Male acquired urinary incontinence can be a complication of radical prostatectomy and posterior urethroplasty. Mild urinary incontinence can be improved by pelvic floor exercises, biofeedback and medicine treatment. Severe urinary incontinence requires more active treatment, such as injection therapy, artificial urethral sphincter insertion, and bulbourethral sling. Recent progress in the treatment of male acquired urinary incontinence is reviewed in this article.
Humans ; Male ; Postoperative Complications ; therapy ; Prostatectomy ; adverse effects ; Urinary Incontinence ; etiology ; therapy ; Urologic Surgical Procedures, Male ; adverse effects

OBJECTIVETo compare holmium laser enucleation (HoLEP) versus open prostatectomy (OP) for large volume benign prostatic hyperplasia.

METHODSThe randomized controlled trials (RCTs) pertaining to HoLEP and OP for management of large volume benign prostatic hyperplasia were retrieved from Medline and Embase. Meta-analysis was performed using Review Manager 5.0 software.

RESULTSThree RCTs were included in the analysis. No significant differences were found in IPSS or Qmax between HoLEP and OP (P>0.05). Compared with OP, HoLEP was associated with significantly less blood loss, a shorter catheterization time and a shorter hospital stay, but a longer operating time. HoLEP and OP were similar in terms of urethral stricture, stress incontinence, transfusion requirement and the rate of reintervention.

CONCLUSIONHoLEP and OP have similar therapeutic effects in the management of large volume benign prostatic hyperplasia. Although with a longer operating time and less resected tissue, HoLEP causes less blood loss and requires a shorter catheterization time and a shorter hospital stay. HoLEP has a comparable safety to OP in terms of the adverse events.

Humans ; Lasers, Solid-State ; adverse effects ; Male ; Prostatectomy ; adverse effects ; methods ; Prostatic Hyperplasia ; surgery ; Randomized Controlled Trials as Topic

Benign prostatic hyperplasia (BPH) is a common problem among elderly males. Surgical resection of the hyperplastic tissue to relieve urinary tract obstruction remains a major option for the treatment of BPH. Operations, whether open prostatectomy, transurethral resection of the prostate, or transurethral laser resection of the prostate, will inevitably affect the sexual function of the patient. With the increased attention to patients' quality of life, more and more importance is being attached to the changes in post-BPH sexual function. This review covers the sexual function changes induced by different surgical methods and assesses the possible risk factors of BPH surgery.
Erectile Dysfunction ; etiology ; Humans ; Male ; Prostatectomy ; adverse effects ; Prostatic Hyperplasia ; surgery ; Risk Assessment ; Risk Factors ; Transurethral Resection of Prostate ; adverse effects

Animals ; Male ; Prostate-Specific Antigen ; analysis ; metabolism ; Prostatectomy ; adverse effects ; standards ; Specimen Handling ; methods ; standards

OBJECTIVE: To compare the clinical therapeutic effect between electroacupuncture at "four points of sacral region" and transurethral Erbium laser in treatment of moderate to severe stress urinary incontinence after radical prostatectomy. METHODS: A total of 68 patients of moderate to severe stress urinary incontinence after radical prostatectomy were divided into an electroacupuncture group (34 cases) and an Erbium laser group (34 cases, 3 cases dropped off) according to the settings. In the electroacupuncture group, electroacupuncture was applied at "four points of sacral region", i.e. points of 0.5 cun beside bilateral sacrococcygeal joints and bilateral Huiyang (BL 35), with continuous wave, 2 Hz in frequency, 60 min each time, once every other day, 3 times a week, 12 times as one course of treatment. In the Erbium laser group, transurethral Erbium laser technology was given, once every 4 weeks as one course of treatment. Both groups were treated for 5 courses. The scores of the International Consultation on Incontinence questionnaire-short form (ICI-Q-SF) and the incontinence quality of life questionnaire (I-QOL) were observed before treatment, after each course of treatment and in follow-up after 1 and 2 months of treatment completion, respectively, and the clinical efficacy was evaluated after treatment in the two groups. RESULTS: Compared with those before treatment, the ICI-Q-SF scores were decreased while the I-QOL scores were increased after 5 courses of treatment and in follow-up after 1, 2 months of treatment completion in the two groups (P<0.01). The ICI-Q-SF score in follow-up after 2 months of treatment completion were higher than that after 5 courses of treatment in the Erbium laser group (P<0.05). After 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the ICI-Q-SF scores in the electroacupuncture group were lower than those in the Erbium laser group (P<0.05, P<0.01); after 2, 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the I-QOL scores in the electroacupuncture group were higher than those in the Erbium laser group (P<0.01). The change ranges of ICI-Q-SF score and I-QOL score between before treatment and after each course of treatment in the electroacupuncture group were lager than those in the Erbium laser group (P<0.01, P<0.05). The total effective rate was 61.8% (21/34) in the electroacupuncture group, which was superior to 19.4 (6/31) in the Erbium laser group (P<0.01). CONCLUSION Both electroacupuncture at "four points of sacral region" and transurethral Erbium laser can improve the clinical symptoms and the quality of life in patients of moderate to severe stress urinary incontinence after radical prostatectomy. The short-term efficacy and long-term efficacy of electroacupuncture are superior to the Erbium laser technology.
Male ; Humans ; Quality of Life ; Urinary Incontinence, Stress/therapy* ; Sacrococcygeal Region ; Electroacupuncture ; Erbium ; Prostatectomy/adverse effects*

