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Impact of a structured rehabilitation program on the functional outcomes of patients undergoing robot-assisted radical prostatectomy: A single tertiary-care center experience
European Urology ; 83(Supplement 1):S705, 2023.
Article in English | EMBASE | ID: covidwho-2250599
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.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: European Urology Year: 2023 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: European Urology Year: 2023 Document Type: Article