Background Focal therapy maintains local control of prostate cancer (PCa) while preserving part of the healthy prostate parenchyma in order to limit the functional impact. This study has evaluated the medium-term oncological and functional outcomes of primary focal HIFU therapy in patients with localized prostate cancer. Methods From 2009 to 2019, 256 patients with low- or intermediate-risk PCa (unilateral positive biopsy ISUP grade 1 to 3, ≤cT2b and PSA ≤15ng/ml) were included. Follow-up with regular and MRI was performed. All patients had systematic follow-up biopsies at 1 year and in case of suspected recurrence. Failure was defined by any positive biopsy in the treated area. Univariate and multivariate analyses were performed to identify failure-predictive factors. Urinary continence and erectile function were analyzed. Results The median age was 68.1 years (IQR: 62.3-72.2), and the median follow-up was 5.2 years (IQR: 3.0-7.1). 118 (46.1%) patients were considered in HIFU failure because of positive control biopsy in a treated area, and 66 had clinically significant cancer. 138 patients (53.9%) had local control of PCa after primary HIFU (95 had negative biopsies, and 43 had positive biopsies in non-treated areas). Failure-free survival at 2 and 4 years were 67.3% (95% CI 57.5-76.1) and 53.8% (95% CI 44.8-63.3). No death from PCa was reported. PSA density (PSA-D) (OR: 0.55, 95% CI 0.31-0.97) was found to be an independent predictive factor of focal HIFU failure (p=0.041). The rates of erectile dysfunction and urinary incontinence were 7% and 1.6%. Conclusion Focal HIFU treatment provides satisfactory medium-term disease control in more than half of the patients with limited morbidity. Preoperative PSA density was significantly associated with failure. in the future, patient selection will have to take into account additional parameters if we want to further improve treatment results. Patient summary: We analyzed the medium-term oncological and functional outcomes of primary focal HIFU therapy in patients with localized prostate cancer. The treatment provides a mid-term disease control in more than half of the patients with limited morbidity. More rigorous patient selection, including PSA density, should lead to improved oncologic outcomes of focal HIFU.

OBJECTIVE To present the patient -reported quality of life (QoL) outcomes from a prospective, randomized controlled trial comparing the use of pelvic floor muscle training (PFMT) and duloxetine after robot -assisted radical prostatectomy (RARP). METHODS We identified 213 men with organ -confined disease having post-RARP urinary incontinence who were randomly assigned to received PFMT, duloxetine, combined PFMT-duloxetine and pelvic floor muscle home exercises. Urinary symptoms burden was measured by marked clinical important difference improvement (MCID) defined by using the International Prostate Symptom Score (IPSS) difference of - 8 points ( Delta IPSS <=- 8). QoL was assessed according to Visual Analog Scale (VAS), King's Health Questionnaire (KQH), and International Index of Erectile Function (IIEF-5). Multivariable regression analyses aimed to predict MCID, burden of urinary symptoms (IPSS >= 8), and patients reporting to be satisfied (IPSS QoL <= 2) or comfortable (VAS <= 1) post-RARP. RESULTS Moderate to severe urinary symptoms decreased from 48% preoperatively to 40%, 34%, and 23% at 3, 6, and 12 months post-RARP. After surgery, MCID improvement was observed in 19% of patients, and deterioration in 3.3%. Large prostate was the only factor associated to MCID (OR 1.03 [95%CI 1.01-1.05], P = .005). At 6 months, patients reached the same degree of preoperative satisfaction. Neurovascular bundle preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR 12.8 [CI95% 1.47-111.7], P = .02 at 3 months) and was also associated to higher median postoperative IIEF-5. CONCLUSION Despite urinary incontinence following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms within a year, which subsequently elevates QoL. Furthermore, nerve -sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL. UROLOGY 185: 73-79, 2024. (c) 2024 Elsevier Inc. All rights reserved.