OBJECTIVE: To assess the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and prostatic volume (PV) and intravesical prostatic protrusion length (IPPL) on preoperative magnetic resonance imaging (MRI). METHODS: 88 patients with pathologic confirmed prostate carcinoma who were underwent LRP were included in this study. MRI examination was performed in 1 week before the biopsy. The patients were divided into two groups according to PV (<50 mL, ≥50 mL) on preoperative MRI. The patients were divided into two groups according to IPPL (<5 mm, ≥5 mm), IPPL was measured on MRI as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder. After surgery we recorded and analyzed recovery of urinary continence of the patients for one year. RESULTS: All the 88 patients received extra-peritoneal LRP successfully. The average operation time was (155±67) min, and the estimated blood volume was (145±159) mL. There was a significant difference between group PV<50 mL and ≥50 mL in the operation time (P=0.045). All the patients who underwent MRI preoperatively showed that their mean PV was (44.54±26.58) mL and mean IPPL was (5.2±5.7) mm. The continence rate for all the patients after LRP was 53.4%, 84.1% and 94.3% in their follow-up of 3, 6 and 12 months. Three months after LRP, the continence rate for group PV<50 mL and ≥50 mL were 61.5% and 30.4%, which were completely continent (P=0.010). Six or twelve months after surgery, the continence rate was 87.7% and 73.9% (P=0.120), 96.9% and 87.0% (P=0.076) for group PV<50 mL and ≥50 mL separately. Three months after LRP, the continence rate for group IPPL<5 mm and ≥5 mm were 66.1% and 31.3%, which were completely continent (P=0.002). Six months after surgery, the continence rate was 92.6% and 68.8% (P=0.003), and one year after surgery, the continence rate was 98.2% and 87.5% for group IPPL<5 mm and ≥5 mm separately (P=0.037). There was a significant difference between group PV<50 mL and ≥50 mL in the urinary continence curve (P=0.017), and the same significant difference between group IPPL<5 mm and ≥5 mm (P=0.001). CONCLUSION The PV and IPPL on preoperative MRI were associated with significantly slower return of urinary continence, especially for early recovery (3 months) of continence after LRP.
Humans ; Laparoscopy ; Male ; Prostatectomy/adverse effects* ; Prostatic Neoplasms/surgery* ; Recovery of Function ; Urinary Incontinence

Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the "gold standard" for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.
Humans ; Prostatectomy/adverse effects* ; Prosthesis Design ; Urinary Incontinence, Urge/surgery* ; Urinary Sphincter, Artificial

PURPOSE: The objective of this study is to evaluate the continence rate following reconstruction of the posterior urethral plate in robot-assisted laparoscopic radical prostatectomy (RLRP). MATERIALS AND METHODS: A retrospective analysis of 50 men with clinically localized prostate cancer who underwent RLRP was carried out. Twenty-five patients underwent RLRP using the reconstruction of the posterior aspect of the rhabdosphincter (Rocco repair). Results of 25 consecutive patients who underwent RLRP prior to the implementation of the Rocco repair were used as the control. Continence was assessed at 7, 30, 90, and 180 days following foley catheter removal using the EPIC questionnaire as well as a follow-up interview with the surgeon. RESULTS: There was no statistically significant difference between the two groups in any of the patient demographics. At 7 days, the Rocco experimental group had a continence rate of 19% vs. 38.1% in the non-Rocco control group (p = 0.306). At 30 days, the continence rate in the Rocco group was 76.2% vs. 71.4% in the non-Rocco group (p = 1). At 90 days, the values were 88% vs. 80% (p = 0.718), respectively. At 180 days, the pad-free rate was 96% in both groups. CONCLUSION: Rocco repair offers no significant advantage in the time to recovery of continence following RLRP when continence is defined as the use of zero pads per day. On the other hand, Rocco repair was associated with increased incidence of urinary retention requiring prolonged foley catheter placement.
Aged ; Humans ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Prostatectomy/adverse effects/*methods ; Retrospective Studies ; Urethra/*surgery ; Urinary Incontinence/*epidemiology/surgery

PURPOSE: To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. MATERIALS AND METHODS: Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. RESULTS: A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. CONCLUSION: RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP.
Humans ; Male ; Postoperative Complications/*etiology ; Prostatectomy/*adverse effects/methods ; Prostatic Neoplasms/surgery ; Robotic Surgical Procedures/*adverse effects ; Treatment Outcome ; Urinary Incontinence/etiology

OBJECTIVETo compare suprapubic prostatectomy (SPPC) with transurethral resection of the prostate (TURP) in inducing erectile dysfunction (ED) and retrograde ejaculation (RE) in Chinese men.

METHODSWe retrieved all the case-controlled studies on the comparison of SPPC and TURP in inducing ED and RE by searching Medline and Chinese Journal Full-text Database (CJFD) (up to January 2009), screened the eligible literature according to the selection and exclusion criteria, and performed meta-analyses on the included studies using the software Revman 4. 2.

RESULTSEight eligible reports were identified in this study, including 515 cases of SPPC and 462 cases of TURP. The SPPC group showed a little higher incidence of ED than the TURP group (pooled OR: 1.34; 95% CI, 0.97, 1.85), with no statistically significant difference (P > 0.05), while the latter exhibited a significantly higher incidence of RE than the former (pooled OR: 0.58; 95% CI, 0.44, 0.76, P < 0.05).

CONCLUSIONThere is no significant difference between the incidence of ED after SPPC and that after TURP in Chinese men, but the latter may induce a much higher rate of retrograde ejaculation than the former.

Asian Continental Ancestry Group ; Ejaculation ; Erectile Dysfunction ; etiology ; Humans ; Incidence ; Male ; Prostatectomy ; adverse effects ; Sexual Dysfunction, Physiological ; Transurethral Resection of Prostate ; adverse effects