Search

We evaluated the accuracy and reliability of a new smartphone-based acoustic voided volume (VV) measurement application compared to VV estimation based on the measurement of urine volume in a bladder by ultrasound bladder scan.A total of 53 subjects from 01/2021 to 09/2021 were prospectively enrolled. Bladder scan-based VV estimation is based on the difference in the volume of urine in a bladder measured before urination and volume measured after urination. The acoustic VV measurement is based on smartphone-based acoustic VV measurement mobile application. VV estimates for the same void were compared between two techniques. Urinary measures were obtained from 49 male subjects resulting in a total of 245 measurements for analysis. VV measures were compared using Pearson's correlation coefficient (PCC), evaluation of observed versus predicted VV measures using linear regression fit indices, and Bland-Altman method.VV between the two techniques revealed strong correlation (PCC 0.811, p 0.001). Means of the number of measurements per patient and inpatient days for measurements analyzed are 5 and 2.7, respectively. In 245 measurements, VV measured by bladder scan is 238.69 ± 122.32 mL, VV measured by mobile application is 254.69 ± 119.28 mL, and their difference of two measurements is 16 ± 74.29 mL.Through the comparison with VV estimated by ultrasound bladder scan, which is a technology to measure the urine volume in a bladder, it was confirmed that the smartphone-based acoustic VV measurement application proudP

Few studies have been conducted on the serial evaluation of predictors for recovery of urinary continence (RC) after radical prostatectomy (RP) among same cohort. We developed and validated nomograms to predict immediate (≤1), early (≤3), and late (≤12 months) RC from a contemporary series and compared each nomogram with regard to the significance of predictors for RC. Among consecutive men who received robot-assisted or open retropubic RP between 2004 and 2011, 872 (74.7 %) and 296 (25.3 %) were randomly assigned to subcohorts for the development of nomograms and for the split-sample external validation. The final multivariate model was selected based on the stepwise procedure, and the regression coefficient-based nomograms were developed based on final models. Age at surgery, membranous urethral length (MUL), and robot-assisted RP were significant for RC at 1, 3, and 12 months. Saving the neurovascular bundle (NVB) and prostate volume were significant only for RC at 12 months. Odds ratios for age and MUL were constant over time, whereas the odds ratio for robot-assisted surgery decreased over time. Each developed nomogram was reasonably well fitted to the ideal line of the calibration plot. The split-sample external validation of nomograms indicated 63, 65, 71 % accuracy for each RC time point. We developed nomograms for RC at each time point after RP and validated adequately. Saving the NVB and prostate volume may affect only late RC after RP. In contrast, age, MUL, and robot-assisted surgery seem to be consistently associated with immediate, early, and late RC.

Protrusion of the median lobe (PML) is thought to add technical difficulty during robot-assisted laparoscopic prostatectomy (RALP). Thus, we quantified PML using preoperative magnetic resonance imaging (MRI) and evaluated its impact on base surgical margin (BSM) status during RALP. The clinical data of consecutive patients who underwent RALP were retrieved from a prospectively registered database. Of the 655 eligible men, 9 patients were excluded because they did not undergo MRI. PML was measured in a T2-weighted mid-sagittal scan. We performed univariate and multiple logistic regression analyses. The mean PML was 8.3 ± 3.6 mm. The rate of positive surgical margins was 17.3 % (73/423) in pathologic stage T2 and 34.6 % (226/646) in all cases. The BSMs were positive in 10.1 % (66/646) of cases. A logistic regression analysis revealed that PML was significantly correlated with BSM positivity in all cases (odds ratio [OR] 1.080, p = 0.026). In particular, they had a stronger correlation with pathologic stage T3 or higher (OR 1.1143, p = 0.004). PML was an independent predictor of BSM positivity (OR 1.113, p = 0.046) in pathologic stage T3 or higher, as were preoperative prostate-specific antigen, prostate size, and pathologic stage. Cases with 10 mm or higher PML had significantly more BSM positivity than cases with