BACKGROUND:Urinary incontinence (UI) can negatively impact quality of life (QoL) after robot-assisted radical prostatectomy (RARP). Pelvic floor muscle training (PFMT) and duloxetine are used to manage post-RARP UI, but their efficacy remains uncertain. We aimed to investigate the efficacy of PFMT and duloxetine in promoting urinary continence recovery (UCR) after RARP. METHODS:A randomized controlled trial involving patients with urine leakage after RARP from May 2015 to February 2018. Patients were randomized into 1 of 4 arms: (1) PFMT-biofeedback, (2) duloxetine, (3) combined PFMT-biofeedback and duloxetine, (4) control arm. PFMT consisted of pelvic muscle exercises conducted with electromyographic feedback weekly, for 3 months. Oral duloxetine was administered at bedtime for 3 months. The primary outcome was prevalence of continence at 6 months, defined as using ≤1 security pad. Urinary symptoms and QoL were assessed by using a visual analogue scale, and validated questionnaires. RESULTS:From the 240 patients included in the trial, 89% of patients completed 1 year of follow-up. Treatment compliance was observed in 88% (92/105) of patients receiving duloxetine, and in 97% (104/107) of patients scheduled to PFMT-biofeedback sessions. In the control group 96% of patients had achieved continence at 6 months, compared with 90% (p = 0.3) in the PMFT-biofeedback, 73% (p = 0.008) in the duloxetine, and 69% (p = 0.003) in the combined treatment arm. At 6 months, QoL was classified as uncomfortable or worse in 17% of patients in the control group, compared with 44% (p = 0.01), 45% (p = 0.008), and 34% (p = 0.07), respectively. Complete preservation of neurovascular bundles (NVB) (OR: 2.95; p = 0.048) was the only perioperative intervention found to improve early UCR. CONCLUSIONS:PFMT-biofeedback and duloxetine demonstrated limited impact in improving UCR after RP. Diligent NVB preservation, along with preoperative patient and disease characteristics, are the primary determinants for early UCR.

The Cancer of the Bladder Risk Assessment (COBRA) score is a predictive tool for estimating Cancer Specific Survival (CSS) after Radical Cystectomy (RC) for urothelial carcinoma. COBRA score variables are: age at RC, Tumor stage and Lymph Node Density (LND). We sought to externally validate the COBRA score and to improve its performance in estimating CSS adding Lymphovascular Invasion (LVI) as a further variable (Modified COBRA score). Clinicopathological and survival data from 789 patients who underwent RC and Pelvic Lymph Node Dissection (PLND) between January 2007 and December 2020 in two European referral centers (Paris, France and Badalona, Spain) were analyzed. COBRA score was applied to our cohort and CSS Kaplan-Meier curves were performed. Univariable and Multivariable analysis was performed in order to identify risk factors for Cancer Specific Mortality (CSM) and a score was assigned for any statistically significant risk factor; afterward, c-index calculation was performed and CCS curves have been plotted for the model after having integrated LVI variable to the COBRA score. Finally, we compared both COBRA score and Modified COBRA score models with the established AJCC model. A total of 789 patients underwent RC during the observation period. Complete data were available for 731 patients with a median follow-up of 32 months (8-47). CSM was 27.6% (no. 218 patients) at follow-up. When COBRA score was applied to our cohort, c-index was 0.76. Regression COX analysis has shown HR 0.36, CI 95% (0.16-0.83), P = .016 for patients with COBRA score 1; HR 0, CI 95% (0-1.77), P =.94 for score 2; HR 0.51, CI 95% (0.39 -0.67), P =.001 for score 3; HR 1.67, CI 95% (1.23-2.27), P =.001 for score 4; HR 2.45, CI 95% (1.51-3.99), P =.001 for score 5; HR 2.01, CI 95% (1.42-2.85), P =.001 for score 6 and HR 0.66, CI 95% (0.09-4.73), P =.682 for score 7. When the LVI variable was added to the CSS predictive model the discriminatory power increased to a c-index of 0.78. COBRA score adequately identifies those patients with a higher risk of CSM, with a c-index of 0.76. Moreover, LVI variable further improves its predictive accuracy from c-index of 0.76 to c-index of 0.78. LVI variable could be integrated in the COBRA score to optimizing prognosis stratification for patients who undergo RC.

