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Objective: To compare continence outcomes in post-prostatectomy patients undergoing supervised in-person versus online pelvic floor muscle training and pelvic floor education (iPMFT vs oPFMT/PFE). Despite the proven benefit of in-person PFMT for urinary incontinence (UI) following prostatectomy, numerous barriers impede access. We developed a comprehensive online program to deliver oPFMT/PFE., Methods: We performed a retrospective review of patients receiving iPFMT versus oPFMT/PFE with minimum 12-month follow-up. Outcomes were assessed at 3 weeks, 3-, 6-, and 12 months following robotic-assisted laparoscopic prostatectomy using validated ICIQ-MLUTS and IIQ-7 questionnaires and additional items (daily pad use [PPD] and satisfaction). The primary study outcome was ICIQ-MLUTS SUI domain score (SDS). Secondary outcomes were PPD, PPD cure (0 PPD at 12 months), SUI cure (12-month SDS=baseline score), and QOL score (IIQ-7 Sum)., Results: Analysis included 41 men. Though men enrolled in oPFMT/PFE demonstrated lower SUI domain scores than iPFMT at most time points (3wk P <.01, 3 mo P = .04, 6 mo P = .15, 12 mo P = .04), the rate of improvement from 3 weeks to other time points was similar between groups (P = NS at all time points). SDS Cure was no different for oPFMT/PFE (75%, 15/20) compared to iPFMT (60%, 12/20, P = .3). PPD and IIQ-7 were also similar at all time points and demonstrated a similar rate of decrease over time through 12 months., Conclusion: Significant and similar improvements in UI and QOL are seen both in men completing iPFMT or oPFMT/PFE programs. Our novel online program provides another option to improve PFMT/PFE access in men undergoing RALP., Competing Interests: Declaration of Competing Interest Dr. Rapp is the owner of HFITNESS, LLC and creator and owner of the website and copyright for educational materials of the reported oPFMT/PFE. Conflict of Interest exemption and related management plan was approved by the UVA COI Committee (2018–17). As part of this plan, enrollment was performed by study research coordinators without Dr. Rapp present. All subjects were informed of Dr. Rapp’s financial interest in HFITNESS, LLC and provided with ombudsperson contact information to approach if they believed that Dr. Rapp’s financial interest interfered with the course of research. Dr. Rapp provided website and program tutorial at program initiation. All outcomes data collection and related database entry, including validated questionnaires, was performed independently by clinical research coordinators. All data and statistical analysis were performed independently by UVA Department of Public Health Sciences. An independent faculty member not participating as a study investigator was also appointed to review project results to ensure data integrity., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: We evaluated whether placement of a retropubic urethral sling fashioned from autologous vas deferens during robotic assisted radical prostatectomy would improve recovery of continence., Materials and Methods: In a phase 2, single blind trial age stratified patients were randomized to undergo robotic assisted radical prostatectomy by multiple surgeons with or without sling placement. The outcomes were complete continence (0 urinary pads of any type) and near continence (0, an occasional or 1 pad per day) at 6 months, which was assessed by the Fisher exact test and logistic regression. The Kaplan-Meier method and the log rank test were used to evaluate time to continence. EPIC-UIN (Expanded Prostate Cancer Index Composite-Urinary Inventory) and I-PSS (International Prostate Symptom Score) 1, 3 and 6 months after catheter removal were evaluated by mixed models for repeated measures., Results: Of 203 patients who were recruited 95 and 100 were randomized to undergo sling and no sling placement, respectively, and completed postoperative interviews. Six months after surgery the proportions reporting complete and near continence (66% and 87%, respectively) and times to complete and near continence were similar in the groups. Younger age was associated with a higher likelihood of complete continence (OR 1.74 per decreasing 5-year interval, 95% CI 1.23-2.48, p <0.01) and near continence (OR 2.18 per decreasing 5-year interval, 95% CI 1.21-3.92, p <0.01) adjusting for clinical, urinary and surgical factors. Adjusted EPIC-UIN and I-PSS scores changed with time but did not differ between the groups. No serious adverse events were observed., Conclusions: This trial failed to demonstrate a benefit of autologous urethral sling placement at robotic assisted radical prostatectomy on early return of continence at 6 months. Continence was related to patient age in adjusted models., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Unlabelled: What's known on the subject? and what does the study add?: Previous studies have shown that robot-assisted radical prostatectomy (RARP) can be performed in men with high-risk prostate cancer with similar outcomes to that of open surgery. However, most of the literature consists of small case series and compares RARP outcomes to open outcomes from the literature. This study compared a cohort of high-risk patients undergoing open RP and RARP at a single institution with good follow up. We found no difference in positive margin rates or likelihood of prostate cancer recurrence. This adds to the growing evidence that RARP is a safe option for men with high-risk disease., Objective: To compare oncological outcomes in high-risk patients who underwent open retropubic radical prostatectomy (RRP) and robot-assisted RP (RARP) at a single institution. Despite equivalent oncological outcomes between open RRP and RARP, the use of RARP in men with high-risk tumours has been debated., Patients and Methods: A retrospective analysis of high-risk patients treated with open RRP or RARP at UCSF from 2002 to 2011 was conducted. The relationship between surgical approach and positive margin rate was assessed by multivariate logistic regression Cox proportional hazards regression assessed the effect of surgical approach on time to tumour recurrence., Results: In all, 177 open RRP and 233 RARP patients made up the final cohort for analyses. The mean (SD) age was 61.6 (6.6) years and the median (range) follow-up was 27 (2-112) months. RARP patients had less blood loss (median 200 vs 400 mL, P < 0.01) and underwent complete bilateral nerve sparing more often (54% vs 34%, P < 0.01) than those undergoing open RRP. There were no differences by approach in pathological grade, stage, or positive margin rates. However, there was a trend towards higher positive margin rates with RARP early on. Recurrence-free survival was similar at 2 years (84% and 79%) and 4 years (68% and 66%) after open RRP and RARP, respectively (log-rank P = 0.53)., Conclusions: This study is novel in that it assesses outcomes of open RRP vs RARP in a cohort of high-risk men at a single institution. RARP appears to be a feasible option for men with high-risk prostate cancer and displayed equivalent oncological outcomes compared with open RRP., (© 2013 BJU International.)

Purpose: Prostate cancer biopsy information is important for patient risk assessment. Although the number and extent of positive biopsies have been used to predict recurrence, the impact of positive biopsy location and contiguity is less clear. We compared the ability of positive prostate biopsy location and pattern with number and percent positive biopsies to predict recurrence after RP., Materials and Methods: From CaPSURE we identified 2,037 men treated with RP from 1992 to 2002 for whom detailed biopsy information and 2 or more followup PSA values were available. Treatment failure was defined as 2 consecutive PSA values of 0.2 ng/ml or higher, or a second treatment delivered more than 6 months after RP. Biopsy tumor volume (number and percent positive sites), location of disease (anatomical site, laterality), and contiguity of positive biopsies were entered into Cox proportional hazards models to predict risk of disease recurrence while controlling for Gleason grade, PSA and T stage., Results: Higher number and percent of positive biopsy cores were associated with prostate cancer recurrence, risk stratification category and Gleason grade, p <0.0001, HR 1.09 (CI 1.02 to 1.16) and 1.01 (CI 1.00 to 1.01), respectively. Number of biopsy cores taken, laterality, contiguity and positive biopsy location were not associated with disease recurrence., Conclusions: The number and the percentage of biopsies positive for cancer correlated with treatment failure after radical prostatectomy. Contiguity, laterality and location were not associated with recurrence.