objective at 3 months (padtest)

66.7% (~27)

For pT2 tumours, surgical positive margin rates were 18,8%, 15%

and 16%. Location

was at apex in 47.1%. 33% and 52%. at bladder neck in

41.2% 41.6% and 20% and posterolateral

(w40)

52.6%

turnouts,

(~38)

positive surgical

in ll.8%,

margin rate was 54.98,

25% et 28%. For pT3

30.3% and 46%, Location

was at apex in 38.2%. 50% and 44%. at bladder neck in 44.1%, 25% and 22.2%, 76% (Il=L?S)

posterolateral

76% (n=25)

in 17.6%, 25% and 33.3%

continence

CONCLUSION: CONCLUSION: A treatment program of electrical stimulation or biofeedback enhanced pelvic floor exercises began immediately after catheter removal did not significantly affect continence after three months in this study.

remains

After comparing

the highest

risk among

several approaches, the retropubic

apical surgical

and laparoscopic

approach,

whereas bladder neck involvement is mostly seen in perineal approach.

275 RADICAL

PROSTATECTOMY

LAPAROSCOPIC:

MORBIDITY

Salomon

Saint

Laurent,

Dominique.

BY RETROPUBIC,

Fabien,

Hoanek

And&,

PERINEAL

Cicco

Antony,

AND

Chopin

Abbou Claude

margin

276 IMPROVED URINARY CONTINENCE IN RADICAL RETROPUBIC PROSTATECTOMY AFTER PREPARATION OF A LONG INTRAPROSTATIC URETERAL STUMP - RESULTS OF A QUESTIONNAIRE IN 575 CONSECUTIVE CASES van Randenboreh Hartung Rudolf

Heinz,

Paul

Roger.

Frischholz

Margret,

Jtirgen

Breul.

Urology, TU Munich, Munich, Germany Urologie, CHU H Mondor, Creteil. France

INTRODUCTION performed

& OBJECTIVES:

by retropubic,

compared

morbidity

MATERIALS

& METHODS:

were performed

Radical

and

prostatectomy

laparoscopic

can

approach.

be

We have

of these 3 approaches.

From 1988 to 2000,401

for localised prostate cancer,

by perineal approach, rate, medical

perineal

137 laparoscopic

and surgical

145 by retropubic

approach.

complications,

radical prostatectomies

Operating

approach,

I I9

time, transfusion

bladder catheterisation

and hospital

stay were noted

RESULTS: operating

Respectively

for retropubic,

perineal

and laparoscopie

time was 197 mn, 178 mn and 285 mn, transfusion

15.9% and 2.9%, medical complications complications

approach,

rate was 26.2%,

rate was 8.3%. 5.9%. 5.1% and surgical

rate was 13.1%, 7.5%. 7.30/c, bladder catheterisation

was 15.9

days,] I .9 days, 6.9 days, hospital stay was13 days. X.7 days and 5.4 days.

CONCLUSION: radical

Improvement

prostatectomy

of surgical

with a decreasing

operative

time,

advantages

of the laparoscopic

laparoscopic

procedure approach.

techniques

morbidity offers

allows

performing

rate. In spite of its higher identical

results

with

the

INTRODUCTION & OBJECTIVES: Urinary contmence is one of the most important factors of quality of life in patients after radical retropubic prostatectomy. In the literature the achieved continence rates are between 75% and 97% of all patients. To improve the rate of full continence in our patients we used a careful preparation of the intraprostatic part of the uretera to obtain a long ureteral stump for the vesico- urethral anastomosis since June 1997. Before this time, the urethra has been transsected at the apex of the prostate. This study was performed to compare the rate of urinary continence as well as positive surgical margins in these two groups. MATERIALS & METHODS: 156 patients with (group I) and 419 patients without (group 2) a long intraprostatic stump of the urethra were asked by a questionnaire about their continence status. All patients have been fully continent before the operation. The status was defined as continent, if the patient did not use any pads, as stress-incontinent I” (SIK) in the case of I pad. as SIK II” in the case of 2-3 pads and SIK III” if the patient needs more than 3 pads and/or more than I pad at night. The rate of positive surgical margins in the histopathological results was compared. The mean follow-up for group I is 2.5 years and for group 2 4.5 years. RESULTS: Full contmence (no pads) was achieved in 93% of all patients in group I and in 82% in group 2. Stress-incontinence (SIK) I” was found in 4.5% and 12.2% respectiveley. SIK II” was noted in 2.5% and S.6% and complete incontinence was seen in no patient in group I but in I .8% in group 2. This difference is statistically highly significant (p
Urology Supplements

1 (2002)

No. 1, pp. 71