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Background: (1) The pelvic floor muscle training is an effective first choice intervention., Background: (2)  Scarcity of studies describing the protocols of pelvic floor muscle training detail., Background: (3)  There is no consensus between the instructions contained in the different protocols., Objective: to map pelvic floor muscle training protocols available in the literature for the management of post-prostatectomy urinary incontinence., Method: this is a scoping review conducted in six databases. Information retrieval was performed using a specific instrument, including: title, authorship, year of publication, journal, objective, study design and description of the protocols' content., Results: a total of 24 studies were included, which resulted in different protocols. The most frequent recommendations were the following: three sessions per day; with a frequency of six to 15 contractions per session; performing the exercises in the lying, sitting, and standing positions. The most cited guidelines in the protocols were anal sphincter and bulbocavernosus muscle contractions. All protocols followed the principle of regular pelvic floor muscle contraction, but there was no consensus regarding the start of the protocol, treatment duration, contraction/relaxation time, and intensity of the contraction force., Conclusion: different orientations were found in the pelvic floor muscle training protocols post-prostatectomy urinary incontinence, with emphasis on contraction time, relaxation time, number of contractions per session, training position, and protocol duration time. Different concepts were adopted to define urinary continence in the protocols. It is necessary to develop consensus guidelines that clearly define the parameters of training protocols.

This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I 2 =83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed., (Copyright © 2023 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The EAU proposed a progression and death risk classification in patients with biochemical recurrence after radical prostatectomy (PR)., Objective: To validate the EAU BCR-risk classification in our setting and to find factors related to progression and death., Material and Methods: Multicenter, retrospective, observational study including 2140 patients underwent RP between 2011 and 2015. Patients with BCR were identified and stratified in low risk (PSA-DT >1yr and pGS <8) or high-risk (PSA-DT ≤1yr or pGS ≥8) grouping. PSA and metastatic free survival (PSA-PFS, MFS), cancer specific survival (CSS) and overall survival (OS) were calculated (Kaplan Meier curves and log-rank test). Independent risk factors were identified (Cox regression)., Results: 427 patients experienced BCR (32.3% low-risk and 67.7% high-risk). Median PSA-PFS was 135,0 mo (95% CI 129,63-140,94) and 115,0 mo (95% CI 104,02-125,98) (p<0,001), for low and high-risk groups, respectively. There were also significant differences in MFS and OS. The EAU BCR risk grouping was independent factor for PSA-progression (HR 2.55, p 0.009). Time from PR to BCR, was an independent factor for metastasis onset (HR 0.43, 95% CI 0.18-0.99; p 0.044) and death (HR 0.17, 95% CI 0.26.0.96; 23 p 0.048). Differences in MFS (p 0.001) and CSS (p 0.004) were found for <12, ≥12-<36 and ≥36 months from PR to BCR. Others independent factors were early salvage radiotherapy and PSA at BCR., Conclusions: High-risk group is a prognostic factor for biochemical progression, but it has a limited accuracy on MP and death in our setting. The inclusion of other factors could increase its predictive power., (Copyright © 2023 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Urinary incontinence after radical prostatectomy (RP) is an adverse event with high impact on patient's quality of life. Nowadays there is no standardized method for urinary continence measurement. Posterior rhabdosphincter reconstruction (PRR) is a surgical step that can improve early urinary continence after RP. Our objective was to analyse different continence definitions and predictors of urinary continence recovery after robot-assisted RP (RARP)., Material and Methods: We conducted a double-blind, randomised controlled trial (NCT03302169) including 152 consecutive patients with localized prostate cancer subjected to RARP. Patients were randomised to single urethrovesical anastomosis (control arm) or PRR before urethrovesical anastomosis (PRR arm). Urinary continence was measured with the EPIC-26 and ICIQ-SF validated questionnaires, and pad use (0-1 pads and no pads), at 7, 15, 30, 90, 180 and 365 days after catheter removal. Prognostic factors for early urinary continence recovery were analysed., Results: 72 patients were included in the control arm and 80 in the PRR arm. Baseline characteristics were similar between arms, except body mass index, which was higher in PRR arm. "No pad" was the only definition assessing the benefit of PRR at 30 days, 33.8% in PRR arm and 18.1% in control arm, p = 0.022; and at 90 days, 58.8 and 43.1% respectively, p = 0.038. Questionnaires did not detect differences in terms of continence recovery. PRR was the only predictor for early continence recovery, p = 0.03., Conclusions: PRR increased early urinary continence recovery after RARP. Continence definition was critical to assess benefit. The only predictive factor for early continence recovery was PRR., (Copyright © 2022 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Rectal injury is a rare complication after extraperitoneal laparoscopic radical prostatectomy. The development of rectourethral fistulas (URF) from rectal injuries is one of the most feared and of more complex resolution in urology., Material and Methods: Between 2013 and 2020 we have operated on a total of 5 patients with URF after extraperitoneal endoscopic radical prostatectomy through a perineal access using the interposition of biological material. All fistulas had a diameter of less than 6 mm at endoscopy and were less than 6 cm apart from the anal margin., Results: The mean age of the patients was 64 years old. All patients had a previous bowel and urinary diversion for at least 3 months. Under general anesthesia and with the patient in a forced lithotomy position, fistulorraphy and interposition of biological material of porcine origin (lyophilized porcine dermis [Permacol®]) were performed through a perineal access. Mean operative time was 174 min (140-210). Most patients were discharged on the third postoperative day. The bladder catheter was left in place for a mean of 40 days (30-60). Prior to its removal, cystography and a Gastrografin® barium enema were performed, showing resolution of the fistula in all cases., Conclusions: The interposition of biological material from porcine dermis through perineal approach is a safe alternative with good results in patients submitted to urethrorectal fistulorraphy after radical prostatectomy., (Copyright © 2021 AEU. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Open prostatectomy is an efficacious treatment for Benign Prostatic Hyperplasia (BPH), but its complication rates and risk factors for these might vary due to the characteristics of populations and health systems. OBJECTIVE: To determine the frequency of complications and the risk factors for these, in the first three months after open prostatectomy in a hospital in Medellín (Colombia). METHODS: This is a cohort study in which patients undergoing retropubic open prostatectomy were taken. Medical records were reviewed to obtain demographic, preoperative, and intraoperative data. The main outcome was the incidence of complications in the first three postoperative months and this was divided into early (day 1 to 7 post-surgery) and late (day 8 to 90 post-surgery) complications. Risk factors were determined by estimating Relative Risks (RR)., Results: 191 patients with a median age of 70 years were included. The frequency of complications was 34.5%,14.6% occurred early and 19.9% late. Risk factors were dyslipidemia (RR: 2.37, 95% CI: 1.25 to 4.47), irrigation time (RR: 1.31, 95% CI: 1.02 to 1.67) and duration of the postsurgical catheter (RR: 1.07, 95% CI: 1.03 to 1.12); general anesthesia was a protective risk factor compared to spinal (RR: 0.47, 95% CI: 0.24 to 0.91)., Conclusion: The frequency of complications of open prostatectomy with a retropubic approach was within the figures reported in the literature. The risk factors found could be modifiable and considered for the prevention of adverse outcomes. This study provides an updated basis for future comparisons with alternative treatments for BPH.

