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PubMed2006

Biochemical disease-free survival in men younger than 60 years with prostate cancer treated with radical prostatectomy.

OBJECTIVES: To determine the biochemical disease-free survival rates in patients 60 years old or younger who were treated with surgery for localized prostate cancer. METHODS: We reviewed the medical records of 291 patients 60 years old or younger who had undergone radical prostatectomy as the sole primary treatment for prostate cancer. Follow-up prostate-specific antigen (PSA) levels were measured 6 to 8 weeks after surgery and 4 to 6 months thereafter. Biochemical failure was defined as a detectable PSA level (greater than 0.01 ng/mL). The median follow-up of the entire study group was 50 months. RESULTS: Eighty-one percent of the patients presented with a serum PSA level of 10 ng/mL or less, and 52% had a Gleason score of less than 7 on prostate biopsy. The radical prostatectomy specimens showed organ-confined disease in 72% of patients, and 83% of tumors had a Gleason score of 7. The 1, 5, and 7-year biochemical disease-free survival rate was 99%, 91%, and 91%, respectively. The fitted multivariate Cox proportional hazards model showed that having a prostatectomy specimen Gleason score greater than 7 or seminal vesicle invasion or nodal disease significantly increased the risk of biochemical failure. CONCLUSIONS: In the PSA era, men with prostate cancer who are 60 years old or younger and treated with surgery have an excellent biochemical disease-free outcome.

Age Factors↗
PubMed2006

Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy.

OBJECTIVES: To determine the incidence of, and ability to preserve, accessory pudendal arteries (APAs) in patients undergoing laparoscopic radical prostatectomy (LRP). The incidence of APAs is not well established. Preservation of APAs may be important for the maintenance of erectile function after prostatectomy. Data are limited regarding the ability to preserve APAs during laparoscopic surgery. METHODS: At the beginning of each of 70 consecutive laparoscopic radical prostatectomies performed at my institution, a purposeful search for APAs was performed during dissection of the space of Retzius. The operative findings were systematically dictated, and video documentation was obtained whenever possible. In every case in which APAs were identified, an attempt was made to spare them. RESULTS: Of the 70 patients, 18 (25.7%) were identified as having 23 APAs on the left (n = 8), right (n = 5), or both (n = 5) sides. Documentation and the technique of preservation are detailed in the accompanying video. In all but 1 case, APAs were identified at the initial exploration. APAs were preserved in 78.3% of cases. Of 10 preoperatively potent, sexually active men undergoing bilateral nerve-sparing surgery, all had preservation of APAs. CONCLUSIONS: The incidence of APAs in this consecutive series of LRP was 25.7%. Preservation of the APAs was successful in 78.3% of those with APAs found. Although occasionally the anatomy may not permit vascular preservation, vigilant examination and strategic laparoscopic dissection allow APAs to be successfully spared in most cases.

Adult↗
PubMed2006

Impact of variations in prostatic apex shape on early recovery of urinary continence after radical retropubic prostatectomy.

OBJECTIVES: To investigate the impact of the variations in the shape of the prostatic apex observed on preoperative magnetic resonance imaging (MRI) on patients' status regarding urinary continence after undergoing radical retropubic prostatectomy, as well as the prevalence of such variations. METHODS: We performed a retrospective analysis of 156 patients who had undergone preoperative MRI of the prostate and were followed up postoperatively by review of the records. For our analyses, patients were categorized into four different groups according to the shape of the prostatic apex shown on the midsagittal MRI scan. Patient status, including early (within 3 months after surgery) recovery of urinary continence, was also assessed. RESULTS: Group 1 was the largest with 59 patients (37.8%), group 2 had 39 patients (25%), group 3 had 24 (15.3%), and group 4 had 34 patients (21.8%). Group 4 was composed of patients with the prostatic apex not overlapping with membranous urethra either anteriorly or posteriorly on MRI and had a significantly greater percentage (83.3% versus 66.7%) of patients with an early return of urinary continence after radical retropubic prostatectomy compared with the other groups (P = 0.014). On multivariate analysis of the predictive factor for the early return of urinary continence, anterior or posterior overlapping of the membranous urethra with the prostatic apex as shown on preoperative MRI was the only variable significantly associated with an early return of continence. CONCLUSIONS: The results of our study provide objective evidence that variations in the shape of the prostatic apex in relation to the membranous urethra may significantly affect early recovery of urinary continence after radical retropubic prostatectomy.

Aged↗
PubMed2006

Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy.