BACKGROUND:For patients with cT1 renal lesions, Partial Nephrectomy (PN) is the gold standard treatment. However, 20% of small renal masses are benign, situation in which the PN is an overtreatment. The percutaneous Renal Tumor Biopsy (RTB) may lower the risk of overtreatment as there is a 90% concordance rate on histotype between the RTB and the final pathology. It has been suggested that the RTB could increase the difficulty of the PN and increase the risk of surgical complications. OBJECTIVE:To compare surgical outcomes and complications of PN with or without previous RTB. DESIGN, SETTING, AND PARTICIPANTS:monocentric retrospective review of patients who underwent laparoscopic or robotic-assisted PN between January 2012 and December 2019. MEASUREMENTS:perioperative complications were recorded using Clavien-Dindo classification, peroperative data included operative time, clamping time and blood loss, and histological outcomes of RTB and PN. RESULTS AND LIMITATIONS:In total, 163 patients were included in our study. There were significantly less benign lesions in PN with prior RTB: 7% (4/56) vs. 20% (22/107) without prior RTB (P=0.03). There were no significant differences regarding Clavien-Dindo>2 perioperative complications with respectively 7% (4/56) vs. 10% (11/107) (P=0.57). Same goes for peroperative data such as duration of surgery (P=0.81), warm ischemia (P=0.07) and blood loss (P=0.13). CONCLUSIONS:RTB does not increase the risk of surgical complications of PN and may reduce the risk of small renal masses overtreatment. LEVEL OF EVIDENCE: 4:

Objectives. - To assess surgical outcomes and failure factors in the management of rectoure-thral fistulas treated surgically with the modified York Mason technique based on our center's 25 years of experience. Methods. - From 1997 to 2021, in a single center study, a total of 35 consecutive patients, underwent rectourethral fistula cure, using the modified York Mason technique. Preoperative patient data, surgical outcomes and failure factors were assessed. Results. - Of the 35 patients, 28 were successfully managed without the need of further inter-vention (80%). Median age was 67 years (IQR 62-72) and median follow-up time was 71 months (IQR 30-123). There was no significant difference between the patients that had recurrence or not after the first York Mason. Conclusions. - The modified York Mason technique offers a high success rate for the cure of iatrogenic rectourethral fistulas. No predictive factor of failure, after a first cure of recto-uretral fistula by modified York-Mason technique was reported. Level of evidence.- 3. (c) 2021 Elsevier Masson SAS. All rights reserved.

The use of renal tumor biopsy (RTB) for small renal masses (SRMs) in daily practice, although safe and accurate, is unusual. Considering the large number of benign tumors in patients with renal masses < 4 cm, some patients with benign tumors are directly referred for surgery instead. This study aimed to report the diagnostic rates of RTB, determine the concordance with surgical pathology, and assess the number of procedures that could have been avoided. We retrospectively studied 255 patients who underwent RTB at our institution in 2010–2019. Of them, 73 were excluded from the analysis (exclusion criteria: > 4 cm, cystic lesion, missing data). The remaining 182 with undetermined SRMs ≤ 4 cm underwent RTB under computed tomography guidance. Biopsies were diagnostic in 154/182 (84.6%) cases. Of the non-diagnostic biopsies, 11 were diagnostic when repeated. When RTB was performed of all undetermined SRMs, active treatment (surgery or cryotherapy) was avoided in 50/182 patients (27.5%) because of a benign diagnosis, while 9/182 patients (4.9%) underwent surveillance after a shared multidisciplinary decision. The overall diagnostic rate was 90.6%. All adverse events (approximately 4%) were Clavien-Dindo grade I and did not require active treatment. RTB histology results and nuclear grade were highly concordant with the final pathology (96% and 86.6%, respectively). On univariate logistic regression analysis, male sex was the only contributing factor of diagnostic biopsy. RTB of SRMs should be performed more frequently as part of a multidisciplinary decision-making process since it avoided unnecessary surgical treatment in 1 of 3 patients in our institution.

