Long-term outcomes of pelvic-fascia sparing robotic-assisted radical prostatectomy versus standard technique: Superior urinary function and quality of life without compromising oncologic efficacy in a single-surgeon series.

MedStar author(s):
Citation: Urologic Oncology. 42(3):67.e17-67.e24, 2024 03.PMID: 38212151Institution: MedStar Washington Hospital CenterDepartment: UrologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Prostatic Neoplasms | *Robotic Surgical Procedures | *Surgeons | *Urinary Incontinence | Fascia | Humans | Male | Prostatectomy/ae [Adverse Effects] | Prostatic Neoplasms/su [Surgery] | Quality of Life | Treatment Outcome | Urinary Incontinence/et [Etiology] | Year: 2024ISSN:
  • 1078-1439
Name of journal: Urologic oncologyAbstract: BACKGROUND: Prostatic fascia-sparing robotic-assisted radical prostatectomy (PFS-RARP) has improved short-term postoperative continence compared to standard prostatectomy (S-RARP) but long-term differences remain unclear.CONCLUSIONS: PFS-RARP improves continence and patient-reported QOL up to 24 months postoperatively without compromising oncologic outcomes. Copyright © 2023 Elsevier Inc. All rights reserved.MATERIALS AND METHODS: One hundred two S-RARP followed by 239 PFS-RARPs were performed by a single surgeon. Univariate analyses were performed with t-test, chi2, Wilcoxon rank sum, Fisher exact, and analysis of variance (ANOVA). Regression models analyzed associates of EPIC-CP scores and oncologic outcomes. Cox proportional hazards modeling assessed postoperative continence. Primary outcomes included patient-reported urinary incontinence (UI) via EPIC-CP and continence rates. Secondary outcomes included EPIC-CP scores, positive surgical margins (PSM), and biochemical recurrence (BCR). Perioperative outcomes and time to continence were measured.RESULTS: Median follow-up for PFS-RARP vs. S-RARP was 26 vs. 65 months. PFS-RARP demonstrated improved EPIC-CP UI and total scores at 24 months. On multivariate analysis, PFS-RARP was associated with improved EPIC-CP UI and total scores through 18 months, but not with PSM or BCR. PFS-RARP had a 39% and 66% reduced risk of incontinence using 0 and 0 to 1 pad-use definitions (HR 0.61, 95% CI 0.39 - 0.95; HR:0.34, 95% CI 0.16 - 0.76). Continence returned faster with PFS-RARP (0 PPD: 91.0 days vs. 261 days, P < 0.001; 0-1 PPD: 32.7 days vs. 171 days, P < 0.001). There were no differences in PSM (35% vs. 25%, P=0.064). There were more anterior PSM in PFS-RARP vs. S-RARP (47% vs. 26% P=0.035), but no differences in BCR (16% vs. 22% P=0.241).All authors: Dall CP, Mason JB, Choudhury E, Mora-Garijo B, Egan J, Hu JC, Kowalczyk KJFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2024-04-24
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Journal Article MedStar Authors Catalog Article 38212151 Available 38212151

BACKGROUND: Prostatic fascia-sparing robotic-assisted radical prostatectomy (PFS-RARP) has improved short-term postoperative continence compared to standard prostatectomy (S-RARP) but long-term differences remain unclear.

CONCLUSIONS: PFS-RARP improves continence and patient-reported QOL up to 24 months postoperatively without compromising oncologic outcomes. Copyright © 2023 Elsevier Inc. All rights reserved.

MATERIALS AND METHODS: One hundred two S-RARP followed by 239 PFS-RARPs were performed by a single surgeon. Univariate analyses were performed with t-test, chi2, Wilcoxon rank sum, Fisher exact, and analysis of variance (ANOVA). Regression models analyzed associates of EPIC-CP scores and oncologic outcomes. Cox proportional hazards modeling assessed postoperative continence. Primary outcomes included patient-reported urinary incontinence (UI) via EPIC-CP and continence rates. Secondary outcomes included EPIC-CP scores, positive surgical margins (PSM), and biochemical recurrence (BCR). Perioperative outcomes and time to continence were measured.

RESULTS: Median follow-up for PFS-RARP vs. S-RARP was 26 vs. 65 months. PFS-RARP demonstrated improved EPIC-CP UI and total scores at 24 months. On multivariate analysis, PFS-RARP was associated with improved EPIC-CP UI and total scores through 18 months, but not with PSM or BCR. PFS-RARP had a 39% and 66% reduced risk of incontinence using 0 and 0 to 1 pad-use definitions (HR 0.61, 95% CI 0.39 - 0.95; HR:0.34, 95% CI 0.16 - 0.76). Continence returned faster with PFS-RARP (0 PPD: 91.0 days vs. 261 days, P < 0.001; 0-1 PPD: 32.7 days vs. 171 days, P < 0.001). There were no differences in PSM (35% vs. 25%, P=0.064). There were more anterior PSM in PFS-RARP vs. S-RARP (47% vs. 26% P=0.035), but no differences in BCR (16% vs. 22% P=0.241).

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