Background and Aim: Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application., Material and Methods: Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed., Results: The average age was 65.22years (48-78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24hours. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis., Conclusions: In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique., (Copyright © 2019 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Urinary incontinence is the adverse effect with more impact on patients' quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy., Evidence Acquisition: We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis., Evidence Synthesis: The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence., Conclusions: The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: to assess the level of urinary incontinence and its impact on the quality of life of patients undergoing radical prostatectomy., Method: cross-sectional study carried out with prostatectomized patients. The data were collected from the following instruments: sociodemographic questionnaire, Pad Test, International Consultation on Incontinence Questionnaire - Short Form and King Health Questionnaire. Data were submitted to descriptive and bivariate statistical analysis. The level of significance was set at 0.05., Results: a total of 152 patients participated, with a mean age of 67 years. Among incontinent patients, there was a predominance of mild urinary incontinence. Urinary incontinence had a very severe impact on the general assessment of quality of life in the first months and severe impact after six months of surgery. The greater the urinary loss, the greater the impact on the quality of life domains Physical Limitations, Social Limitations, Impact of Urinary Incontinence and Severity Measures. Most participants reported no erection after surgery and therefore did not respond to the question of the presence of urinary incontinence during sexual intercourse., Conclusion: the present study evidenced the occurrence of urinary incontinence after radical prostatectomy at different levels and its significant impact on the quality of life of men, which reveals the need of interventions for controlling it.

Objective: To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ)., Participants: Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy., Method: A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables., Results: Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used., Conclusions: Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs., (Copyright © 2018 Elsevier España, S.L.U. y SERMEF. All rights reserved.)

Objective: Urethrorrhagia after radicalprostatectomy(RP) is very uncommon, regardless of the surgicalapproach used. Arterio-urethral fistula formation betweeninternal pudendal artery branches(IPA) and bulbarurethra is an exceptional finding., Methods: We report what we consider the first series oftwo cases (one has already been published) of urethrorrhagiaafter open retropubic RP due to urethrovascular fistulaformation with its origin in the IPA or in one of its terminalbranches., Results: Both cases were diagnosed with contrast-enhancedCT, confirmed with arteriography, and they weretreated with superselective transarterial embolization(STE)with spongostan. After 5 years, the first case maintainserectile function using tadalafil on demand. The other caseis in the 2nd postoperative month., Conclusion: Severe urethrorrhagia after RP is an exceptionalcomplication. The existence of an arterio-urethralfistula must be considered when both urethrorrhagia andabnormal bulbar enhancement in CT are present. Arteriographyallows to confirm the diagnosis, most frequently involvingIPA distal branches. STE is an effective and safetreatment.

Objectives: Urinary incontinence (UI) is a significant complication after radical prostatectomy (RP). Although sphincter incompetence is considered the main cause; bladder dysfunction can contribute substantially. Our objective was to evaluate the results of the urodynamic study (UDS) in men with UI after radical prostatectomy and analyze the correlation between symptoms and urodynamic parameters., Methods: We carried out a retrospective study reviewing the symptoms and urodynamics in patients with urinary incontinence after RP. We describe the symptoms, urodynamic findings and we analyze the correlation between both., Results: Our study included 74 patients. The median number of pads used per day was 3. 61% reported urgency, 63% stress urinary incontinence, 11% urgency urinary incontinence and 26% mixed urinary incontinence. The UDS showed stress urinary incontinence in 53% of patients, detrusor overactivity in 53% and, reduced bladder compliance in 43%. Urgency urinary incontinence was reported in 56% of patients with reduced bladder compliance. Urodynamics showed no incontinence in 16% of patients, of whom 80% showed urgency urinary incontinence. Urodynamics data showing obstruction of the urinary tract was reported in 17% and detrusor hypo or acontractility in 36%. Among patients with obstruction, 46% showed incontinence due to detrusor overactivity. The correlation of symptoms and urodynamics showed that only 31% of patients with stress urinary incontinence had incontinence due to detrusor overactivity in urodynamics. Among those with mixed urinary incontinence, urodynamic stress urinary incontinence only was found in 42% and 33% incontinence due to detrusor overactivity only. Finally, among those with symptoms of urgency urinary incontinence, the urodynamics showed detrusor overactivity in 27%., Conclusions: In patients with urinary incontinence after radical prostatectomy, there is a high percentage of patients with urinary tract obstruction, detrusor overactivity and decreased compliance. Moreover, the correlation between symptoms and urodynamics is low.