PURPOSE OF REVIEW:To compare laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) performed in two European tertiary centers using the classic optimal surgical definition - "MIC" - and a new optimal surgical definition: the "Novel TRIFECTA" (NT) concept. We sought to strengthen the PN evidence and to test the NT's performance.RECENT FINDINGS:The study population comprehended 505 cases of localized kidney cancer from two tertiary centers between 2012 and 2019. The NT achievement was higher in the RAPN group when compared to LPN (70.5 vs. 87.4%; p = 0.004), while no differences were found when considering the MIC criteria. Also, a similar high-grade complications rate (Clavien-Dindo > III) and operative time (105 min vs. 100 min; p = NS) were found. In the multivariable regression, the RAPN approach was a predictor of NT achievement (OR 2.45; p = 0.008). NT achievement was higher in the RAPN group, while similar results were found when evaluating the MIC criteria. The NT definition could be more sensitive to the individual-specific responses related to the PN.

PURPOSE:Focal brachytherapy (F-BT) is a suitable technique for focal therapy in localized prostate cancer. It has the ability to adapt the seed implantation to the volume and location of the tumor. The aim of this study was to assess F-BT oncologic, functional, and toxicity midterm outcomes in men who underwent prostate cancer treatment. METHODS AND MATERIALS:The study included 39 men with low- to intermediate-risk prostate cancer treated with F-BT between 2010 and 2015. The dose prescription was 145 Gy. Failure was defined as the presence of any residual prostate cancer in the treated area. The primary and secondary endpoints were the F-BT oncologic and functional outcomes, respectively. A 2-sided P value < .05 indicated statistical significance. RESULTS:The mean follow-up time was 65 months (range, 43-104 months). After 24 months, 34 patients underwent control biopsies and 5 patients refused. The biopsies were negative in 27 cases (79%) and positive in 7 cases (21%), all outside the volume treated. Biochemical relapse-free survival at 5 years, disease-free survival, and overall survival were 96.8% ± 0.032%, 79.5% ± 0.076%, and 100%, respectively. The mean International Prostate Symptom Score at 2 months was significantly higher than initially (P = .0003), with no significant difference later. No late urinary, sexual, or rectal toxicity was observed. Salvage treatment was possible with good tolerance at 3.4 years of follow-up. Limitations of this study include the retrospective nature and lack of randomization. CONCLUSIONS:F-BT is a safe and effective treatment for selected patients presenting with low- or intermediate-risk localized prostate cancer.

PURPOSE:We assessed whether prostate cancer (PCa) location might affect oncologic outcomes after focal therapy (FT) for PCa.MATERIALS AND METHODS:We identified 274 men receiving FT for PCa using either high intensity focused ultrasound (HIFU) or cryotherapy at a high volume center between 2009 and 2018. Survival analyses using Kaplan-Meier method were used to assess any additional treatment and radical treatment rates according to PCa location. Propensity-score match analysis was used to compare oncologic outcomes of HIFU vs cryotherapy according to PCa location. Covariates were prostate specific antigen, clinical stage, prostate volume, Gleason score, maximum cancer core length, percentage of positive cores and treatment modality.RESULTS:A total of 166 and 108 men received FT with HIFU and cryotherapy, respectively. Overall, 39% (106) and 31% (85) received at least an additional treatment and a radical treatment after FT, respectively, with a median followup of 51 months. At 36 months' followup, the rates of any additional treatment-free survival were 71%, 75%, and 69% for patients with basal, mid-prostate and apical disease, respectively (p=0.7). At multivariable logistic regression analysis, PCa location was not significantly associated with higher risk of either any additional treatment or radical treatment (all p >0.4). After matching, there was no difference between HIFU vs cryotherapy in terms of any additional treatment rates according to PCa location.CONCLUSIONS:The PCa location does not significantly affect the rate of failure after FT. The presence of an apical lesion should not be considered an exclusion criteria for FT. Both HIFU and cryotherapy likely achieve similar medium-term oncologic results regardless of PCa location.

