[Quality of life after robotic prostatectomy: Impact of BMI and age on urinary incontinence]. / Qualité de vie après prostatectomie robotique : impact des indices de masse corporelle et âge sur l'incontinence urinaire.

INTRODUCTION: Data evaluating risk factors for urinary incontinence (UI) and quality of life (QoL) after robotic-assisted radical prostatectomy are scarce. The objective of our study was to explore the impact of age and body mass index (BMI) on postoperative incontinence, and the impact of such incontinence and urinary symptoms on QoL. MATERIAL AND METHODS: Two hundred and seventy two patients undergoing robotic-assisted radical prostatectomy answered the questionnaires ICIQ-UI short-form (evaluating UI) and EORTC QoL PR25 (evaluating QoL) in the preoperative setting, then at 1, 3, 12 et 24 months after surgery. Data regarding bother due to UI and urinary symptoms were extrapolated and calculated from the EORT PR25 questionnaire. The modification of ICIQ, of the bother from UI and of urinary symptoms was compared between the preoperative and the early (1-3 months) and late postoperative period (12-24 months). Differences of these scores were explored across non-obese and obese patients, as well as across different age groups. Chi-squared and logistic regression models were performed to test the association between BMI, age and ICIQ score, the bother from UI and urinary symptom score. RESULTS: Median age was 64 years and median BMI was 26.4kg/m2. After surgery, all scores (ICIQ, bother from UI and urinary symptoms) were significantly modified and worsened compared to preoperative values; in particular, median ICIQ passed from 1 to 10, 20% of patients were highly bothered by their urinary symptoms (compared to 2% in the preoperative setting) and the urinary score symptom passed from 8% to 33%. We observed a progressive amelioration of all scores of late controls (12-24 months), with a significantly improved QoL. Across BMI groups, we did not observe any significant difference in terms of modification of ICIQ, of the bother from UI or of urinary symptoms. Moreover, on multivariate logistic regression, BMI was not a risk factor for UI at neither 1 month (P>0.35) nor 12 months (P=0.35). On the other hand, age was significantly associated to an increased risk of UI in the immediate postoperative period on multivariate analysis (P<0.001). Indeed, the rate of patients with an ICIQ≥1 in the immediate postoperative period was higher in men>60 years old compared to younger men<60 years (96% vs 78%, P<0.001). When exploring the QoL scores, we did not observe any significant association between age and QoL, with the exception of an inversion correlation between age and urinary symptoms at 1 month after surgery (P=0.01). CONCLUSION: In this study, after robotic-assisted radical prostatectomy, older men appear to be at increased risk of immediate postoperative incontinence when compared to their younger counterparts, although their QoL is less likely to be bothered. BMI instead was not significantly associated to either urinary incontinence nor to QoL scores as bother form UI and urinary symptoms. LEVEL OF EVIDENCE: 4.

Penile intraepithelial neoplasia overlying Kaposi's sarcoma lesions: role of viral synergy?

Several viral agents have been detected in the lesional tissue of Kaposi's sarcoma (KS). Their precise oncogenic role remains to be determined. A 32-year-old heterosexual man with acquired immunodeficiency syndrome (AIDS) who had penile lesions of KS with overlying epithelial changes characteristic of intraepithelial neoplasia associated with concurrent infection by human papillomavirus (HPV) and human herpesvirus 8 (HHV-8) is reported. The absence of viral DNA from uninvolved skin suggests that this coinfection is more than coincidental and may involve synergy between these viruses, as has already been suggested for HPV and herpes simplex 2 virus.