Introduction: Urinary incontinence (UI) is a complication of radical prostatectomy (RP) and transurethral resection of the prostate (TURP). The gold-standard treatment is the artificial urinary sphincter, however, new treatments have been investigated., Objective: To examine the outcome of an adjustable transobturator male system (ATOMS ® ) in men with UI after prostatic surgery in a low to medium volume continence center., Materials and Methods: Twenty-five men with UI were implanted with ATOMS ® system between 2012 and 2014. The most common indication was UI after RP (92%), followed by UI after TURP (8%). Eleven patients (44%) had received adjuvant external beam radiotherapy (RT). Patients were considered to be 'dry' if they stopped wearing pads or needed just one protective pad per day; and improved if the daily number of pads used decreased by at least half. The Incontinence Quality of Life questionnaire (ICIQ-SF) was used, adding a verbal question about the satisfaction of the patient considering the outcome., Results: After a mean follow-up of 21.56 months, 64% were dry and 8% revealed a significant improvement. The success of the procedure was negatively correlated with the severity of the previous UI and with previous treatment with RT. Concerning patients satisfaction, 84% of the patients would repeat the procedure., Conclusion: ATOMS ® offers good rates of cure and improvement of UI after prostatic surgery with a reasonable rate of minor complications. The results of this study, performed in a low to medium volume continence center, are comparable to the results achieved in high volume continence centers., (Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: The aim of this article is to classify and describe the different types of complications of radical prostatectomy, their frequency of appearance, as well as the different factors that may influence their development., Methods: A systematic review of the literature was carried out, based on the search of published articles between 2002 and 2015., Results: Laparoscopic or robotic radical prostatectomy may require conversion into open surgery, and these cases are significantly associated with longer hospital stay and greater rate of complications. Vascular damage comprises from injuries to small and medium caliber vessels (Santorini plexus or epigastric vessels) to possible lesions of large vessels (iliac), although they are infrequent. The most common nerve injury is that of the obturator nerve, which can be treated in the case of a complete section, and in incomplete lesions, damage is usually reversible. Intestinal injury is one of the most serious complications because it could be lifethreatening. Rectal injury is a complication that needs a correct diagnosis and intraoperative treatment, since it may lead to the development of a secondary rectourethral fistula. Such fistulae in most cases require surgical treatment. Lymphocele is a characteristic complication of radical prostatectomy with pelvic lymphadenectomy, requiring treatment only in cases of complication. Anastomotic leakage is a frequent complication, and a prognostic factor for the later development of anastomosis stricture. Some of the factors that seem to influence the development of complications are associated comorbidity, anatomical factors, surgical approach and surgical experience, among others., Conclusions: It is crucial to know the potential complications of radical prostatectomy, as well as the associated risk factors, in order to avoid their appearance.

Objectives: Prostate cancer can be treated by radical prostatectomy and provoke urinary incontinence as secondary effect. Our aim is to calculate the prevalence of urinary incontinence, characteristics of leakage and influential factors, through a historical series., Methods: We perform a descriptive, observational and retrospective study of 1310 patients who received treatment for PCa between 1989 and 2011. Prevalence was obtained after 12 months of recovery and using ICS definition. To complete ICIQ-SF and number of pads/day used we perform a cross-sectional study. The series is studied globally and divided in two groups according to oncologic characteristics. We perform a descriptive, comparative and predictive analysis., Results: Prevalence of the series was 23.5%, 296 patients. 279 incontinent patients completed ICIQ-SF with a mean score of 11.1±4.03. 16.4% of the patients use 1 pad/day or none, 69% (11.4% of the total) use compress and 22% diapers. 8% of the total use more than 1 pad/day. Clinico-pathological factors divide series in two groups: 1989-1999 with a prevalence of 24.6% and 2000-2011 with 22.8%. Multivariate analysis shows influential factors: age (65 years) (OR:1.65, p=0.013) and prostate volume (50cc) (OR:1.49, p=0.029)., Conclusions: Urinary incontinence is a disease with some prevalence that varies depending on definition. The most common situation was to leak several times a day (42.2%), a small amount (59.1%), using compress (69%) most of incontinents with a mild (0-7: 88.2%) impact on quality of life. Predictive factors were age (65 years) and prostate volume (50cc). The historical changes does not influence over prevalence.

Objectives: To measure the impact of psychotherapy associated to the use of Tadalafil in the improvement of erectile function after radical prostatectomy., Methods: From 132 patients surgically treated for prostate cancer, thirty sequential patients with bilateral nerve sparing, low risk controlled disease and post-surgery erectile dysfunction (ED) took Tadalafil 20mg and underwent psychotherapy sessions, both weekly for three months. Patients were interviewed to establish the quality of erection using the instrument IIEF-5 and to measure psychological features impacting erectile function, aspects related to function, dysfunction, physical and emotional discomfort were evaluated with the help of an intensity scale., Results: The average age was 62.5 (46 to 77 years), 96.7% had a stable relationship, 56.6% of the patients accepted the diagnosis and 43.2% exhibited defense mechanisms (3.3% negation, 6.6% revulsion, 33.3% concern). A positive correlation was observed between erectile function and time exposed to treatment (IIEF-5 - 9.7 to 13.3, p=0.0006), with increased satisfaction with life in general (2.1 to 2.7, P=.028) and sexual life (3.1 to 3.7, P=.028), added to facilitation of expressing feelings/emotions (1.8 to 3.0, P=.0008). Satisfaction with relationship and intimacy with partner did not present significant improve (P=.12 and P=.61, respectively)., Conclusions: A holistic patient care with more complete ED rehabilitation includes psychotherapy with a positive correlation between erectile function and treatment exposition. Psychotherapy allowed the identification of important spouse related factors in this scenario., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP)., Material and Methods: A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis., Results: After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 μm(2)vs. 1,056 ± 844 μm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied., Conclusions: Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications., (Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.)

Objectives: There are various treatments forprostate cancer nowadays, including techniques that have been used for manyyears such as surgery and radiotherapy, and newer procedures that are gaining prominence in the Urological field like cryotherapy or HIFU (high intensity focused ultrasound). Rectourethral fistula is a rare complication that demands the urologist a great capacity; it may happen after either existent treatment., Methods: PubMed literature review with articles published during the last 10 years using the terms "rectourethral fistula" and "prostate cancer"., Evidence Sinthesis: We present the current situation of rectourethral fistula secondary to prostate cancer in terms of epidemiology, diagnosis and treatment, with special focus on the various types of fistulae and their management. We comment on general features in relation to surgical management of this pathology; type of approach, type of repair, use of flaps, concomitant fistula and urethralstenosis, delay of surgery and bowel diversion. We describe the surgical techniques more frequently used today and their limitations. We present the results published by different groups with each of these techniques, as well as the corresponding recommendations based on each group's experience., Conclusions: Rectourethral fistula is a surgical challenge for the urologist. We must choose the appropriate management in accordance to the characteristics of the fistula.