You have accessJournal of UrologyLate-breaking Abstract II - Malignant1 Sep 2021LBA02-08 THE IMPROVE TRIAL: SURGICAL TECHNIQUE REMAINS THE MOST IMPORTANT FACTOR ASSOCIATED WITH RECOVERY OF URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY Rafael Sanchez-Salas, Arjun Sivaraman, Rafael Tourinho-Barbosa, Caio Pasquali, Luigi Candela, Giancarlo Marra, Lara Rodriguez-Sanchez, Nathalie Cathala, Annick Mombet, Chahrazad Bey Boumezrag, Petr Macek, and Xavier Cathelineau Rafael Sanchez-SalasRafael Sanchez-Salas , Arjun SivaramanArjun Sivaraman , Rafael Tourinho-BarbosaRafael Tourinho-Barbosa , Caio PasqualiCaio Pasquali , Luigi CandelaLuigi Candela , Giancarlo MarraGiancarlo Marra , Lara Rodriguez-SanchezLara Rodriguez-Sanchez , Nathalie CathalaNathalie Cathala , Annick MombetAnnick Mombet , Chahrazad Bey BoumezragChahrazad Bey Boumezrag , Petr MacekPetr Macek , and Xavier CathelineauXavier Cathelineau View All Author Informationhttps://doi.org/10.1097/JU.0000000000002149.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-radical prostatectomy (RP) urinary incontinence (UI) is not uncommon. Both pelvic floor muscle training (PFMT) and duloxetine have been shown to be effective in improving post-RP UI in retrospective series. We aim to assess the efficacy of PFMT and duloxetine in urinary continence recovery (UCR) after robot-assisted RP (RARP). METHODS: We conducted a prospective, randomized controlled trial (NCT02367404) involving patients who experienced UI after RARP. Patients were randomized to 1 of 4 arms: (1) PMFT-biofeedback (BFB) only, (2) duloxetine only, (3) combined PMFT-BFB and duloxetine, and (4) control group. The PMFT program consisted of pelvic muscle contraction exercises conducted with electromyographic feedback weekly, for 3 months. Patients in duloxetine arms were instructed to take oral duloxetine 60 mg at bedtime for 3 months. The primary end point was continence rate at 6 months, defined as no leakage of urine during 3 consecutive days on the 24-hour pad test. Urinary symptoms and quality of life (QoL) were assessed by using a visual analog scale, the International Prostate Symptom Score questionnaire, and the King’s Health Questionnaire. RESULTS: A total of 240 patients (60 in each arm) were included in the trial between 2015 and 2018. Overall, 89% of patients completed 1 year of follow-up. From the patients allocated to receive treatment, 58% (69 of 120) had properly taken duloxetine and 38% (46 of 120) performed at least 10 sessions of PMFT. In the control group 53% of patients have achieved continence at 6 months, compared with 35% (p=0.07) in the PMFT-BFB arm, 39% (p=0.2) in the duloxetine arm, and 27% (p=0.009) in the combined treatment arm, without difference in time to UCR. Moderate to severe urinary symptoms were less frequent in the control group (11%) compared with treatment arms: 27% (p=0.03), 30% (p=0.01), 24% (p=0.07), respectively. At 6 months, QoL was qualified as uncomfortable or worse in 17% of patients in the control group, compared with 44% (p=0.02), 45% (p=0.01), and 38% (p=0.06) in treatment arms, respectively. After accounting for other variables, neurovascular bundle preservation was the only factor found to be associated with UCR (OR 3.5 [IQR 1.2-10.3]; p=0.02). CONCLUSIONS: PMFT-BFB and duloxetine do not improve UCR after RP, and may have negative impact on QOL; therefore, they should not be routinely recommended to patients who have undergone RP. Neurovascular bundle preservation was the only factor found to be associated with RUC. Source of Funding: This research received no specific grant from any source of funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1178-e1178 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Sanchez-Salas More articles by this author Arjun Sivaraman More articles by this author Rafael Tourinho-Barbosa More articles by this author Caio Pasquali More articles by this author Luigi Candela More articles by this author Giancarlo Marra More articles by this author Lara Rodriguez-Sanchez More articles by this author Nathalie Cathala More articles by this author Annick Mombet More articles by this author Chahrazad Bey Boumezrag More articles by this author Petr Macek More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement Loading ...