OBJECTIVES: Robotic-assisted surgery using the da Vinci Surgical System is gaining popularity among urologists. However, training residents to use this system presents new challenges for surgical educators. We describe a method for training residents to perform robotic-assisted radical prostatectomy. METHODS: Residents first received da Vinci certification training followed by table-side assistance with a second attending urologist present to provide real-time instruction. After demonstrating proficiency with assistance, residents performed segments of robotic prostatectomies as the console surgeon. The procedure was divided into five steps: (a) bladder take-down, (b) endopelvic fascia and dorsal venous complex, (c) bladder neck and posterior dissection, (d) neurovascular bundles, and (e) urethral anastomosis. Performance was rated using an analog scale (0, very poor to 5, outstanding). The resident was allowed to proceed to the next step once proficiency (score greater than 3 of 5) had been demonstrated on three separate occasions. In addition, each procedure was digitally recorded and reviewed with the attending physician after the operation. RESULTS: Two chief residents underwent this training regimen. All 83 cases with surgical console involvement during a 7-month period were reviewed. The combined residents' mean operative time in minutes and overall performance (score 0 of 5 to 5 of 5) for each step were recorded. Using logistic regression analysis, a statistically significant trend was seen, with faster operative times and greater analog scores over time for both residents (P <0.005). CONCLUSIONS: A systematic approach can be used to safely and effectively train urology residents to perform robotic radical prostatectomy using the da Vinci robotic system.

Humans↗
PubMed2006

Lymphovascular invasion in radical prostatectomy specimens: prediction of adverse pathologic features and biochemical progression.

OBJECTIVES: Patients and referring physicians often ask about the significance of lymphovascular invasion (LVI) on pathology reports from radical prostatectomy specimens. However, limited data are available concerning the relationship between LVI and preoperative screening characteristics, pathologic tumor features, and patient prognosis. METHODS: LVI was evaluated for its ability to predict elevated prostate-specific antigen velocity, adverse pathologic features, and biochemical progression in 1709 men who underwent radical prostatectomy for clinically localized disease. RESULTS: LVI was present in 118 (7%) of the 1709 men. On univariate analysis, LVI was significantly associated with tumor grade, tumor volume, and other adverse pathologic features. Prostate-specific antigen velocity was not significantly associated with the presence of LVI. Biochemical progression occurred in 34% of those with LVI compared with 10% of those without LVI (P <0.0001). However, on multivariate analysis with other pathologic tumor features, LVI was not an independent predictor of progression. CONCLUSIONS: LVI is a relatively uncommon finding in radical prostatectomy specimens for clinically localized disease. Although LVI was seen primarily in large-volume, high-grade tumors, it was not an independent predictor of progression in the multivariate model.

Disease Progression↗
PubMed2006

Outcomes of Gleason score 10 prostate carcinoma treated by radical prostatectomy.

OBJECTIVES: To evaluate the outcome of radical prostatectomy for the rarest and most poorly differentiated prostate tumors of all: those with Gleason score 10. Controversy exists as to which form of therapy is most effective for high-grade prostate cancer (PCa). METHODS: We retrospectively reviewed the charts of all patients with pathologic Gleason score 10 PCa treated at our institution with radical prostatectomy from 1977 to 1999. All pathology specimens were reviewed by a urologic pathologist, and 13 cases with true Gleason score 10 PCa were identified. The preoperative covariables (prostate-specific antigen level, biopsy Gleason score, and clinical stage), perioperative covariables (pathologic stage, margin status, and tumor ploidy), and postoperative covariables (prostate-specific antigen level and adjuvant and salvage treatments) were assessed with respect to the oncologic outcomes. RESULTS: The median follow-up was 4.2 years. Preoperatively, only 4 of the 13 cases were correctly identified at biopsy, and the median preoperative prostate-specific antigen level was 4.5 ng/mL (interquartile range 0.3 to 12.5). Pathologic examination showed a small cell component in 7 cases, seminal vesicle invasion in 11, and positive lymph nodes in 3. Six patients developed recurrent PCa: three local, two systemic, and one biochemical recurrence. The biochemical recurrence-free and cancer-specific survival rate at 5 years was 53.8% and 76.9%, respectively. CONCLUSIONS: Gleason score 10 PCa is a highly aggressive disease that is usually lethal if managed conservatively. The results of the present study have provided some evidence that radical prostatectomy may be of benefit to patients with Gleason score 10 PCa.