Radical prostatectomy is currently the mainstay of treatment for localized prostate cancer. Although there is evidence that the evolution in surgical technique with the introduction of laparoscopic and robot-assisted radical prostatectomy has resulted in an improvement of functional outcomes, a significant percentage of patients are still bothered by post-prostatectomy incontinence. However, the majority of patients will find improvement in their continence status from conservative measures and a small cohort will require more invasive therapeutic options. Conservative treatment includes pelvic floor muscle training with or without biofeedback techniques and pharmacotherapy. There is evidence that immediate initiation of physiotherapy after surgery will help in early restoration of continence, while additional benefit can be provided from pharmacotherapy mainly from duloxetine. The present review aims to provide an update on the epidemiology of post-prostatectomy incontinence, identify risk factors for incontinence after surgery and suggest current trends for conservative treatment.

Testosterone Deficiency Syndrome is associated with age. Recent studies advocate for the safety of hormonal treatment with testosterone in patients with history of Prostate Cancer (PC) ,once disease-free survival is confirmed. A total of five publications describe 110 patients treated with testosterone replacement therapy, having a history of PC, who had undergone radical prostatectomy (RP). Only one patient had biochemical recurrence during replacement therapy. Testosterone replacement therapy must be indicated in selected patients with history of low risk localized prostate cancer treated satisfactorily who are symptomatic and have good oncological control. The testosterone levels to achieve should be the minimum effective to obtain a symptomatic response. Adequate information on the benefits and potential risks must be understood and accepted by the patient.

Objectives: The study was conducted to assess the incidence of positive surgical margins (PSMs ) in our series of laparoscopic radical prostatectomy (LRP ) performed by a fellowship trained surgeon in independent practice., Methods: In this series, 300 patients underwent LRP by the same surgeon at our institution. The prospectively created records of all consecutive LRPs were reviewed. The patients were divided into three groups based on the time of surgery: group I included the first 100 cases;group II included the second 100 cases; and group III the last 100 cases. We compared the incidence rate and the location of PSMs among the groups. As additional variables, prostate-specific antigen (PSA ) level, biopsy/specimen Gleason score, clinical/pathological stage and pathologic tumor volume were also evaluated., Results: Patient demographics and preoperative staging variables were comparable among the three groups, with no statistically significant differences among them. The PSM rates were 27%, 22% and 27% for groups I, II and III, respectively. The difference in overall PSM rates in the three groups was statistically insignificant (p: 0.966 ) . PSM rates decreased specifically at the posterolateral region and in pT3b stage with non/significant difference when comparing the first 100 patients to the last 100 patients., Conclusion: Pathologic surgical margin safety can be achieved with laparoscopic fellowship/training (LFT ) from the initial cases in independent practice.

Radical prostatectomy is currently the standard of care for localized prostate cancer. In the last decade, the minimally invasive surgery, especially the robotic surgery has been growing and open techniques are less frequent performed. A non-systematic review of the literature is performed, highlighting the current situation of the perineal radical prostatectomy in the minimally invasive era, its indications, and functional and oncological outcomes. Radical perineal prostatectomy, when compared with other surgical approaches, still experience favorable outcomes. Urologist might be abandoning an underused surgical approach.

Radical prostatectomy is a well known treatment for prostate cancer, with a low incidence of early postoperative complications. Our case is a 54 year old patient diagnosed with prostate adenocarcinoma, Gleason score 3+3=6 with 8 ng/ml of PSA, treated by retropubic prostatectomy, who suffered spontaneous perforation of the duodenum. We chose a conservative management, resolved in 30 days. When dealing with a surgical patient all kinds of complications must be taken into account by performing the minimum tests that will enable a sure diagnosis to be achieved. The usual treatment is surgery or conservative management, depending on the case and the patient.

Objectives: To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks)., Material and Methods: Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently., Results: For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations., Conclusions: The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Radical prostatectomy is an excellent salvage method for patients with prostatic cancer when radical radiotherapy or brachytherapy fail. To define local failure is not always reliable; nevertheless, performing a prostatic biopsy two years after treatment could reach an early diagnosis. Another accepted attitude is to perform the biopsy after biochemical recurrence, but sometimes the pathological stage is already locally advanced tumor. It is also difficult to determine which patients are suitable for this rescue treatment, probably those with locally confined tumors and with favorable PSA kinetics, PSA velocity below 2.0 or a PSA doubling time over 12 months, and in whom detectable PSA is reached 2 years after treatment. These patients are suitable for radical prostatectomy if they have a live expectancy of more than 10 years. Although rescue radical prostatectomy has a higher rate of complications and worse functional results, cancer-specific survival rates are high, and remain high after 15 years of follow-up. Currently, new surgical improvements and new radiotherapy technology are diminishing surgical complications and improving functional results. In summary radical prostatectomy is a feasible rescue procedure after radiotherapy failure although the complications rate remains higher than prostatectomy as initial therapy.

Objectives: To report the clinical characteristics of rectourethral fistula (RUF) after radical prostatectomy (RP) as well as our experience managing them., Methods: We present our experience in the treatment of RUF based on their clinical characteristics and the presence of associated complexity factors. After medical history and physical examination, the diagnostic work up was completed in all cases with urethrograms, cystoscopy and barium enema. From January 2000 to July 2010 we treated 12 patients with RUF. Mean age was 64 years(range 56-74 years). The etiology was open surgery in two cases and laparoscopic surgery in ten. Clinical presentation varied from 4 to 60 days after surgery., Results: In our experience, endoscopic and radiological findings were well correlated. Two fistulae were small-less than 5 mm- on the urethral side of the anastomosis allowing spontaneous closure after conservative treatment. Ten patients had larger fistulas on the bladder side of the anastomosis and/or were associated with complexity factors that required a posterior transsphincteric York-Mason approach for resolution, with good recovery of urinary and fecal continence., Conclusion: The RUF is a significant complication after RP and it is difficult to solve. We propose early reconstructive surgery in large or complex RUF. The posterior transsphincteric York-Mason approach has allowed the repair in all cases.