L’HIFU est un des traitements du cancer localisé de la prostate, parfaitement adapté à la thérapie focale. En cas d’échec, les possibilités de traitements de rattrapage sont mal codifiées. L’objectif de cette étude était d’évaluer les différentes options de prise en charge des échecs du traitement focal par HIFU et leur efficacité oncologique. Entre 2009 et 2019, 256 patients atteints d’un cancer unilatéral de la prostate ont eu un traitement focal par HIFU. Tous avaient un score ISUP de 1 à 3, ≤ cT2b et PSA ≤ 15 ng/ml. Le suivi consistait en la réalisation de PSA tous les 6 mois, d’une IRM annuelle et biopsies de contrôle systématiques à 1 an et/ou en cas de suspicion de récidive. Tous les patients qui avaient des biopsies de contrôle positives (en zone traitée, en zone non traitée, ou dans les deux) ont eu une prise en charge secondaire. Les biopsies positives en zone non traitée n’étaient pas analysées comme un échec. Les patients avaient des biopsies positives initiales de score ISUP 1, 2 et 3 dans respectivement 144 (56,3 %), 107 (41,8 %) et 5 (1,9 %) cas. À 5,2 ans de suivi (IQR : 3,0-7,1), 161 patients (62,9 %) avaient une biopsie positive : 84 (52,2 %) en zone traitée, 43 (26,7 %) en zone non traitée, et 34 (21,1 %) dans les deux zones. La prise en charge des patients en échec de traitement focal (n = 118), consistait en une surveillance active dans 24 cas (20,3 %), un traitement focal de rattrapage dans 27 cas (22,9 %) et un traitement radical de rattrapage dans 67 cas (56,8 %). En raison d’un échec du traitement de rattrapage, 18 patients ont eu une troisième ligne thérapeutique : après traitement focal dans 12 cas et après traitement radical dans 6 cas. Les différentes options thérapeutiques du cancer de prostate sont possibles après échec d’un traitement par HIFU focal. Elles peuvent, si nécessaire, être réalisées dans le cadre d’une prise en charge multimodale. Néanmoins, une majorité de patients en récidive sera candidats à un traitement radical de rattrapage. Une analyse approfondie des caractéristiques de l’échec permettrait d’optimiser la stratégie thérapeutique de rattrapage.

La thérapie focale permet un contrôle local du cancer de la prostate tout en préservant une partie du parenchyme prostatique sain, afin de limiter l’impact fonctionnel. Cette étude évalue les résultats à moyen terme du traitement par HIFU focal chez les patients atteints d’un cancer de prostate localisé. De 2009 à 2019, 256 patients, qui avaient un cancer de prostate de risque faible et intermédiaire (biopsie positive unilatérale de score ISUP 1 à 3, ≤ cT2b et PSA ≤ 15 ng/ml) ont été inclus. Un suivi par PSA semestriels et IRM annuelles était effectué. Tous les patients avaient systématiquement des biopsies de contrôle à 1 an et en cas de suspicion de récidive. L’échec était défini par la présence de biopsies positives dans la zone traitée. Des analyses univariées et multivariées étaient réalisées pour identifier des facteurs prédictifs de l’échec. La continence urinaire et la fonction érectile étaient analysées. Les patients avaient un âge médian de 68,1 ans (IQR : 62,3-72,2) (Tableau 1) et leur suivi médian était de 5,2 ans (IQR : 3,0-7,1). 118 patients (46,1 %) étaient en échec de traitement avec des biopsies positives en zone traitée et 66 avaient un cancer cliniquement significatif. 138 patients (53,9 %) avaient un contrôle local du cancer après traitement (95, des biopsies négatives et 34, des biopsies positives en zone controlatérale). La survie sans traitement de rattrapage à 2 et 5 ans était de 67,3 % (IC95 % : 57,5-67,1) et 53,8 % (IC95 % : 44,8-63,3). Aucun décès par cancer de la prostate n’a été rapporté. La densité du PSA était un facteur prédictif indépendant d’échec d’HIFU focal (Tableau 2, Tableau 3). Les taux de dysfonction érectile et d’incontinence urinaire étaient de 7 % et 1,6 %. Le traitement par HIFU focal permet un contrôle satisfaisant à moyen terme de la maladie chez plus de la moitié des patients, et ce, avec une morbidité limitée. La densité pré opératoire du PSA était significativement associée à l’échec. À l’avenir, une meilleure sélection des patients devrait permettre une amélioration des résultats oncologiques.