Presentation Authors: Morena Turco*, Andrea Boni, Alessio Paladini, Michele Del Zingaro, Giovanni Cochetti, Mattia Panciarola, Ettore Mearini, Perugia - Terni, Italy
Introduction: Urinary incontinence after Robot-Assisted Radical Prostatectomy (RARP) is one of the most bothersome side effects, impairing Quality of Life (QoL) especially in the early postoperative period, regardless of surgical approach. Positive Uroflow Stop Test (UST) seems to be associated with early recovery of urinary continence (UC). The aim of the study was to evaluate if an early return to preoperative latency time (â‰¤3 months, mos.) during UST with electromyography (EMG) of pelvic floor could be associated with early recovery of UC (3 mos.).
Methods: In this prospective observational study we studied 137 patients (pts) who underwent RARP from January 2017 to April 2018. The same surgeon performed all surgical procedures in 2 high volume university hospitals. Bladder neck sparing, full nerve sparing (NS) and partial NS techniques were performed in 137 (100%), 78 (56,9%) and 41 (32,1%) pts, respectively. All pts performed UST with EMG before surgery, at time of urethral catheter removal, at 1, 3, 6 mos. after RARP. UST was considered positive for voluntary interruption of urine flow for at least 3 seconds after reaching a minimum flow rate of 15 ml/s. The latency was calculated from the beginning of pelvic floor contraction to the stop of urine flow. All pts were instructed to perform Kegel exercises after catheter removal. Pts were considered continent and incontinent when they used no pad and â‰¥1 pad/die, respectively. We identified 2 groups: Group 1 (early presurgical latency recovery, 93 pts) and Group 2 (late, >3 mos. or no presurgical latency recovery, 44 pts). Statistical analysis was performed by using SPSSÂ® software, Chi-squared test.
Results: Preoperative characteristics (clinical ones, IPSS and QoL questionnaires scores) were comparable between the 2 groups. There was a statistically significant difference between the 2 groups in terms of pads use at 3 mos. after RARP (p < 0.05). The Table shows the pad-free continence rates at 6 mos. after surgery. Pts with positive UST had a faster recovery of UC, regardless of pad-free rate.
Conclusions: UST with EMG is a simple, reliable and feasible test that gives us information about the pelvic floor integrity after RARP. The early recovery of preoperative latency time could help us to select pts who may benefit of targeted rehabilitation or therapeutic approach in order to improve the QoL.