Objective: To know the incidence of vesicourethral anastomotic stricture in patients with prostate cancer treated with radical prostatectomy. Our secondary aim was to verify if postoperative radiotherapy increases the risk of presenting anastomotic stricture., Materials and Methods: We retrospectively checked the clinical records of patients that had undergone radical prostatectomy as their primary treatment between January 2000 and December 2008, with a minimum clinical follow-up of 12 months. Of the total patients, 258 met the foregoing requirements. Of them, 25 (9.6%) received postoperative radiotherapy, 12 (48%) received adjuvant radiotherapy and 13 (52%) received salvage radiotherapy. The mean age of the patients that received radiotherapy was 64 (46-77) years. The mean pre-radiotherapy PSA was 2.3 (0.04-26.1) ng/ ml. The mean time between surgery and radiotherapy was 17.4 (3-72) months. The mean dosage administered was 68 (58-70) Gy. The mean follow-up was 50.5 (15-177) months., Results: Of 25 prostatectomized patients that received radiotherapy, four (16%) developed vesicourethral anastomotic stricture. The mean time from the completion of the radiotherapy until the appearance of the stricture was 4 months (1-22). On the other hand, 36 (15.4%) of the prostatectomized patients that did not receive postoperative radiotherapy presented the same complication. Comparatively, we did not note significant differences between both groups (p=0.599)., Conclusions: In our retrospective review, postoperative radiotherapy did not significantly increase the incidence of vesicourethral anastomotic stricture., (Copyright © 2010 AEU. Published by Elsevier Espana. All rights reserved.)

Objectives: To know the rate of nosocomial infections in open prostate surgery and to assess the application of pre-surgery preparation and preoperative antibiotic prophylaxis protocols at three public hospitals in the Autonomous Community of Madrid., Materials and Methods: Prospective observational and multicentre study, including all the patients operated on at the services monitored and admitted for more than 48 hours between 1 January and 31 December 2009. They were monitored from admittance until their discharge., Results: The rate of hospital infection observed was 3.38%. The most frequent infection was surgical localization, with an incidence rate of 2.77% (superficial=1.23%; deep=0.31%; organ-space=1.23%). The percentage of appropriate surgical prophylaxis, both in the indication and in the selection of antibiotics, initiation and duration, with respect to all those patients that received it, was 47.42%. According to the data obtained from their clinical records, the percentage of patients in which the pre-surgery preparation protocol was correctly complied with, was 92%., Conclusions: The results obtained in this multicentre study can serve not only as a reference to other public hospitals, but they are also comparable to other international monitoring systems. Monitoring and controlling infections associated with healthcare must be a key aspect in Patient Care and Safety programmes., (Copyright © 2011 AEU. Published by Elsevier Espana. All rights reserved.)

Moderate-severe urinary incontinence and refractory-to-treatment erectile dysfunction after radical prostatectomy are two entities causing an important loss of quality of life to patients. The double implant of penile prosthesis and artificial urinary sphincter is a safe and effective option in these cases. This article describes preoperative considerations and the most important technical steps to do it satisfactorily.

Objective: To assess erectile dysfunction in patients with prostate cancer undergoing surgery by radical prostatectomy, laparoscopic prostatectomy or robotic prostatectomy., Material and Methods: Systematic Review of literature based on a search strategy (2000-10) in MedLine, Embase, Cochrane Library, CRD, ECRI, and Hayes. Mesh terms used were Prostatectomy, "Prostatic Neoplasm, Transuretral Resection Prostate, Impotence and as free terms erectile dysfunction and prostatectomy. Studies included patients with prostate cancer underwent by prostatectomy radical with open surgery (retropubic), laparoscopic or robotic surgery., Results: Ten observational studies with moderate quality and 29 case series with low quality were selected. Observational studies showed lower percentages of erectile dysfunction after intervention in the patients underwent robotic surgery (3-51%). Radical surgery (36-91%) and laparoscopic surgery showed higher values of impotence. In the studies that compared surgery versus radiotherapy, the results were better for radiotherapy (3-72% erectile dysfunction). In the case series, lower percentages of erectile dysfunction were shown in patients underwent to robotic surgery (22%), the following was for laparoscopic surgery (40%) and open radical prostatectomy (41.4%)., Conclusions: This result should be considered with caution because of the low methodological quality of the studies included. However, the different surgical techniques assessed showed similar effects in the two types of studies included and we found that robotic surgery presented lower percentages of sexual impotence.

Objectives: Evaluate the introduction of the enucleation with Holmium laser in our center, including the surgeon's learning curve by the analysis of the patients., Materials and Methods: 150 procedures have been analyzed in a retrospective manner with an average follow-up of 11 months. Qmax, IPSS and Qol have been determined before surgery, at 6 months and 12 months, realizing their statistic analysis. PSA was measured before surgery and after 3 months. Complications, surgical time and hospital stay have been analyzed., Results: Average patient age was 72, 4 years. Average prostatic size was of 71,3 gr (18-150). Average hospital stay was of 22 h. Qmax before surgery, 6 months, 12 months was of 7,53 ml/s, 23,24 ml/s and 21,62 ml/s being statistically significant (p<0,01). Transfusion rate was of 1,3% and urethral stenosis rate of 4%. IPSS improvement at 6 and 12 months was statistically significant as well (p<0, 01)., Conclusions: Enucleation with Holmium laser is a safe and effective technique with lower complication rate than TURP, included during the learning curve.

