PMID- 24660774
OWN - NLM
STAT- MEDLINE
DCOM- 20141008
LR  - 20181202
IS  - 1557-900X (Electronic)
IS  - 0892-7790 (Linking)
VI  - 28
IP  - 7
DP  - 2014 Jul
TI  - How to optimize patient selection for robot-assisted radical prostatectomy: 
      functional outcome analyses from a tertiary referral center.
PG  - 792-800
LID - 10.1089/end.2014.0007 [doi]
AB  - INTRODUCTION: The role of surgical approach on functional outcomes recovery in 
      prostate cancer (PCa) patients treated with bilateral nerve-sparing radical 
      prostatectomy (BNSRP) is still debated. In this study, we examine the association 
      between the surgical approach and functional outcomes after BNSRP. PATIENTS AND 
      METHODS: The study included 609 patients treated with robot-assisted radical 
      prostatectomy (RARP) or open radical prostatectomy (ORP) between June 2008 and 
      January 2011. Erectile function recovery was defined as an International Index of 
      Erectile Function-Erectile Function domain (IIEF-EF) score >/=22. Urinary 
      continence recovery was defined as being completely pad-free over a 24-hour 
      period. Patients were stratified according to their probability of postoperative 
      erectile dysfunction and urinary incontinence, according to previously published 
      predictive models. Multivariable logistic regression tested the association 
      between the surgical approach and functional outcomes recovery in the overall 
      population after stratifying patients according to their risk of erectile 
      dysfunction and urinary incontinence. RESULTS: Patients treated with RARP had 
      higher 2-year erectile function (52.1% vs 67.8%; P<0.001) and urinary continence 
      (72.0% vs 87.4%; P<0.001) recovery rates as compared to their ORP counterparts. 
      After stratification according to the erectile dysfunction risk, RARP led to 
      higher erectile function recovery rates in the low- and intermediate-risk 
      erectile dysfunction groups (all P<0.001).This did not hold true, however, in 
      patients at high risk of erectile dysfunction (P=0.5). Similarly, when patients 
      were stratified according to their urinary incontinence risk, RARP was associated 
      with a higher probability of urinary continence recovery in the very low, low, 
      and intermediate risk groups only (all P<0.001). This did not hold true, however, 
      in the group of men at high risk of postoperative urinary incontinence (P=0.8). 
      CONCLUSIONS: RARP leads to higher urinary continence and erectile function 
      recovery rates compared with ORP. Not all patients benefit from this approach to 
      the same extent, however. Accurate preoperative patient selection would result in 
      substantial savings for the health care system.
FAU - Gandaglia, Giorgio
AU  - Gandaglia G
AD  - 1 Urological Research Institute, Vita-Salute San Raffaele University , San 
      Raffaele Scientific Institute, Milan, Italy .
FAU - Suardi, Nazareno
AU  - Suardi N
FAU - Gallina, Andrea
AU  - Gallina A
FAU - Zaffuto, Emanuele
AU  - Zaffuto E
FAU - Cucchiara, Vito
AU  - Cucchiara V
FAU - Vizziello, Damiano
AU  - Vizziello D
FAU - Shariat, Shahrokh
AU  - Shariat S
FAU - Cantiello, Francesco
AU  - Cantiello F
FAU - Damiano, Rocco
AU  - Damiano R
FAU - Guazzoni, Giorgio
AU  - Guazzoni G
FAU - Montorsi, Francesco
AU  - Montorsi F
FAU - Briganti, Alberto
AU  - Briganti A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20140324
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
SB  - IM
MH  - Aged
MH  - Erectile Dysfunction/etiology
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Organ Sparing Treatments/*methods
MH  - *Patient Selection
MH  - Penile Erection/*physiology
MH  - Postoperative Period
MH  - Prostatectomy/adverse effects/*methods
MH  - Prostatic Neoplasms/surgery
MH  - Recovery of Function/*physiology
MH  - Regression Analysis
MH  - Robotics/*standards
MH  - Tertiary Care Centers
MH  - Urinary Incontinence/etiology
EDAT- 2014/03/26 06:00
MHDA- 2014/10/09 06:00
CRDT- 2014/03/26 06:00
PHST- 2014/03/26 06:00 [entrez]
PHST- 2014/03/26 06:00 [pubmed]
PHST- 2014/10/09 06:00 [medline]
AID - 10.1089/end.2014.0007 [doi]
PST - ppublish
SO  - J Endourol. 2014 Jul;28(7):792-800. doi: 10.1089/end.2014.0007. Epub 2014 Mar 24.