To identify the perioperative and oncological impact of different intervals between biopsy and robot-assisted laparoscopic radical prostatectomy (RALP) for localized prostate cancer. All consecutive patients with localized prostate cancer who underwent RALP with primary curative intent in January 2008–July 2014 in a large tertiary hospital were enrolled in this retrospective cohort study. The patients were divided into groups according to whether the biopsy–RALP interval was ≤2, ≤4, ≤6, or >6 weeks. Estimated blood loss and operating room time were surrogates for surgical difficulty. Surgical margin status and continence at the 1 year were surrogates for surgical efficacy. Biochemical recurrence (BCR) was defined as two consecutive postoperative prostate serum antigen values of ≥0.2 ng/ml. Of the 1446 enrolled patients, the biopsy–RALP interval was ≤2, ≤4, ≤6, and >6 weeks in 145 (10 %), 728 (50.3 %), 1124 (77.7 %), and 322 (22.3 %) patients, respectively. The >6 week group had a significantly longer mean operation time than the ≤2, ≤4, and ≤6 week groups. The groups did not differ significantly in terms of estimated blood loss or surgical margin status. Kaplan–Meier analysis showed that interval did not significantly affect postoperative BCR-free survival. Multivariable Cox proportional hazards model analysis showed that interval duration was not an independent predictor of BCR (≤2 vs. >2 weeks, HR = 0.859, p = 0.474; ≤4 vs. >4 weeks, HR = 1.029, p = 0.842; ≤6 vs. >6 weeks, HR = 0.84, p = 0.368). Performing RALP within 2, 4, or 6 weeks of biopsy does not appear to adversely influence surgical difficulty or efficacy or oncological outcomes.

The dorsal vascular complex (DVC) of the prostate is considered to be a functional structure having smooth muscles that are connected to the detrusor apron. We conducted this study to provide basic information regarding DVC size as measured by magnetic resonance imaging and to investigate whether DVC size is related to the recovery of continence following radical prostatectomy (RP).We prospectively collected data that included the results of prostate MRI and continence recovery of patients who underwent RP. From April 2006 through February 2010, 862 patients underwent RP. Of these, a total of 731 cases were included in the final analysis. The height and width of the DVC were measured in the T1-weighted axial image at the level that showed the puboprostatic ligament.The continence rate of the total patient cohort at 12 months was 96.7 %. The mean width, height and area of the DVC were 2.0 ± 0.4 cm, 1.2 ± 0.3 cm and 1.8 ± 0.6 cm(2), respectively, and there was no linear correlation between continence recovery and these parameters. However, the patients who had a moderately large-sized DVC (2.3-2.8 cm(2)) regained their continence significantly sooner (mean duration = 2.1 months) than those with small (3.7 months, p = 0.002) or extremely large DVC (4.0 months, p = 0.006). In a multivariate analysis, DVC size, age, transfusion and the length of membranous urethra were significant predictors of continence recovery.The patients who had a moderately large DVC regained continence faster following RP.

To investigate the association between preoperative neutrophil–lymphocyte ratio (NLR) and oncological outcomes in patients with localized prostate cancer (PCa) after radical prostatectomy (RP). We retrospectively reviewed the records of 1367 patients who underwent RP between November 2003 and April 2012. Patients who underwent a concurrent biopsy/procedure in other organs, had evidence of acute infection, or had systemic inflammatory disease were excluded. We divided the patients by NLR level and analyzed their perioperative outcomes. To determine NLR significance, we performed a multivariate logistic regression analysis of the pathological adverse outcomes and a Cox proportional hazard analysis of the biochemical recurrence (BCR), which was defined as a prostate-specific antigen level ≥0.2 ng/mL on two consecutive tests. Among the 1367 patients, 158 (11.6 %) in the high-NLR (≥2.5) group had a higher biopsy Gleason score (p

Due to lack of tactile feedback, dissection of surgical planes during delicate procedures of nerve-sparing robot-assisted laparoscopic radical prostatectomy (RALRP) can be hampered more by postbiopsy hematomas or adhesions compared with open surgery. Thus, we investigated association between extent of postbiopsy hemorrhage observed via preoperative magnetic resonance (MR) imaging with surgical difficulty of RALRP.We reviewed records of 154 men who received prostate biopsy, MR imaging, and subsequently, nerve-sparing RALRP for clinically localized prostate cancer within 2 weeks of MR imaging. We scored degree of postbiopsy hemorrhage as shown on T1-weighted MR imaging (hemorrhage score) and analyzed potential association of hemorrhage score with variables representative of surgical difficulty (operative time, estimated blood loss, and margin positivity) and functional outcomes (urinary continence and erectile function).Among our subjects, total hemorrhage score demonstrated no significant associations with interval from biopsy to MR imaging (p = 0.210). In multivariate analyses, prostate volume and total hemorrhage score were observed to be significantly associated with operative time (p = 0.004 and 0.039, respectively) and estimated blood loss (p = 0.009 and 0.023, respectively). Patients' age and total hemorrhage score was observed to be independent predictor of the return of erectile function sufficient for vaginal intercourse at 6 months following RALRP (p = 0.003 and 0.036, respectively).Degree of postbiopsy hemorrhage observed in preoperative MR imaging may be predictive of surgical difficulty for RALRP. Such findings provide concrete evidences that aftereffects of prostate biopsy have significant impact on performing RALRP.