Objectives: We show our experience in the treatment of post-prostatectomy stress urinary incontinence with the male Remeex system (MRS). We also describe the elements of the system, its therapeutic indications, technical implantation and appropriate adjustment., Methods: From March 2007 to January 2009 five male patients aged 57 to 71 years (mean age 66 years) with postprostatectomy stress urinary incontinence were operated on to insert a suburethral readjustable sling (Remeex). All patients had severe urinary incontinence with deterioration of their quality of life. The evolution period ranged from 2 to 10 years with an average of 3.5 years, requiring from 5 to 8 pads a day., Results: All patients are continent after a mean follow up of 15.4 months (range 6-28 months). Only two of them use one security pad when they perform physical efforts. The Incontinence Impact Questionnaire (7) scores before surgery and 6 months after diminished from 68+/-7 to 10+/-3. All patients are very satisfied., Conclusions: MRS is a valid therapeutic option for post-prostatectomy incontinence, being a reproducible technique, of easy execution, that allows readjustment through a suprapubic incision under local anesthesia as an outpatient procedure. It has a low complication rate with excellent and endured results.

Introduction: Radical prostatectomy in all its approaches is the treatment of choice for localized prostate cancer and especially in young, sexually active patients with a desire to keep their sex life. In addition to the well-known and defined postoperative erectile dysfunction, erectile silent period causes, in many patients (9-1%), structural changes, in the penile structure, sometimes irreversible. These tissue changes, resulting in a loss of length and girth, that concern patients., Objective: To systematically review to date published data in the literature regarding penile changes after radical prostatectomy., Material and Methods: We performed a systematic search in: PubMed, EMBASE, Cochrane, SCOPUS, Science Citation Index period January 1990 to September 2009 for the terms prostatectomy, organ size, fibrosis, sexual activity, erectile dysfunction, penile size, radical prostatectomy, prostatic neoplasms, body weights and penis measures. Seven series of patients were selected for analysis., Results: We described the different measurement methods and their potential biases and differences. Also, we reviewed main physiopathogenic theories to explain this phenomenon. Finally, we detail the results of different series of patients reported., Conclusions: It seems to be a proven fact that the penis undergoes major changes in its length and girth after radical prostatectomy. Several authors have communicated the data of their series and the different treatment options (5PDE inhibitors, vacuum devices, penile extenders, etc.). Strategies addressed to preserve and protect cavernous tissue and tunica albuginea after the procedure, as well as to increase oxygenation and allow erection to be recovered in the shortest possible time positive will impact on the quality of life of our patients.

Objective: To review the incidence of and analyze the factors contributing to perioperative complications in patients undergoing robotic radical prostatectomy in our experience of 250 procedures., Materials and Methods: An analytical, descriptive, retrospective study was conducted of 250 consecutive patients who underwent robotic radical prostatectomy during a period of three years and two months (January 06-March 09). Data recorded included age, preoperative Gleason grade and PSA, and prostate volume. All procedures were performed by three surgeons through a transperitoneal approach using a four-arm da Vinci robotic system. Microsoft Excel support was used. Surgical variables recorded included setup time, console operation time, mean bleeding, transfusion rate, hospital stay, and urethral catheterization time. Incidences and intraoperative and postoperative late and early complications in these patients were reviewed., Results: Demographic data recorded included: mean age, 61.5 years (47-74); mean preoperative PSA, 8.18 ng/mL (2.6-34 ng/mL); mean Gleason grade, 6.8 (2-9); and mean prostate volume 34.9 mL (12-124). Surgical variables recorded included: console setup time, 10.8 min (6-47): console operation time, 125 min (90-315); mean bleeding, 150 mL (50-1150); and a 3.6% (9/250) transfusion rate. There was no peroperative mortality, and no conversion to open or laparoscopic surgery was required. Ninety-six percent of patients (240/250) had an adequate postoperative course, with a mean hospital stay of 4.2 days (3-35) and urinary catheter removal after 8 (5-28) days. Overall complication rate was 10.6%, with major complications occurring in only 3.2% of patients (8/250) and consisting of five surgical and three medical complications. Repeat surgery was required in 1.6% of cases (4/250) due to late peritonitis for cecal perforation, bleeding from epigastric artery, perineal percutaneous drainage of retrovesical hematoma, and pelvic urinoma after bladder catheter dislodgment. One patient required selective arterial embolization for persistent hematuria due to vesical artery fistula. Medical complications included acute renal failure due to thrombotic purpura resolved with hemodialysis in one patient and late pulmonary embolism managed with anticoagulation in two patients. Robot malfunction with no surgical implications or need for surgical conversion occurred in four patients (1.6%). Surgical maneuvers required to resolve late complications included one umbilical hernia repair, one meatotomy for meatal stenosis, one bladder neck endoscopic incision after contracture, and one endoscopic extraction of Hem-o-lok and vascular clip following erosion-migration into the bladder., Conclusions: Robotic radical prostatectomy is a safe and reproducible procedure with optimal functional and oncological results, a shorter learning curve, greater comfort and vision for surgeons, and a complication rate similar to and even better than reported for open and laparoscopic surgery series. Complications decrease with the learning curve, but surgical team experience continues to be the key factor to achieve better results.

Objectives: Prostate cancer is the urologic neoplasia that has experienced more changes in the last decade, with a great increase in incidence and diagnosis. Prostate cancer patient's management is clearly multidisciplinary, with the participation of urologists mainly, but also specialized pathologists, radiologists, biochemists, medical oncologists, radiation oncologists and others. The expected long survival makes the routine visit for PSA control non sustainable, without paying attention to the presence of urinary symptoms and other functional disorders with great repercussion on the quality of life., Objectives: To present urinary dysfunction in patients with prostate cancer from a non oncological but urodynamic and quality of life point of view. Secondarily, to pose the clinical features not translated to functional and urodynamic pathology (urinary toxicity, radiation toxicity, bladder hyperactivity...), Methods: We review and update voiding dysfunction that may be present in prostate cancer patients. Not only urinary incontinence after radical prostatectomy. We integrated author;s experience with its physiopathology, sphincter electromyography, and urodynamics, and a general review on the topic using the latest bibliography., Results: Surgical techniques have improved very much, resulting in very high continence rates, which do not enable to consider one approach or the use of robotics better than others. Prostate cancer present multiple urodynamic scenarios. Constrictive or compressive lower urinary tract obstruction, detrusor muscle hyperactivity, diminished compliance, stress urinary incontinence due to sphincteric deficit, mixed urinary incontinence, bladder dysfunction. Other scenarios are not defined by urodynamics., Conclusions: Patients with prostate cancer may currently receive a defective evaluation by their urologists in terms of urinary symptoms due to the prevalence of oncological features in their evaluation. Prostate cancer shows a great diversity of urodynamic scenarios subject of study, not only post-radical prostatectomy incontinence.