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PubMed2006

Comorbidity is poor predictor of survival in patients undergoing radical prostatectomy after 70 years of age.

OBJECTIVES: To investigate several comorbidity classifications as possible predictors of mortality, because the value of comorbidity as a prognostic factor is uncertain in patients older than 70 years of age and radical prostatectomy in patients older than 70 years is controversial. METHODS: A total of 214 consecutive patients aged 70 years or older who underwent radical prostatectomy from December 1992 to December 2002 were stratified according to the Charlson score, American Society of Anesthesiologists physical status classification, New York Heart Association classification of cardiac insufficiency, classification of angina pectoris from the Canadian Cardiovascular Society, and age (70 to 72 versus 73 to 74 versus 75 years or older). The mean follow-up in the surviving patients was 5.1 years (range 1.3 to 12.5). A sample of 240 consecutive patients aged 67.0 to 69.9 years treated during the same period was used for comparison. The overall and comorbid mortality were the study endpoints. Mantel-Haenszel hazard ratios were calculated. Comparisons were made using the log-rank test. RESULTS: Unlike for patients aged 67.0 to 69.9 years, for those 70 years old or older, only one of the investigated stratifications reached significance as a predictor of mortality. A New York Heart Association classification of 2+ versus 0 was significant for overall mortality (hazard ratio 5.8, P = 0.021) and comorbid mortality (hazard ratio 15.9, P = 0.046). CONCLUSIONS: Comorbidity is of limited prognostic value in patients selected for radical prostatectomy and 70 years old or older.

Age Factors↗
PubMed2006

Anterior transanal, transsphincteric sagittal approach for fistula repair secondary to laparoscopic radical prostatectomy: a simple and effective technique.

INTRODUCTION: To report our experience with the anterior, transanal, transsphincteric, sagittal approach in the correction of rectourinary fistula secondary to laparoscopic radical prostatectomy. TECHNICAL CONSIDERATIONS: Of the first 110 laparoscopic extraperitoneal radical prostatectomies performed from December 2001 to February 2004, 9 (8%) were complicated by rectal injury. Of the nine rectal lesions, seven were diagnosed intraoperatively and the rectal defects closed laparoscopically. Primary repair failed in 1 of the 7 patients. In 2 other patients, the rectal injuries were missed intraoperatively, and a rectourinary fistula later developed. Rectourinary fistula was confirmed in these 3 patients by cystoscopy and digital rectal examination. The procedure chosen for repair was the anterior sagittal transrectal anal approach. The time from diagnosis to fistula repair was 1 to 3 months. Fistula repair was successful in all patients. The mean follow-up was 12 to 24 months. No patient presented with fecal incontinence or anal strictures. Postprostatectomy urinary continence was not affected by the procedure. CONCLUSIONS: The transsphincteric transanal surgical approach provides many advantages for the repair of acquired urethrorectal fistulas after laparoscopic radical prostatectomy. It allows for good surgical exposure and fistula tract identification and ensures good access to well-vascularized tissue. This surgical technique is simple, effective, reproducible, and associated with minimal morbidity.

Aged↗
PubMed2006

Permanent prostate brachytherapy: pathologic implications as assessed on radical prostatectomy specimens of broadening selection criteria for monotherapy.

OBJECTIVES: To assess the impact of clinical selection criteria on pathologic features among patients treated by radical retropubic prostatectomy and to evaluate the implications of broadening eligibility for permanent prostate brachytherapy monotherapy. METHODS: A consecutive series of 423 patients with prostate cancer, who underwent diagnostic biopsy and subsequent radical retropubic prostatectomy, were selected for this study. Four subgroups were defined using the American Brachytherapy Society selection criteria, including prostate size limits (group 1), no prostate size limits (group 2A), a modified set of criteria (group 2B), and clinical Stage T1-T2 (group 3). The rates of extraprostatic extension, seminal vesicle invasion, and lymph node involvement were compared. RESULTS: Adverse pathologic features at radical retropubic prostatectomy were noted in 8 (9.3%) of 86 patients in group 1, 11 (5.6%) of 195 patients in group 2A, 35 (12.0%) of 292 patients in group 2B, and 90 (21.8%) of 413 patients in group 3. The rates of extraprostatic extension, seminal vesicle invasion, and lymph node involvement appeared comparable among groups 1 (5.8%, 3.5%, and 0.0%, respectively), 2A (3.6%, 2.1%, and 0.0%, respectively), and 2B (6.9%, 3.8%, and 1.4%, respectively), but were greater in group 3 (9.7%, 7.8%, and 4.4%, respectively). CONCLUSIONS: Judicious broadening of the clinical selection criteria may allow a greater number of patients to be eligible for permanent prostate brachytherapy monotherapy by including patients whose risk of having adverse pathologic features is comparable to that of patients currently deemed suitable for permanent prostate brachytherapy monotherapy. Prospective assessment of oncologic outcomes of such an approach is required.

