ABSTRACT
INTRODUCTION AND OBJECTIVE: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program in these patients. METHOD(S): A two arm, retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT;period from prostate biopsy to surgery), biochemical recurrence (BCR) and/or imaging evidence of progression. RESULT(S): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p<0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were continent and 30 (22.1%) patients had recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p<0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p<0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or imaging disease progression (8.1% vs 2.7%, p>=0.05). CONCLUSION(S): Our rehabilitation program is an valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies are still needed to confirm our results.
ABSTRACT
Introduction & Objectives: Robotic assisted radical prostatectomy (RARP) is an invaluable whole gland treatment for intermediate, high-risk prostate cancer (PCa). However, a non-negligible proportion of these patients still harbour urinary incontinence and erectile disfunction after surgery. To assess the efficacy of our rehabilitation program among patient with intermediate, high-risk PCa underwent RARP. Material(s) and Method(s): A two arm, retrospective study on patients who underwent a RARP at a single institution in two time intervals, namely March-July 2019 (study group) and March-July 2020 (control group), was conducted. Patients in the study group underwent a specific rehabilitation program, consisting of counseling with a prostate case-manager, an urologist and a physiotherapist, therefore starting pelvic floor muscle training (PFMT) at least 1-month before RARP. Due to the Covid-19 pandemic restrictions, this structured program was not delivered to the control group. The primary endpoint was the assessment functional outcomes at 30 days, 3 and 6 months after surgery. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as erection sufficient for an intercourse. Secondary endpoints included the following: surgical waiting time (SWT), defined as period from prostate biopsy to surgery and oncological outcomes, defined as biochemical recurrence (BCR) and/or imaging evidence of progression. Result(s): We included 249 patients, 136 (54.6%) in the study group and 113 (45.4%) in the control group. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. At 30 days after RARP, 49 (36.0%) patients in the study group were completely continent, and 6 (4.4%) had preserved EF as compared to 8 (7.1%) and 0 (0%) in the control group (p <0.001 and p=0.072 respectively). At 3 months, 131 (96.3%) were fully continent and 30 (22.1%) patients had full recovery of EF in the study group, compared with 77 (68.14%) and 9 (8.0%) in the control group (p <0.001). Finally, at 6 months, 134 (98.5%) were continent and 50 (36.8%) had erection sufficient for intercourse in the study group, as compared with 96 (85.0%) and 19 (16.8%) in the control group (p <0.001). Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020, (p<0.001). Median follow-up was 42 months (43-44) in the study group vs 32 (31-32) in the control group. No significant differences were observed in the proportion of patients experiencing BCR or disease progression between the two groups (8.1% vs 2.7%, p>=0.05). Conclusion(s): Our rehabilitation program appears to be a valuable tool to enhance functional outcomes in patients undergoing RARP. Further prospective studies on larger populations are still needed to confirm our results.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
ABSTRACT
Author of the study: The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of several urological malignancies. To determine the impact of COVID-19 pandemic on the outcomes of patients with prostate cancer (PCa) treated with robotassisted radical prostatectomy (RARP) at a single tertiary-care center. Material(s) and Method(s): A retrospective study on patients who underwent a RARP at a single institution in two pre-specified time intervals, namely March-July 2019 (pre-COVID) and March-July 2020 (during-COVID), was conducted. Surgical waiting time (SWT) was defined as the period from prostate biopsy to surgery. All patients in the pre-COVID era underwent a specific pre- rehabilitation program, consisting of preoperative pelvic floor muscle exercises starting at least 1-month before RARP, as well as counselling with a prostate casemanager. After surgery, all patients underwent a structured follow-up both with physiotherapists and andrologists. During the COVID period, this specific program was not guaranteed. Continence recovery was defined as no use of pad, while erectile function (EF) recovery was defined as an erection sufficient for intercourse. Oncological outcomes were defined as biochemical recurrence and/or imaging evidence of progression. Result(s): A total of 249 patientswere eligible for analysis,136 (54.6%) in the pre-COVID and 113 (45.4%) in the COVID time-span. No significant differences in baseline characteristics, clinical and pathological features were observed between the two groups. Median SWT was 2.9 (2.5-3.1) in 2019 and 5.8 (5.0-7.0) in 2020. Median (IQR) follow-up was 25 (15-27) months. At 45 days, 6 months and 1 year follow-up no significant differences were observed in biochemical recurrence and progression- free survival rates. Biochemical recurrence at last followup was observed in 11 (8.1%) patients of pre-COVID and 3 (2.7%) patients during COVID. At the first follow-up visit 45 days after RARP, 49 (36.0%) patientswere continent and 6 (4.4%) patients had preserved EF in the pre-COVID group period, as compared to 8 (7.08%) and 0 (0%) in the COVID group (p < 0.001 and p = 0.072 respectively). At 6 months, 131 (96.3%) patients `were continent and 30 (22.1%) patients had EF recovery in pre-COVID group, as compared to 77 (68.14%) and 9 (8.0%) in the COVID group (p < 0.001). Finally, at 1 year 134 (98.5%) patients were continent and 50 (36.8%) patients were fully potent in the pre- COVID period, compared with 96 (85.0%) and 19 (16.8%) during COVID (p < 0.001). Conclusion(s): The use of a pre-rehabilitation program, which was routinely used in the pre-COVID era, appears to significantly improve the functional outcomes of patients subjected to RARP. On the other side, surgical delay does not appear to significantlyworsen oncological outcomes, even though these findings are limited by the short followup time. Copyright © 2022 European Association of Urology. Published by Elsevier B.V.