Urinary artificial sphincter (UAS) is currently the gold standard treatment for urinary incontinence after radical prostatectomy. 5-25% of the patients under-going radical prostatectomy develop urinary incontinence. This complication generates important deterioration in the quality of life of these patients. Conservative and minimally invasive treatments, such as Kegel exercises, use of pads, drugs, and electrostimulation, or minor surgery have been used without success. This review summarizes the advantages and complications of the urinary artificial sphincter and its efficacy in the management of urinary incontinence after radical prostatectomy.

Objectives: To diffuse the concept and implantation surgical technique of a new prosthesis for the treatment of stress urinary incontinence, the Flow Secure artificial urinary sphincter., Methods: The prosthesis is a single silicone piece filled with saline solution which has the following parts: (1) Pressure regulation reservoir, (2) assistance reservoir for stress situations, (3) control pump with self-sealant port and (4) a cuff. One of the main characteristics is the self-sealant port enables pressure adjustment depending of the clinical needs of the patient as many times as necessary., Results: The surgical technique is simple and the level of continence achieved excellent. The only complication inherent to the Flow Secure design is perforation of the cuff during the act of pressurization, but it has been corrected by designing a new control pump which can not be punctured. Self limited scrotal edema/hematoma are frequent; they can be avoided minimizing the time of trocar use. The remainder complications are common with the AMS 800 and other implantable prosthesis., Conclusions: Despite midterm good results, we need to wait for a greater number of patients with the Flow Secure sphincter and longer follow up to determine the definitive role of this prosthesis for the treatment of urinary incontinence.

Objectives: Update on the urodynamic evaluation in patients with prostate cancer who have incontinence., Methods: To review the urodynamic studies in prostate cancer patients who suffer from incontinence, irrespective of the treatment carried out., Results: The largest amount of information on urodynamic studies in patients with prostate cancer and incontinence was found in those with post-prostatectomy incontinence. There is much more limited work on irradiated patients, and after medical treatment., Conclusion: The urodynamic study in these patients may help clarify the etiopathogenic mechanisms of incontinence, try to predict risk factors before treatment and help the therapeutic decision making. Further studies are needed, especially in patients undergoing radiotherapy, to further assess the mechanisms involved in lower urinary tract abnormalities that occur in these patients.

Objectives: Prostate cancer early detection campaigns have led to the diagnosis of a greater number of patients with organ-confined disease candidates for intention-to-cure treatment. Radical prostatectomy is one of these treatments; despite the technical advances with the development of laparoscopic or robotic operations it still has urine incontinence as a side effect affecting patient's quality of life., Methods/results: Based on the experience in the Urology Department at Hospital La Paz we describe the technique and our results, comparing with a bibliographic review of other techniques used for the treatment of urinary incontinence after radical prostatectomy from the Medline database., Conclusions: The insertion of the paraurethral ProACT is the treatment of choice for mild-moderate incontinence after radical prostatectomy in our environment due to its high success rate and low morbidity, technical easiness, and adequate cost and resources requirements.

Objectives: Stress urinary incontinence alter radical prostatectomy is one of the most worrisome sequelae for the patient and urologist. The aim of this paper is to evaluate the indications of the suburethral mesh Invance, giving details on our preoperative evaluation and indication, surgical technique, and the correlation between preoperative findings and functional results., Methods: Between February 2006 and January 2009 27 patients underwent surgery. All of them had more than one year of follow up after prostatectomy, urodynamic study and preoperative cystoscopy. Continence was evaluated by the number of pads/day and the ICIQ-UI SF questionnaire. Through a perineal incision three titanium screws with a polipropylene suture were inserted in each ischiopubic rami, and a silicon/polipropylene mesh (Invance) is affixed to them, compressing the bulbar urethra. Patients were divided into two groups: good prognosis (1-2 pads/day without urodynamic anomalies in the filling phase) and bad prognosis (3 pads/day, history of radiotherapy or bladder neck incision, and urodynamic anomalies). Cure was defined as a patient not needing pads, and improvement was defined as decrease in the number of pads per day., Results: Median follow up after Invance was 18 months (4-38). Nine patients used one pad/day, 10 used two, and eight used three pads /day. Six cases had underwent previous bladder neck incision and three radiotherapy. Globally, 20 patients (74% ) were cured and five (19% ) had improved. Cure rate was 100% in the good prognosis group and 61% in the bad prognosis group (p=0.03). No intraoperative complications were registered. During the immediate postoperative period,one patient required cystostomy tube for 10 days. Seven patients (26% ) presented perineal discomfort; neither de novo urgency nor urethral erosion nor sling explants due to infection were registered., Conclusions: Invance is a safe technique that guarantees a high continence rate in selected patients. It is a reproducible operation and, with a midterm follow up, no loss of continence has been observed, and the risk of urethral erosion is null in our experience. Patients with mild-moderate incontinence, without urodynamic anomalies nor previous radiotherapy are the ideal candidates.