Adult↗
PubMed2006

Prospective health-related quality-of-life assessment in an initial cohort of patients undergoing robotic radical prostatectomy.

OBJECTIVES: To prospectively assess the health-related quality-of-life outcomes of patients undergoing robot-assisted laparoscopic prostatectomy using a validated patient self-assessment questionnaire. METHODS: Patients undergoing robot-assisted laparoscopic prostatectomy between September 2003 and May 2005 were given the Expanded Prostate Cancer Index Composite questionnaire preoperatively and 1, 3, 6, 9, 12, and 18 months postoperatively. Patients with a minimum follow-up of 3 months were included in the analysis. The mean domain-specific health-related quality-of-life scores +/- SD and the proportion of patients achieving their baseline scores were calculated. Multivariate proportional hazards regression analysis was used to determine the potential prognostic factors for a return to baseline of the domain scores and continence. RESULTS: The median follow-up was 9.5 months. The median time to recovery of the baseline summary scores was 6.6 months (95% confidence interval [CI] 5.9 to 7.2) in the urinary domain, 2.8 months (95% CI 2.0 to 3.7) in the bowel domain, and 3.0 months (95% CI 2.2 to 3.9) in the hormonal domain. The baseline sexual summary score was recovered by 19.2% of patients at 12 months. The median time to return of continence (0 to 1 pads/day) was 4.0 months (95% CI 3.0 to 4.9). The median time to the return of erections firm enough for intercourse was 13.5 months (95% CI 9.9 to 17.1). On multivariate proportional hazards regression analysis, age, body mass index, prostate size, nerve-sparing technique, and number of comorbidities were not significantly associated with the time to recovery of the baseline domain scores or continence. CONCLUSIONS: Patients undergoing robot-assisted laparoscopic prostatectomy have a favorable health-related quality-of-life recovery profile that appears comparable to those of established surgical approaches.

Follow-Up Studies↗
PubMed2006

Robot-assisted extraperitoneal radical prostatectomy in a patient with a pelvic kidney.

With the increasing popularity of the robotic approach for performing radical prostatectomy, the awareness of potential genitourinary anomalies is a necessity. The ectopic position of a pelvic kidney can present a unique challenge to the success of robot-assisted radical prostatectomy while preserving function in the kidney. We describe our experience of performing extraperitoneal robot-assisted radical prostatectomy in a patient with a pelvic kidney.

Adenocarcinoma↗
PubMed2006

Ejaculatory urine incontinence after radical prostatectomy.

OBJECTIVES: Urinary incontinence and erectile dysfunction remain the long-term complications that affect most patients' lives after radical prostatectomy. Previous reports evaluating incontinence have focused on volumes of urine loss and daily pad use to assess these issues. We have observed that small volumes of urinary incontinence during sexual activity can be just as disconcerting to patients. We attempt to further describe and assess the phenomenon of urinary incontinence with ejaculation in a series of patients. METHODS: We reviewed the experience of one physician who received referrals for the treatment of erectile dysfunction after radical prostatectomy from July 2002 to March 2005 and identified 26 men experiencing urine leak predominantly during ejaculation. Questionnaires assessing urinary incontinence were sent to all these patients. RESULTS: The mean age was 62 years (range 54 to 73). Sixteen patients underwent bilateral nerve-sparing, five unilateral nerve-sparing, and five nonnerve-sparing radical retropubic prostatectomy. At a median follow-up of 42 months (range 15 to 118), all patients had experienced urine leakage (volume 0.5 teaspoon to 1 cup) during ejaculation. The incontinence questionnaire revealed that most patients had mild incontinence; however, they experienced ejaculatory urine incontinence "most, or all of the time" and considered it a "big problem." CONCLUSIONS: Although the prevalence of ejaculatory urine incontinence is unclear, in our experience it occurs often enough to be considered a part of the routine postprostatectomy evaluation. A better understanding of the pathophysiology of postprostatectomy incontinence will lead to targeted therapy and an improved quality of life for the patient.

