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IPP as a predictor of incontinence after LRP
Editorial Comment Editorial Comment to Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy Urinary incontinence affects the quality of life of men after radical prostatectomy (RP). Because of this, many studies have analyzed the risk factors for urinary incontinence after RP. In particular, nerve sparing,1 procedure and operative methods are important factors for urinary continence. Several systematic reviews have evaluated the risk factors for urinary incontinence after laparoscopic radical prostatectomy compared with retropubic radical prostatectomy. Recently, several studies have identified preoperative factors and surgical techniques associated with the urinary continence recovery rate after robot-assisted radical prostatectomy compared with retropubic radical prostatectomy or laparoscopic radical prostatectomy.2,3 Intravesical prostatic protrusion (IPP) is a useful parameter for voiding function associated with bladder outlet obstruction. Some reports have also shown that IPP affects storage symptoms of the bladder. The present study evaluated the significance of IPP as a predictor of early urinary continence after RP.4 If urinary incontinence after RP is urge incontinence associated with overactive bladder, it should be considered separately from stress incontinence. One of their speculations why IPP status predicts urinary continence is the correlation of IPP with the storage symptom scores of international prostate symptom score. That means IPP is related to the overactive bladder symptoms due to preoperative benign prostatic hyperplasia. However, urinary incontinence is urge urinary incontinence, anticholinergic medicine or beta3-adrenoceptor agonists may work for significant IPP group after RP.
© 2014 The Japanese Urological Association
In contrast, the significant IPP group might sustain more surgical damage at the smooth muscular internal sphincter during bladder neck dissection. IPP measurement is a useful non-invasive method. Therefore, surgeons can use IPP status to select the procedure and operative methods in terms of urinary continence. Yoshiko Maeda M.D., Ph.D. Department of Urology, Tokyo Women’s Medical University, Aoyama Hospital, Tokyo, Japan [email protected] DOI: 10.1111/iju.12443
Conflict of interest None declared.
References 1 Kaye DR, Hyndman ME, Segal RL et al. Urinary outcomes are significantly affected by nerve sparing quality during radical prostatectomy. Urology 2013; 82: 1348–54. 2 Ficarra V, Novara G, Artibani W et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur. Urol. 2009; 55: 1037–63. 3 Ploussard G, Taille AD, Moulin M et al. Comparisons of perioperative, functional, and oncologic outcome after robot-assisted versus pure extraperitoneal laparoscopic radical prostatectomy. Eur. Urol. 2014; 65: 610–19. 4 Lee CH, Ha HK. Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy. Int. J. Urol. 2014; 21: 653–6.
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IPP as a predictor of incontinence after LRP
Editorial Comment Editorial Comment to Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy Urinary incontinence affects the quality of life of men after radical prostatectomy (RP). Because of this, many studies have analyzed the risk factors for urinary incontinence after RP. In particular, nerve sparing,1 procedure and operative methods are important factors for urinary continence. Several systematic reviews have evaluated the risk factors for urinary incontinence after laparoscopic radical prostatectomy compared with retropubic radical prostatectomy. Recently, several studies have identified preoperative factors and surgical techniques associated with the urinary continence recovery rate after robot-assisted radical prostatectomy compared with retropubic radical prostatectomy or laparoscopic radical prostatectomy.2,3 Intravesical prostatic protrusion (IPP) is a useful parameter for voiding function associated with bladder outlet obstruction. Some reports have also shown that IPP affects storage symptoms of the bladder. The present study evaluated the significance of IPP as a predictor of early urinary continence after RP.4 If urinary incontinence after RP is urge incontinence associated with overactive bladder, it should be considered separately from stress incontinence. One of their speculations why IPP status predicts urinary continence is the correlation of IPP with the storage symptom scores of international prostate symptom score. That means IPP is related to the overactive bladder symptoms due to preoperative benign prostatic hyperplasia. However, urinary incontinence is urge urinary incontinence, anticholinergic medicine or beta3-adrenoceptor agonists may work for significant IPP group after RP.
© 2014 The Japanese Urological Association
In contrast, the significant IPP group might sustain more surgical damage at the smooth muscular internal sphincter during bladder neck dissection. IPP measurement is a useful non-invasive method. Therefore, surgeons can use IPP status to select the procedure and operative methods in terms of urinary continence. Yoshiko Maeda M.D., Ph.D. Department of Urology, Tokyo Women’s Medical University, Aoyama Hospital, Tokyo, Japan [email protected] DOI: 10.1111/iju.12443
Conflict of interest None declared.
References 1 Kaye DR, Hyndman ME, Segal RL et al. Urinary outcomes are significantly affected by nerve sparing quality during radical prostatectomy. Urology 2013; 82: 1348–54. 2 Ficarra V, Novara G, Artibani W et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur. Urol. 2009; 55: 1037–63. 3 Ploussard G, Taille AD, Moulin M et al. Comparisons of perioperative, functional, and oncologic outcome after robot-assisted versus pure extraperitoneal laparoscopic radical prostatectomy. Eur. Urol. 2014; 65: 610–19. 4 Lee CH, Ha HK. Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy. Int. J. Urol. 2014; 21: 653–6.
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