Objectives: In patients with localized prostate cancer and life expectancy longer than 10 years, radical prostatectomy (RP) remains the Gold Standard. Radical surgery must achieve good oncological and functional outcomes with early continence and potency. In expert hands RP offers very low post-prostatectomy urinary incontinence rates. To analyze functional outcomes regarding urinary incontinence (UI) after RP in our centre in the last ten years., Methods: We have performed a retrospective study of the 137 patients who had a radical prostatectomy (open retropubic or laparoscopic) on the General University Hospital of Elche from 1998 to 2008. Two patient groups were analyzed, patients who had surgery from 1998 to 2003, and those who had surgery from 2004 to 2008. Stress UI rates after RP were determined in both groups at 1, 3, 6 and 12 months following surgery with patient pad day usage. Urethrovesical anastomosis strictures were also analyzed in each group and their resolution., Results: 15 patients were excluded from the initial 137 because cT3 stage was detected, remaining 122 prostatectomies with

External beam radiotherapy is consolidated like radical treatment for localized and locally advanced prostate cancer. In addition, more and more studies show its effectiveness as much in postoperative as in salvage intention. Before choosing a therapeutic option, it is important to know the baseline state of the patients and the possible side effects of the treatment. In that way, different questionnaires and toxicity scales are at our disposal. Acute effects, during the treatment and the following weeks, are due to irritating and inflammatory symptoms. Chronic toxicity, months or years after radiotherapy, are consequence of the fibrosis and ischemia, as well as of alterations at the myogenic and neuronal level. Urinary incontinence is a relatively uncommon symptom among patients who have been treated with radiotherapy. But, due to the profound impact on the quality of life of our patients, it is necessary to identify patients at higher risk. Antecedent of transurethral resection of the prostate, before or after the irradiation, and severity of acute genitourinary toxicity increase the risk of developing incontinence.

Objectives: To present recent data on the epidemiology of urinary incontinence in prostate cancer (PCa). To review the incidence of urinary incontinence, its impact on quality of life and related pharmacoeconomic features., Methods: We performed a bibliographic review about the complications of the various therapeutic options for PCa including radical prostatectomy (RP) (open, laparoscopic and robotic), external beam radiotherapy, brachytherapy, cryotherapy, and high intensity focused ultrasound (HIFU)., Results: The lack of uniformity for urinary incontinence definition, for its evaluation, and for the way to report it makes the interpretation of functional results and impact on quality of life after any treatment option difficult and uneven. Generally, we documented that urinary incontinence after treatment appears more often in patients undergoing radical surgery. Nevertheless, we stated that neurovascular bundle preservation, performance of the procedure in high volume centers, by high volume surgeons, and development of robotic surgery may positively influence the global outcomes of this technique. Moderate incontinence is less frequent after external beam radiotherapy, but the association of rectal pain and diarrhea, in up to 40%of the patients, worsens voiding symptoms. Irritative and obstructive voiding symptoms after perineal brachytherapy are especially associated with long term erectile dysfunction as well as rectal morbidity. In the case of cryotherapy and HIFU the available studies are case series and there are not randomized studies comparing them with the primary treatment of localized PCa., Conclusions: Each treatment modality for PCa is associated with a different pattern of changes in the urinary, sexual, intestinal and hormonal related quality of life domains. Two key factors when evaluating incontinence are information about continence before the procedure and the use of validated, self-administered evaluation means. Although technical improvements in all procedures should contribute to diminish the impact of complications, we should not forget the trend to the association of therapies- multimodal therapy- has a higher complication profile. Therefore, they should be reserved for patients in whom a benefit has been proved.

Objectives: To summarize the lessons learnt after having performed more than 250 AdVance sling procedures. Postprostatectomy incontinence is a depressing reality that is often underestimated by the prostate surgeon. The practiced gold standard for treating severe stress urinary incontinence has been the artificial urinary sphincter. No such consensus exists for mild to moderate incontinence. This paper is about an incontinence operation with the goal to support postprostatectomy sphincter laxity., Methods: The hypothesis of postprostatectomy sphincter laxity is new, as well as restoring continence by proximal relocation of the proximal corpus spongiosum. Abstracts dealing with these issues are summarized. Selected points of technique are highlighted, including modifications that have been made along the way. Lastly the first and last 20 patients treated in this series of 250 patients are compared in terms of operative indication, surgical technique and treatment outcome. Some definitions are added for clarity., Results: It could be demonstrated that the final position of the AdVance sling is retroluminal, i.e. 5-10mm dorsal/behind the lumen of the membranous urethra (=sphincteric urethra). Comparing the first 20 to the last 20, there were no treatment failures in the latter. A two year follow-up showed a continence rate of 65% in the first group, compared to a 85% continence rate in the second group taking into account the short median follow- up of 4.1.months in the latter. Tunneling the sling subcutaneously decreased postoperative loosening significantly., Conclusion: The AdVance sling is a safe method of treating mild to moderate postprostatectomy incontinence, with no erosions in this series of patients. The hypothesis of sphincter laxity seems to play a definitive role in the pathophysiology of male incontinence. Correction of this urethral support descent or "prolapse" seems to be highly effective. Further studies are needed to accurately define the exaxt mechanism of action of the AdVance sling.

Stress urinary incontinence (SUI) is a symptom appearing in both males and females. Pharmacological treatment has demonstrated to be effective for female SUI, but its role for treatment in males is controversial. This review evaluates the various types of drugs, their effects, and levels of efficacy in the studies.

Introduction: Increased life expectancy has made possible radical treatment of localized prostate cancer in patients over 70 years of age. Perioperative morbidity of radical prostatectomy in elderly patients depending on surgical procedure has not been adequately analyzed., Objectives: To comparatively analyze the incidence, severity, and management of perioperative complications of retropubic versus laparoscopic radical prostatectomy in patients older than 70 years., Material and Methods: A retrospective review was made of 68 patients over 70 years of age (of whom 42 underwent retropubic and 26 laparoscopic radical prostatectomy) taken from a series of 500 patients. The modified Clavien classification was used to study complications from both surgical procedures., Results: The overall complication rate was 59.5% for the retropubic and 23% for the laparoscopic procedure (P=.003). Three grade I, 2 grade Id, 19 grade II, and 1 grade IId complications were seen with retropubic surgery, as compared to 2 grade I and 5 grade Id complications with the laparoscopic procedure. The most common complications included intraoperative bleeding (38%) and urinaryi fistula (15%) respectively., Conclusions: Radical prostatectomy is a procedure that is not free from complications in patients older than 70 years, though these are usually mild. The advantages usually attributed to laparoscopy also apply to elderly patients, and should therefore be considered as the procedure of choice., (Copyright 2009 AEU. Published by Elsevier España, S.L. All rights reserved.)