Aged↗
PubMedDate not supplied

Laparoscopic radical prostatectomy.

Laparoscopic radical prostatectomy is a relatively new approach to the surgical treatment of localized prostate cancer. Since its inception, the technique, however challenging, is undergoing continuous refinements which make it today a feasible, reproducible, and teachable operation practiced by urologists worldwide. The advantages of the laparoscopic approach are a magnified view of the anatomic structures, and a decreased venous bleeding in the surgical field allowing an accurate dissection of the prostate and neurovascular bundles. These advantages translate to a low positive surgical margin rate, low morbidity profile, and favorable postoperative quality of life outcomes. However, since the technique has only been performed for the past 6 years, long term cancer control and functional results data following laparoscopic radical prostatectomy are not available. For a successful laparoscopic prostatectomy program, advanced laparoscopic skills, knowledge of the prostatic anatomy, and expertise in surgical oncology are required.

Humans↗
PubMed2002

Laparoscopic radical prostatectomy.

Prostate cancer is the second leading cause of cancer deaths among men, after lung cancer. Traditionally, the traumatic open radical prostatectomy procedure was the only treatment option available. Although nerve-sparing techniques have evolved, the development of laparoscopic radical prostatectomy (LRP) has been one of the most significant changes in surgical treatment of the disease. Like many minimally invasive abdominal procedures, LRP reduces trauma, resulting in less postoperative pain, reduced length of hospital stay, and more rapid return to normal activity when compared to open radical prostatectomy. This article describes the preoperative, intraoperative, and postoperative care of a patient undergoing LRP. It is anticipated that LRP will be the future standard for treatment of prostate cancer that requires radical surgery.

Adenocarcinoma↗
PubMed2000

Relapse and cure rates of prostate cancer patients after radical prostatectomy and 5 years of follow-up.

OBJECTIVES: We have compared the ability of an ultrasensitive prostate specific antigen assay and a regular PSA assay to identify relapse and cure rates of prostate cancer patients after radical prostatectomy, during a 5-year follow-up period. DESIGN AND METHODS: We measured PSA by an ultrasensitive assay (detection limit 0.001 ng/mL) and a conventional PSA assay (detection limit 0.1 ng/mL) in serial serum samples obtained from 197 patients who have undergone radical prostatectomy. RESULTS: Based on ultrasensitive PSA analysis, we have identified three groups of patients: 62% of patients did not show any significant changes in serum PSA; 15% of patients demonstrated slow PSA increases over time but none of the measurements exceeded 0.1 ng/mL within 4 years; and 23% of the patients had relatively significant increases of serum PSA and were classified as having 'fast relapse'. The vast majority of these patients were subsequently identified to have relapse by the regular PSA assay. The ultrasensitive PSA assay detected relapse by an average of eighteen months earlier than the conventional PSA method. Fast relapsing patients were associated with other prognostic indicators of the disease including pre-operative PSA, tumor volume, Gleason score, clinical stage, surgical margin positivity, periprostatic tissue involvement, capsular invasion and seminal vesicle invasion. The group with slowly rising PSA had prognosis which was between the patients in remission and fast relapsing patients. CONCLUSIONS: The use of ultrasensitive PSA analysis for monitoring patients after radical prostatectomy provides earlier detection of relapse (by 18 months) and identifies three distinct groups of patients. Fast relapsing patients should be good candidates for early therapeutic interventions.

Aged↗
PubMed1998

111Indium-capromab pendetide in the evaluation of patients with residual or recurrent prostate cancer after radical prostatectomy. The ProstaScint Study Group.

PURPOSE: Standard diagnostic methods are limited for detecting distant metastases in patients with prostate cancer in whom the only evidence of disease after radical prostatectomy is a detectable prostate specific antigen (PSA) level. We evaluated the role of immunoscintigraphy with the radiolabeled monoclonal antibody, 111indium ((111)In)-capromab pendetide, to differentiate between local and distant recurrence in this patient population. MATERIALS AND METHODS: We enrolled 183 men who had undergone radical prostatectomy in whom PSA later increased. Gamma camera images were acquired twice after infusion of a single dose of (111)In-capromab pendetide. RESULTS: Immunoscintigraphy revealed disease in 108 of 181 patients (60%) with interpretable scans. The antibody was localized most frequently to the prostatic fossa (34% of the cases), abdominal lymph nodes (23%) and pelvic lymph nodes (22%). Of the 181 men the scan localized the antibody outside the prostatic fossa in 42%. Half of the positive localizations in the fossa were confirmed by biopsy. CONCLUSIONS: These findings suggest that immunoscintigraphy with (111)In-capromab pendetide can assist in determining the extent of disease in patients who have increasing PSA after prostatectomy.

