JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 64
64
Journal of Clinical Urology 11(1S)
P6-17 Association between maximal urethral
length and continence following robotically
assisted radical prostatectomy
Cahill D1, Kim L1, Patel A1, Jallad S1, Taghavi Azar
Sharabiani M1, Kinsella N1, Ap Daffyd D1
1The Royal Marsden Hospital, London, United Kingdom
Introduction: Incontinence is a morbid outcome of
radical prostatectomy. Membranous urethral length
(MUL) is a predictor of continence in previous studies.
We have evaluated the association between preoperative
MRI MUL and continence post Robotically Assisted
Radical Prostatectomy (RARP).
Methods: We conducted a retrospective review of
patients who underwent RARP by a high volume single
surgeon/supervised fellows 8/2015-6/2017. Patients with
prior or adjuvant treatment were excluded. Continence
was defined as no pad/safety pad. MRI variables included
MUL and were measured by consultants Uro-Radiologist/
Urologist and uro-oncology fellow. Multivariate logistic
regression analyses were performed to identify predictors
of incontinence.
Results: 190 patients were included. Mean age 62 years
(46-73). The mean MUL was 14.6mm (6-24). Age and MUL
were significantly associated with incontinence outcome
at immediate, 3, 6 and 12 months postoperatively. After
age adjustment, MUL remained to be a significant predictor. The area under the ROC curve for continence based
on MUL was 0.78 at 12 months. The risk of incontinence
in patients with MUL of <10mm was 27.8% (13.8%, and
39.1% for patients <65 years, and t65, respectively). The
risk of incontinence with MUL > 15mm was 2.7% (1.5%,
and 4.5% for <65 years, and t65, respectively). < 8mm, 1%
of total, complete urinary incontinence.The inter-observer
concordance rate was 89% for Coronal MUL.
Conclusion: MUL predicts continence following RARP.
This is important for counselling, training and commencing
a service. A larger, prospective study would be required to
verify our findings. We incorporate it as part of preoperative assessment, counselling and surgical planning.
P6-18 Retzius-sparing robotic radical
prostatectomy for high-risk prostate cancer
Moschonas D1, Kusuma M1, Pavlakis P1, Eden C1
1The Royal Surrey County Hospital, Guildford, United Kingdom
Retzius-sparing robot-assisted radical prostatectomy
(RS-RARP) produced significantly better early urinary
continence than its non-RS counterpart in a randomised
controlled trial. Concerns exist however that it might not
allow due to its technical difficulty and the paucity of landmarks a sufficiently wide excision of the prostate when
needed and might therefore be unsuitable for higher risk
prostate cancers.
Of 160 consecutive patients having RS-RARP done by the
same surgeon during a 16-month period, 55 had d'Amico
high-risk prostate cancer. All patients had an extended pelvic lymphadenectomy. Their results were compared with a
matched (for high-risk parameters) group of 55 high-risk
patients operated on robotically by the same surgeon
immediately prior to the adoption of RS-RARP. The mean
follow-up in RS- and non-RS-RARP patients was 8 (1-16)
months & 24 (16-33) months.
Patients in the 2 groups had similar age, BMI, PSA, biopsy
Gleason sum, clinical stage, operating time, extent of
nerve-sparing surgery, blood loss, complication rate, prostate weight, LN yield and post-op. hospital stay.
RS-RARP produces dramatically better (10x) urinary continence at 4 weeks (p=<0.0001) than non-RS-RARP and does
not appear to negatively impact short-terms indicators of
cancer control in patients with high-risk prostate cancer.
Earlier recovery of continence post-surgery allows this
group of patients to undergo adjuvant radiotherapy as part
of multimodality treatment quicker representing an underestimated benefit of the approach. Clearly, longer follow-up
is needed to determine its impact on cancer control.
P6-18: Table 1
n
Op. time (min)
Catheter (days)
4-week pad-free
Clavien t3 complications
PSM
pT2
pT3
total
LN yield
PSA <0.1 ng/ml
BCR
RS
non-RS
P
55
209 (180-300)
9 (8-9)
40 (73%)
2 (3.6%)
55
213 (135-300)
14 (14-14)
4 (7.3%)
2 (3.6%)
1.00
<0.0001
<0.0001
1.00
3/13 (23.1%)
14/42 (33.3%)
17/55 (30.9%)
22 (13-47)
52 (94.5%)
3 (5.5%)
6/19 (31.6%)
16/36 (44.4%)
22/55 (40.0%)
20 (13-30)
53 (96.4%)
3 (5.5%)
0.91
0.44
0.43
0.84
1.00
1.00
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