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP50)1 Sep 2021MP50-07 SURGICAL TECHNIQUE IS THE MAJOR DETERMINANT OF QUALITY OF LIFE FOR PATIENTS RECOVERING CONTINENCE POST-RADICAL PROSTATECTOMY Rafael Tourinho-Barbosa, Arjun Sivaraman, Caio Pasquali, Giancarlo Marra, Luigi Candela, Lara Rodriguez-Sanchez, Nathalie Cathala, Annick Mombet, Petr Macek, Rafael Sanchez-Salas, and Xavier Cathelineau Rafael Tourinho-BarbosaRafael Tourinho-Barbosa , Arjun SivaramanArjun Sivaraman , Caio PasqualiCaio Pasquali , Giancarlo MarraGiancarlo Marra , Luigi CandelaLuigi Candela , Lara Rodriguez-SanchezLara Rodriguez-Sanchez , Nathalie CathalaNathalie Cathala , Annick MombetAnnick Mombet , Petr MacekPetr Macek , Rafael Sanchez-SalasRafael Sanchez-Salas , and Xavier CathelineauXavier Cathelineau View All Author Informationhttps://doi.org/10.1097/JU.0000000000002076.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence(UI) and erectile dysfunction (ED) are common complications of radical prostatectomy(RP) with devastating impact on quality of life(QoL). Baseline characteristics of the patient and disease, surgical technique and postoperative rehabilitation have the potential to affect QoL. To present the patient reported QoL outcomes from a prospective, randomized controlled trial comparing the use of Pelvic Floor Muscle Training (PMFT) and Duloxetine in the recovery of UI post-RP. METHODS: A total of 240 men with organ-confined disease having incontinence after catheter removal post-RARP were included and randomized into one of four arms – PMFT only, Duloxetine only, combined PMFT-duloxetine and no treatment. 213 (88.8%) out of these patients completed the 12-mo follow-up. Continence was defined as no leakage on a 3-day 24-h pad test. QoL tested in relation to incontinence according to Visual Analog Scale (VAS) and King’s Health Questionnaire (KQH), urinary symptoms measured by International Prostate Symptom Score (IPSS) and erectile function measured by International Index of Erectile Function (IIEF-5) were assessed pre-operatively and at 1, 3, 6 and 12months post-RARP. Age, obesity, prostate volume, prostate-specific antigen (PSA), Gleason score, neurovascular bundle preservation (NVB-P) uni or bilateral, and rehabilitation programs were assessed to affect QoL. RESULTS: Recovery of continence was found in 1.3%(3/239), 23%(43/187) and 64.4%(132/205) of patients at 1, 3 and 12months, respectively. Improvement in QoL, UI and ED from first visit to last follow-up was observed in all self-reported outcomes. NVB-P uni or bliateral was the single feature associated to early recovery of continence (at 3months, p=0.03) and better QoL starting from first month post-RP in both VAS (p=0.01) and KHQ (p=0.005). There was no superiority between uni or bilateral NVB-P. Continence recovery was not improved by rehabilitation programs, and was slightly worse at 6months in PMFT and Duloxetine arms (35% and 39%, respectively) compared to the control arm 53%, p=0.06. Only poorer preoperative erectile function and larger prostate were associated to ED at 12months post-RP. CONCLUSIONS: NVB-P (uni or bilateral) provides early recovery of erectile function and urinary incontinence and impacts QoL of patients post-RARP. Rehabilitation programs such as PMFT and Duloxetine have shown no benefit in QoL post-RP. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e888-e888 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Tourinho-Barbosa More articles by this author Arjun Sivaraman More articles by this author Caio Pasquali More articles by this author Giancarlo Marra More articles by this author Luigi Candela More articles by this author Lara Rodriguez-Sanchez More articles by this author Nathalie Cathala More articles by this author Annick Mombet More articles by this author Petr Macek More articles by this author Rafael Sanchez-Salas More articles by this author Xavier Cathelineau More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: Focal instead of whole gland ablation for prostate cancer has been proposed to decrease treatment morbidity. We sought to determine differences in erectile function and urinary continence after focal and whole gland ablation for prostate cancer. Materials and Methods: From 2009 to 2018, 346 patients underwent high intensity focused ultrasound or cryotherapy for prostate cancer. Urinary continence was defined as use of no pads and sexual potency as enough erection for sexual penetration. Logistic regressions to treatment groups and covariates age, prostate specific antigen, International Society of Urological Pathology grading, prostate volume and energy modality were performed to access the effect of focal therapy in sexual potency and urinary continence after 3 and 12 months. IIEF-5 (International Index of Erectile Function) and I-PSS (International Prostate Symptom Score) questionnaires were evaluated. Propensity score matching was performed to adjust for potential baseline differences between groups. Results: After exclusion, 195 post-focal therapy and 105 post-whole gland therapy patients were included in analysis. No significant difference was seen in baseline I-PSS and IIEF-5 scores. In multivariate models focal therapy was the most important factor related to sexual potency at 3 (OR 7.7) and 12 months (OR 3.9). Median IIEF-5 score at 3 months was 12 and 5 (p<0.001), and at 12 months was 13 and 9 (p=0.04) in focal therapy and whole gland therapy groups, respectively. Focal therapy was the only factor related to continence (OR 0.7, p<0.001). Results remained significant after propensity score matching. Conclusions: Focal ablation instead of whole gland therapy is the most important factor related to better sexual and urinary continence recovery after high intensity focused ultrasound and cryotherapy for prostate cancer.

INTRODUCTION AND OBJECTIVE: Optimal management of patients with positive surgical margins (PSM) after PN is unclear. Clinical impact of PSM on recurrence/survival are less clear in the literature. We analyzed the impact of PSM status after PN on recurrence-free survival (RFS) and re-treatment-free survival (TFS) METHODS: We analyzed data on patient who underwent RAPN from 2012 and 2019. Two groups were created: positive (PSM) and negative surgical margin (NSM). Only malignant tumors were included. Risk factors for PSM were investigated in a multivariable logistic regression model. To compare the RFS and TFS, log-rank curves were generated. Cox regression was used to adjust potential confounders. RESULTS: Totally 192 patients were analyzed, mean follow-up was 24 m. PSM rate was 10.4% (n[20). No differences between the groups were found in the following variables: age, gender, BMI, side, Charlson Comorbity Index, RENAL score and preoperative eGFR. The median pre-op tumor size was higher in PSM group (42 vs. 30mm; p[ 0.006), as well as the postoperative tumor size (36 vs. 30mm; p[0.002). No differences were found in mean warm ischemia time (19 vs. 19min), operation time (138 vs. 122min), estimate blood loss (366 vs. 311ml) and postop stay (5 vs. 5 days); p[NS for all. Tumor distribution was similar among the groups with 65.7 vs. 65%, 18.6% vs. 20% and 11.6% vs. 15% [PSM e NSM] for clear cell, papillary and chromophobe tumors (p[NS), respectively. Higher proportion of pT1b (25 vs. 17%) and pT3 (20 vs. 2.9%) were identified in PSM group (p[0.004). In the multivariable LR, only tumor size predicted the PSM status (OR 1.04; p[0.022). Five (25%) and six (3.4%) patients presented recurrence in PSM and NSM groups, respectively. The RFS was higher in NSM in the log-rank estimative (p<0.001) and after adjusting variables as well (HR 7.2; p[0.004). RFS was not affected by tumor size (p[NS), pT1 subcategories (p[NS) and FUHRMAN G1-2 vs. G3-4 (p[NS). TFS was higher in NSM group (HR 5.6; p[0.016). CONCLUSIONS: The PSM was associated with a lower RFS and TFS.