Adult↗
PubMed1998

Radical retropubic prostatectomy outcomes at a community hospital.

PURPOSE: We reviewed a 6-year experience performing radical retropubic prostatectomy at 2 community hospitals (for-profit and not-for-profit) to assess outcomes and to compare them to the published literature reflecting outcomes from major academic hospitals. MATERIALS AND METHODS: Charts of 116 patients who underwent radical retropubic prostatectomy (nerve sparing in select cases) between 1990 and 1996 were reviewed for clinical and pathological outcomes as well as hospital charges. Subjective patient reports of urinary continence, potency and satisfaction were evaluated postoperatively. RESULTS: Average patient age was 66.6 years and average preoperative prostate specific antigen level was 9.6 ng./ml. Of the patients 43% had T1c disease, 63% pT2 and 37% pT3. Positive margins were present in 17.2% of the specimens and 66% of the patients had Gleason scores of 5 and 6. No deaths occurred. Major complications occurred in 5.4% of patients and included deep venous thrombosis (1.8%), pulmonary embolism (1.8%), rectal injury requiring ileostomy (0.9%) and fascial dehiscence (0.9%). Mean blood loss was 872 cc and mean blood transfusion rate was 1.7 units (almost exclusively autologous blood). Hospital charges decreased at the not-for-profit hospital to $13,233 in 1996 from $17,743 in 1990 to 1995, whereas charges increased at the for-profit hospital to $25,979 in 1996 from $24,481 in 1990 to 1995. Mean length of stay decreased from 5 days in 1990 to 1995 to 3 days in 1996. Of the patients 80% were totally continent (pad-free), 12% wore a protective pad once per day for minimal incontinence and 8% wore 2 or more pads. Of the men who were potent preoperatively 18% retained potency and 46% remained sexually active postoperatively either spontaneously or with assistance. Of the patients 84% were satisfied with surgical outcomes, 11% were somewhat satisfied and 5% were dissatisfied. CONCLUSIONS: Radical retropubic prostatectomy can be performed safely and with acceptable clinical and pathological outcomes at a community hospital. Impotence continues to be one of the most bothersome morbidities, particularly in older men. Increasing cost awareness, coincident with the proliferation of managed care, has led to reductions in length of hospital stay and charges at certain hospitals.

Adult↗
PubMed1997

Adverse prognostic features of collagen injection therapy for urinary incontinence following radical retropubic prostatectomy.

PURPOSE: We identified and characterized predictive factors associated with an unfavorable outcome of collagen injection therapy in post-radical prostatectomy incontinence. MATERIALS AND METHODS: A total of 46 patients, 49 to 85 years old (mean age 67) and incontinent after radical retropubic prostatectomy, underwent a mean of 2.8 transurethral injections of collagen (mean cumulative volume injected 31 ml.). Preoperatively, all patients underwent fluoroscopic multichannel video urodynamics including determination of Valsalva's leak point pressure. Stress urinary incontinence was subjectively graded as 1 (0 to 1 pad per day), 2 (2 to 3 pads per day) and 3 (greater than 3 pads per day). Patient age, duration and severity of pretreatment incontinence, presence of detrusor instability and anastomotic strictures, number of injections, total volume of collagen delivered and the impact of a nerve sparing procedure plus adjuvant radiation therapy were assessed and correlated with treatment outcome. RESULTS: Of the patients 11 (24%) became completely dry (9 after 3 or fewer treatments), 21 (41%) improved (17 after 3 or fewer treatments) and 14 (30%) showed no benefit (after more than 3 treatments). Of the 14 patients in whom treatment failed 6 had undergone adjuvant radiation treatment, pretreatment urinary incontinence was grade 3 in all, and concomitant detrusor instability was present in 11 (79%). All patients had received more than 3 treatments (mean total volume injected 37 ml.). CONCLUSIONS: Notwithstanding the need for multiple treatments, the prospect for cure by collagen injection of the post-radical prostatectomy incontinent patient is significantly affected by the severity of pretreatment incontinence, concomitant detrusor overactivity and exposure to radiation therapy. Age, duration of incontinence, presence of mild to moderate anastomotic strictures and a nerve sparing technique did not seem to influence treatment outcome.

Aged↗